In the midst of anti-immigrant policies piping down from the Trump administration, on January 23, Governor Cuomo announced that DACA recipients would remain eligible for the state-funded Medicaid program, regardless of federal policy changes. To better understand the significance of this victory, we sat down with Claudia Calhoun, the NYIC Director of Health Policy. She also told us a little bit about the intersectional struggle for immigration and healthcare coverage, and what you can do to support this work through the “Coverage 4 All” campaign.
Q. Thank you so much for taking the time to speak with me today. I believe in just a few hours after this interview, you are going to run off to testify at a City Council meeting. Could you first tell us a little bit about that?
Both me and my colleague, Max Hadler (the Senior Manager of Health Policy at the NYIC), are or will be speaking in front of different committees of the Council that oversees various agencies like the New York City Department of Health and Mental Hygiene and New York City Health + Hospitals, in order to make sure that the Council knows that the challenges for immigrant New Yorkers are in both accessing healthcare and understanding their rights in the healthcare system. We want to make sure that hospital systems with a mission to take care of all New Yorkers have the resources available to take care of everyone, and that everyone recognizes the value those institutions have for New York City.
Q. Awesome! Well, I won't keep you long then! But before we get into the more nitty gritty of policy, tell me just a little bit about yourself. Before you were with the New York Immigration Coalition, you were a member of the Peace Corps in Ecuador, worked at the Bellevue Program for Survivors of Torture and at the Open Societies Foundation. What was your experience that led you to start working with the NYIC?
I had a lot of opportunities to do a lot of things in public health, but always wanted to work in policy, and on making the health-care system work better on the system level. It is pretty fascinating for me on how decisions about funding and laws translate to the very experiences individuals have when they see a doctor. So I am very passionate about making that a better experience. The NYIC was the first opportunity I had to do policy and advocacy work. And it was a great opportunity to bring together a lot of different experiences I had from my previous work, like working at Bellevue Hospital or serving in the Peace Corps.
Q. You had a lot of international experience working in Ecuador. Has your time there influenced your views or perspectives on health care or immigration issues?
I lived in Cuenca, Ecuador, a city in the southern Sierra that is profoundly affected by migration. Almost everyone I met there during my time in the Peace Corps knew someone in the United States. There are entire generations living there affected by migration. For instance, once when I was doing a presentation at a school in a town outside of Cuenca, I was introducing myself and I asked the children in the class if they had parents living in the United States. Every single one of the kids in the classroom raised their hand. That was a striking moment for me and helped me better understand a little bit more about immigrant communities here and also how immigration as a phenomenon affects families and communities at home.
Q. Let’s talk about the big victory that the NYIC had recently. After the Trump administration announced its recission of DACA (Deferred Action for Childhood Arrivals program) in September, you and your partners were at the forefront of advocating to make sure that DACA recipients in New York will remain eligible for Medicaid. And after more than a year of intense advocacy and pressure, Governor Cuomo announced on January 23 that DACA recipients would remain eligible for state-funded Medicaid program, regardless of federal policy changes. What were those four months like and how was this victory achieved?
I think it was essential that we worked in collaboration with a lot of other dedicated organizations, especially Make the Road New York, New York Lawyers for the Public Interest, Empire Justice Center, Community Service Society, Legal Aid, Children's Defense Fund NY, and all of the other partners that make up the Coverage 4 A All campaign steering committee. We’ve been able to forge a strong partnership with those organizations that has allowed us to respond to the impending end of DACA and to bring attention to the need to come up with a solution for people that would lose their Medicaid if they lose their status. So we are very grateful that we were able to secure this clarification from the governor’s office. But it’s important to note that the work isn't done yet. There are other immigrant populations whose insurance status will be affected by changes at the federal level, including people with Temporary Protected Status (TPS). So we will have to continue to work with state legislators and the governor’s office. We need to make sure that we don't go backward, and that those people don’t lose their coverage.
Q. Going off of that, how does health policy in New York differ from the rest of the country?
For instance, this is one of the few states where DACA recipients are eligible for Medicaid, which is usually not the case. Why is this the case here and not in other states?
New York has a long commitment to covering specific immigrant populations, and it is actually because of a very significant State Court of Appeals case that happened in 2001 called Aliessa v. Novello, where the state affirmed that if someone is here with the knowledge and permission of the federal government, based on their immigration status, you cannot deny them public health coverage benefits that that they would otherwise be entitled to. So that means that participation in programs like DACA in New York guarantees a person access to Medicaid if they meet the income eligibility. Even before that, New York provided children up to age 18, with health insurance regardless of their immigration status through its Child Health Plus Program.
