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Brown’s Effort to Cover Immigrant Children May Depend on Healthcare Industry

Gov. Kate Brown has proposed an agenda for the 2017 session that’s high on difficult cuts, but also perhaps surprisingly has a heavy lift for a big wish.
January 6, 2017

Gov. Kate Brown has proposed an agenda for the 2017 session that’s high on difficult cuts, but also perhaps surprisingly has a heavy lift for a big wish -- spending $57 million to expand healthcare coverage to all of Oregon’s children, even those without legal permission to live in the United States.

Thousands of these children have been in Oregon for years, and many know no other home. They attend public schools. Their parents find work where they can despite a lack of documentation.

But if a child gets sick, these families must rely on the mercy of safety net clinics and the charity of nonprofit hospitals to absolve them from paying most or all of the child’s healthcare costs. Without insurance, many simply avoid interacting with the American healthcare system and suffer without care.

“We were not surprised -- we were pleased to see the governor’s commitment to all the children in the state,” said Alberto Moreno, executive director of the Oregon Latino Health Coalition, which has been striving to improve access for the children for years. “We want to prevent needless suffering and even death in the uninsured children.”

If the governor succeeds, Oregon would be following the lead of Washington and California, as well as Illinois and New York, which already accept these children for their Medicaid programs. The states fund the full tab for their healthcare since they are ineligible for federal support.

A 2014 report from the Oregon Latino Health Coalition and the Oregon Center for Public Policy estimated there were 17,600 children growing up in Oregon without legal permission, with the weight of America’s broken immigration system falling on their small shoulders, without regular access to healthcare for treatable conditions like asthma or appendicitis.

Numerous studies since the Children’s Health Insurance Program was expanded to 200 percent of poverty for most children -- now 300 percent of poverty in Oregon -- showed the rate of uninsured dropped by more than half, and even more dramatically for Hispanic children, who are the most likely to be uninsured.

A two-year study of California’s system showed a 70 percent increase based on reports from parents of their children’s ability to attend class and keep up with their studies once they received Medicaid. A Kansas study showed that children in the program for at least one year missed fewer days of school due to injury or illness.

Finally, a 2014 report from the National Bureau of Economic Research showed that earlier Medicaid expansions dating to the 1980s resulted in a 5 percent decrease in the high school dropout rate for these children years later, and a 3 percent increase in the college completion rate, giving society a more productive generation of young adults.

Last budget cycle, the Legislature approved $10 million to beef up safety net clinics to provide for  children who remain without insurance. This time, advocates will be corralling support from the healthcare industry and legislative champions, including Rep. Alissa Keny-Guyer, D-Portland, and Sen. Elizabeth Steiner Hayward, D-Beaverton, as well as the governor to offer guaranteed care through the Oregon Health Plan, in which hospitals, physicians and the rest of the healthcare industry would see $57 million to take care of these children.

Brown and the immigrant families may have some allies in high places -- including the Oregon Association of Hospitals and Health Systems, but executive vice-president Andy Van Pelt did not return phone calls for comment.

“We’re hoping they’ll see this as good for their bottom line,” Moreno said. “The hospitals could recover currently uncompensated care.”

The hospital association has some of the most influential lobbyists for legislators on both sides of the aisle, and the industry will be the focus of much of the 2017 session, as Brown wants to close budget gaps with increases to the hospital assessment and the conversion of part of the gap to a true tax, as well as restoring a tax on the health insurance industry to help pay for the Medicaid expansion.

President Obama and moderate Republicans tried and failed a few years ago to reform the nation’s immigration policy. Even getting Oregon Republicans to agree to offer free healthcare to unauthorized immigrant children may be difficult to achieve.

Anti-immigrant fervor hit a fever pitch in 2016, as President-elect Donald J. Trump won the keys to the White House in a campaign that began by stoking resentment among working-class white people toward waves of uncontrolled immigration from Latin America.

But, in the past, Rep. Vic Gilliam, R-Silverton, has supported helping these children get healthcare, and Rep. Mitch Greenlick, D-Portland, the liberal lion and chairman expressed confidence.

“We’re going to get all the children covered. You can take my word on that,” Greenlick said.

Chris can be reached at [email protected].