De Blasio Immigrant Health Access Plan Maximizes Taxpayer Investment

Evan Siegfried’s opinion on New York City Mayor Bill de Blasio’s Direct Access proposal to improve health access for immigrants suggests a willful misunderstanding of the way that health care for the uninsured is already paid for in New York City.

Siegfried says that taxpayers should not have to fund improved health access, but doesn’t understand that they already pick up those costs through emergency rooms, where people often go when they have no other options. He insinuates, incorrectly, that the city does not have the support of immigrant advocacy groups to create a pilot program to improve access for immigrants. Moreover, the suggestion that a pilot is nothing more than “window dressing” misses the point of the program, which makes a meaningful effort to identify and test a better way to structure existing services for New York residents with no other coverage options.

Taxpayers already foot the bill for uncompensated care provided through city emergency departments. Testing and proving a model for reducing uncompensated care has the potential to save taxpayers money, while at the same time improving health outcomes.

The Direct Access pilot program, slated to begin this spring, builds on existing services that are already provided by the city’s Health + Hospitals and federally qualified health centers with a mix of federal, state and local funding. As the April 2015 Hastings Center/New York Immigration Coalition report shows, New York City’s safety net provides important services but leaves key gaps, and doesn’t encourage the best and most cost-effective use of health care.

The Direct Access program draws from important models like Healthy San Francisco, which has demonstrated success in reducing unnecessary emergency room use among its enrollees. If done correctly, Direct Access would eliminate cost inefficiencies that stem from these gaps in coverage and make existing health care investments more cost-effective by linking enrollees to primary care medical homes, utilizing the successful IDNYC municipal ID card program and ensuring care coordination so that people can see a specialist when they need to. One of the most exciting features is that the program will coordinate services across institutions, not just across Health + Hospitals sites but also with city health centers, and hopefully, over time, with other providers that choose to participate.

Considering the long list of immigrant-serving organizations that contributed to the work of the mayor’s task force and the recommendations in its report, it’s easy to see that New York City immigrant advocates do, in fact, support this proposal. This includes the New York Immigration Coalition, an umbrella policy and advocacy membership organization representing more than 175 immigrant serving groups statewide. What’s more, the mayor’s task force report reflects a consensus among health care consumer and immigrant advocates that city investment in facilitating access is entirely responsible and appropriate, especially when state and federal restrictions render undocumented immigrants uninsurable.

Finally, Direct Access is investing in a rigorous evaluation to assess and refine the initial program design, and strengthen the city’s ability to make the case for substantial investment. This is a perfectly rational and reasonable next step in implementing the recommendations of the task force. Simply extrapolating the cost of a pilot and evaluation for 1,000 people to 345,507 does not necessarily project the cost of scaling up services for more immigrants. When we learn what works in the pilot and expand on those best practices, we will truly able to assess the return on investment in improved health outcomes for all New Yorkers.

Claudia Calhoon, MPH, is the director of health advocacy for the New York Immigration Coalition, an umbrella policy and advocacy organization for more than 175 groups in New York State that work with immigrants and refugees.