Q. That’s great that we are able to get some progressive changes made at the state level. Another victory I do want to mention now is on the city level. Last year in 2017, you were able to secure $1 million in City Council funding for the third year of Access Health NYC. Tell us a little about this initiative, what kind of community-based organizations it funds, and what type of work or outreach do they do?
Access Health NYC is something that we began fighting for after the Affordable Care Act was implemented. We didn't believe that community-based organizations had the resources to get the information out to immigrant communities about enrollment, what their rights are, and what they can do if they can’t enroll. So the city supports some of these organizations by allowing them to reach people that otherwise might not know how the health system works.
Access Health NYC includes a lot of community-based organizations with a variety of missions such as immigrant serving organizations, some groups that work on HIV prevention and other communities with specific health care needs or limited access to care. The awardees include several community health centers as well. These groups do incredible work, doing outreach through community wellness programs, reaching immigrant communities and many other hard-to-reach communities, like sex workers in nightclubs, to make sure they have access to health care services and coverage.
Q. Interesting! Now what are the most significant threats to health care access for immigrants? Has there been any backlash from say, the federal level or more anti-immigrant policies from the state level that may jeopardize immigrant’s access and affordability to quality health coverage?
The most significant thing we have seen in the last year and a half is people being afraid to seek services. I’ve heard of cases where women who were pregnant were too scared to even leave the house because of they might come in contact with ICE (Immigration Customs and Enforcement) and so they delayed seeking prenatal care. We know it's true that ICE adheres to sensitive location procedures, so they don't undertake immigration enforcement in hospitals. But you also hear stories like the 10-year-old girl with cerebral palsy in Texas, Rosa Maria, who was followed by border patrol when she was in the ambulance on her way for emergency surgery, and was then detained when she left the hospital. These stories terrify people. So the biggest challenge is making sure that people know that they can use health services and insurance safely. That’s why our work for coverage expansions are so significant because they communicate a real commitment from New York state to people staying healthy and getting what they need.
Q. You know, people don’t usually think about Health policy when they think of immigration. Do you see an intersectional struggle for the movements fighting for universal healthcare and immigration to come together and converge?
Yes. You have two of the most complicated areas of policy, and their intersection is exceptionally daunting to try to understand. But we know from our communications with immigrants and members that they know it is essential to be able to get health care when they need it. And we know that health care is an important part of helping immigrants to integrate and grow, and keeps all communities to stay healthy, productive, and have the ability to strive. So we consider it a pillar of our work with our members to make sure the health care system is working for them. And the ultimate goal is not just to be able to see a doctor, but for people to just stay healthy and live longer!
Q. Could you give us a brief overview of one of the biggest programs you are working on now: “Coverage 4 All” campaign. Why is the NYIC co-leading this effort?
We believe that everyone should have access to access to health insurance in New York. And in this state, there are at least 433,000 people who are undocumented and uninsured. That’s a lot of people who don’t have access to insurance, and it is harder for them to establish economic stability, provide for their family, and contribute to the community. Health insurance is an essential mechanism of social inclusion. So the Coverage 4 All campaign was designed to close the gaps for everyone. And since the Trump election, we’ve also found it necessary to ensure that we don’t go backwards and we hold the line.
Q. What are the next steps for the Coverage for All campaign in 2018 and beyond?
So we will continue to work to make sure that people who are at risk of losing benefits because a program comes to an end - for example, TPS - will be able to participate and continue to have insurance. We will continue to push our proposal to expand coverage for young adults up to age 29, through the Child Health Plus expansion.
Q. What would you recommend to people who are eager to do something to not just help immigrants, but want to do something on the Health side as well. How can they get involved in both areas and be a part of the movement?
They can go to our Coverage 4 All campaign and sign up! If they are part of an organization, they can also write a memo of support for the Child Health Plus expansion. They can also sign up for the health collaborative listserve where there is an ongoing conversation about health policy as well – and they can just write me to do that!
Q. Finally, what part of your work excites you the most?
I love talking to people about health policy and how it works. I love hearing from people that serve patients, hearing about what they need and trying to translate that into an advocacy agenda. It is a great pleasure that I get to collaborate with other people that do so much great work.