On May 12, we sat down with Maryland State Delegate Joseline Peña-Melnyk to discuss opportunities and barriers to expand health access for Latino immigrants in Maryland. As we continue to advocate for Salud Sin Barreras, we have created a blog for our community to understand how we can advance health access at the state level with our partners. Read on for more and check out a recording of our conversation with Delegate Peña-Melnyk.

Limits of the Affordable Care Act

Following the passage of the Affordable Care Act (ACA) in 2010, the state of Maryland increased insurance coverage for lower-income adults. As a result, the state has progressively seen the number of uninsured people decrease, allowing it to become among the top 10 insured states in the country. However, approximately 225,000to 275,000Maryland residents remain ineligible for public or privately owned health insurance due to their immigration status.

Immigration Status as a Determinant of Health

Immigration and immigration status affect health through several material and psychological mechanisms, including fear, stress, different access to resources, experiences of prejudice and violence, and differential access to safe work and good quality housing. The differing treatment of immigration statuses leads to a patchwork of coverage for some immigrants and a complete lack of coverage for others including lawfully present migrants (See Figure 1). For example, over 27,500 Temporary Protected Status (TPS) beneficiaries reside in Maryland. TPS holders qualify for ACA subsidies but not Medicaid.

Who are the Uninsured?

The largest uninsured group in Maryland are Latinx (gender neutral term for Latino) immigrants from El Salvador (31%), Guatemala (14%), Honduras (9%), and Mexico (9%). Patterns of uninsurance among this group likely reflect limited access to employer-sponsored coverage. Given their lower incomes, Latinx immigrants also face increased challenges affording employer-sponsored coverage when it is available, or through the individual market, as well as limited access to, and barriers to, enrolling in public coverage options due to their status. Because many uninsured people avoid seeking medical care unless they face an emergency and delay care until their symptoms become intolerable, they are less likely to receive a diagnosis in the early stages of a disease and are more likely to suffer complications from aggravated medical conditions.

Impact of COVID-19

Disparate impacts of the COVID-19 pandemic in terms of cases and deaths have exposed and exacerbated underlying health and health care inequities facing Latinx immigrants. Latinx residents make up 11% of Maryland’s total population, yet account for 20% of all deaths in the state. Chronic diseases such as asthma, diabetes, hypertension, and obesity are factors closely linked to complications from COVID-19. Latinx residents fare worse than white Maryland residents with chronic conditions including diabetes and obesity. Thus, the combination of the pandemic, restrictive access to health care, and fear-inducing immigration policies leaves Latinx immigrants vulnerable to healthcare inaccessibility.

Potential Policy Solutions

As of September 2021, six states (California, Illinois, Massachusetts, New York, Oregon, and Washington) as well as the District of Columbia (D.C.) are implementing affordable coverage for immigrant populations. The State Health and Value Strategies (SHVS) program of the Robert Wood Johnson Foundation outlines that these legislative or administrative actions rely on “establishing state Medicaid/CHIP equivalent or comparable programs; and creating state premium or cost-sharing subsidies to enable individuals to purchase Marketplace coverage.” Adapting some of the lessons learned from other states, two main policy solutions can be used to expand access for immigrants in Maryland: (1) Using state funds to expand Medicaid coverage to low-income immigrants excluded from Medicaid and (2) Creating a cost sharing mechanism to enable individuals to buy health insurance regardless of immigration status.

Let’s Make Salud Sin Barreras a Possibility

Maryland could set a precedent in promoting health equity and establish a model to replicate nationally. Thanks to efforts by our partners in the Maryland Health Care for All coalition, CASA, and Delegate Peña-Melnyk, the Healthy Babies Act recently became a reality, indicating that progress is possible. In addition, the 2020 census revealed that Maryland’s Latinx population grew from 8% to 11% in the last decade and roughly one in seven Maryland residents was born in another country, while one in eight is a native-born American who has at least one immigrant parent. Immigrants support Maryland’s economy across sectors: they make up nearly a third of all Maryland health care support workers and more than a third of the state’s building maintenance workers and groundskeepers. Immigrants in Maryland contributed $139 million in taxes last year. It is time we recognize these contributions and make Salud Sin Barreras a possibility.

Click here to access more information about our Salud Sin Barreras campaign.

—Rodrigo Stein is the Director of Health Equity and Strategic Community Partnerships at La Clínica del Pueblo.