Options are few for medically needy undocumented immigrants

A lack of health insurance prevents Esperanza Galicia from getting the hernia surgery she has needed for two years.

“Sometimes it’s painful,” the 36-year-old said in Spanish last week.

Galicia is among an estimated 190,000 immigrants in Nevada living in the country illegally who are ineligible for health coverage under the Affordable Care Act, also known as Obamacare, which requires U.S. citizens to have medical insurance. The estimated number of immigrants in Nevada is based on a 2011 report released by the Pew Research Center in Washington, D.C.

Being left out of the Affordable Care Act means this population is not able to bargain for health insurance through the state’s insurance exchange and is not eligible to receive help to pay for insurance coverage.

Immigrants living in the country illegally will not face penalties from the federal government for not having insurance, though. That penalty applies only to U.S. citizens.

In Southern Nevada, immigrants living in the country illegally have the same limited options they have always had for medical help. They can either go to the few clinics that will take them or seek help in Clark County’s crowded emergency rooms.

“I think they will continue to come to the emergency room for care,” said Dr. Dale Carrison, University Medical Center’s chief of staff and head of emergency services. “I don’t view the Affordable Care Act as having an impact.”

Galicia on Friday went to get a physical at the Martin Luther King Health Center, which has a new building on Mt. Mariah Drive near Lake Mead and Martin Luther King boulevards. The center is one of 16 in the state offering a sliding fee scale based on income for those who are uninsured. She was told the hernia at her belly button continues to grow.

“It needs surgery,” she said. “It would be good to have insurance. Sometimes one has to go to the emergency room because the (ailment) is already very bad.”

Immigrants living in the country illegally are not eligible to buy insurance through the Silver State Health Insurance Exchange, a marketplace where Nevada consumers and small businesses are able to shop for health plans, said Jake Sunderland, spokesman with the Nevada Division of Insurance.

They are also not eligible to receive subsidies from the federal government to help with the cost of health insurance.

But Sunderland said immigrants living in the country illegally can buy health insurance directly from insurance companies.

“There’s no law, regulation or provision that prevents them from buying health insurance directly from the companies,” he said. “As long as it’s not through the exchange.”

But cost is a challenge for many such as Galicia, who is from Mexico and has lived in Las Vegas for about seven years. Her husband, a cook in a casino, is the only provider in the household. The couple has three American-born children who are on Medicaid.

Immigrants living in the country illegally are not eligible for full Medicaid coverage, according to Mary Woods, spokeswoman for the Nevada Department of Health and Human Services. But they can qualify for Emergency Medicaid, which all states offer and mainly covers such immigrants.

In February, 713 people were receiving Emergency Medicaid coverage statewide. People who apply for Emergency Medicaid must meet requirements including income eligibility, state residency and verification of medical service for the months in which coverage is requested.

A person with a serious chronic condition, such as kidney failure or cancer, may remain eligible for Emergency Medicaid.

State officials have no plans to expand full Medicaid coverage to immigrants living in the country illegally, according to Woods. Full Medicaid covers anything from primary care to mental health services.

Immigrants living in the country illegally might see some improvements as a result of the Affordable Care Act, though. For example, federal funding for community health centers has improved, said Andres Ramirez, president of the Ramirez Group, the state’s largest health-insurance navigator firm. Those centers are typically in areas that are underserved.

And since the Affordable Care Act makes primary care a priority, fewer people will use emergency rooms, making them less crowded for immigrants living in the country illegally, Ramirez said.

“There’s nothing that makes it more difficult for undocumented immigrants to access health care,” he said of the federal act. “Actually there’s more benefits.”

Additional community health centers also are opening up.

Hope Christian Center in North Las Vegas is slated to open June 1, said Steve Flores, chief executive officer. The center will offer primary care, but will eventually also offer care in specialty areas.

The center is already working with pharmacies to potentially provide free medicine for the uninsured, Flores said.

If people have an income, the center will work with them using a sliding fee scale.

“We’ll work with everyone,” he said. “We will not turn anybody away.”

Other states also wrestle with the issue of medical care for immigrants living in the country illegally. In California, Senate Bill 1005 was introduced in February to help provide coverage to that group.

“It would basically make sure that all Californians got help to get affordable health care, regardless of their immigration status,” said Anthony Wright, executive director of Health Access California, a health consumer advocacy coalition.

If the legislation becomes law, it would establish a marketplace where immigrants living in the country illegally with higher incomes could shop for insurance, Wright said. It would also expand Medi-Cal, the state’s Medicaid program, to cover low-income immigrants living in the country illegally.

The state would have to finance the Medi-Cal expansion, Wright said.

“The bill at this time does not specify the funding sources. We are working on that as we speak.”

Reporter Yesenia Amaro can be reached at yamaro@reviewjournal.com or 702-383-0440.