Plan to provide free health care to unauthorized immigrant kids in Oregon draws praise, criticism

SALEM — When an errant baseball hit her in the face years ago, Fatima Preciado’s lip split. Soon, the 8-year-old’s cut became infected.

Preciado’s mother tried to clean the cut with rubbing alcohol and heal it with ointments, but never took her to a doctor. Without health insurance, those types of “house remedies” were often the only medical treatment her family could turn to, Preciado said.

Norma Baltazar says she struggled for years to get dental health care for her young son, Raul. Finally, when a molar in the back of his mouth grew too painful, she rushed him to the emergency room. Without health insurance, she had to pay $900 to have the tooth removed.

Both Preciado and Baltazar are unauthorized immigrants, having separately come to the United States from Mexico more than a decade ago.

Today, Preciado is an 18-year-old Portland State University student and a so-called “Dreamer,” having secured a work permit and deportation deferral under former President Obama’s DACA program.

Baltazar, a Salem house cleaner, brought Raul to America when he was only 3, making him an unauthorized immigrant as well. She’s since had another child, a daughter, who, by virtue of her birth of U.S. soil, is a legal U.S. citizen.

Now, both women are advocating for a new state law, dubbed “Cover All Kids” by supporters, that would extend government-­funded health insurance in Oregon to many unauthorized immigrants under the age of 19.

The proposal would give government-funded health insurance to an estimated 17,600 unauthorized immigrants, at a cost of $55 million in the biennium that starts July 1. Critics blast the concept and the price tag, especially given state government’s cash crisis.

But supporters say it’s a humane and sensible idea.

“My mom always was scared that I would get hurt or get sick because we didn’t have insurance,” Preciado said of her childhood. “I just wanted to play.

“Kids don’t worry about getting hurt, they don’t understand,” she added.

The proposed policy would let those young immigrants receive free health insurance through the Oregon Health Plan, the state’s version of Medicaid, if their families make less than 300 percent of the federal poverty level.

That’s the same eligibility requirement as that for an Oregon minor who is a legal resident now, and it translates to an annual income of $73,000 for a family of four. The coverage would apply only to the unauthorized immigrant children of the household, not the adults.

Faces opposition

The proposal is backed by Gov. Kate Brown, House Speaker Tina Kotek, a Portland Democrat, a contingent of Democratic and Republican state legislators, and many Oregon health care providers.

Similar policies are in place in California, Washington, New York, Illinois and Massachusetts.

Still, the costly proposal in Oregon faces significant headwinds this session as the state must close a $1.8 billion budget gap — a hole that’s in large part the result of the growing cost of the Oregon Health Plan for legal Oregon residents.

Senate Bill 558 and House Bill 2726 would make 17,600 noncitizens newly eligible for the Health Plan, according to early estimates.

The state would have to cover the full cost of their health insurance, a projected $55 million in the 2017-19 budget. That’s different than for the rest of Oregon’s 1 million-strong Medicaid population, where the federal government picks up most of the tab.

The policy and its cost anger opponents of illegal immigration.

“We have a state that thinks it has a $1.8 billion budget gap and yet we’re considering giving more state benefits to thousands of illegal immigrants,” said Jim Ludwick of Oregonians for Immigration Reform. “It boggles the mind.”

Ludwick said his group doesn’t want “any harm to come to children.” But, he added, the bill, if passed, “could well be the foot in the door” for Oregon Health Plan coverage to be extended to unauthorized adult immigrants as well.

Despite progressive stances on many social issues, Oregon voters have sometimes resisted policies favoring unauthorized immigrants. In 2014, they thrashed, by a 2-to-1 ratio, a proposal to grant them short-term driving licenses.

“Emergency clauses”

SB 558 and HB 2726 both contain “emergency clauses,” however. That means that, if they pass, they’ll go into effect immediately and couldn’t be referred to voters.

Supporters say the cost of expanding Medicaid coverage to unauthorized minors would be a smart investment for the state. It would mean they could get more preventative health care, reducing their need for expensive emergency care, and allowing them to be more successful in school and later life.

“Oregon children should have the opportunity to be healthy and ready to learn, and Oregon families should feel confident that a medical event will not dramatically change the trajectory of their lives,” Gov. Brown told the House Health Care Committee on Monday.

Rep. John Huffman, a Republican from The Dalles, said the insurance expansion “makes sense morally and economically.”

“Covering kids up front saves us money down the road,” he added.

Patchwork of care

Both Preciado and Baltazar on Monday described a complicated patchwork of health care options available now to unauthorized immigrants. Many of them don’t or can’t get health insurance through work. They aren’t eligible for the subsidies to help people buy their own health insurance policies on the exchanges set up by Obamacare.

But unauthorized immigrants can receive primary medical care in some public schools and, for a fee, at 200 “safety net” community health centers around the state.

Hospitals, meanwhile, are required by federal law to provide free emergency care to all people, regardless of their residency status, when a patient is at risk of dying, losing a limb or is pregnant.

Many nonprofit groups also help unauthorized immigrants cover their regular health and dental care costs or help raise money for expensive treatments.

For example, Baltazar said Raul was recently found to have a heart condition that could eventually require surgery. She said she’s already identified a church-affiliated nonprofit that might help pay for the operation.

But, she added: “It still worries me. There’s no guarantee.”

“I don’t want (Raul) to worry about how we will pay for it,” Baltazar said. “Any child deserves to have a healthy life.”

Preciado said her older sister is intellectually disabled and prone to epileptic seizures. There were times during her childhood when the family, for weeks, couldn’t afford the daily medication her sister needed, Preciado recalled.

“There would be nights when I would awake from my mother’s frightened screams as she watched my eldest sister uncontrollably experience an epileptic seizure,” she said. “It was very traumatic.”