For the first time in five tries, Democrats in the state Senate have approved a program to extend health coverage to undocumented immigrants.

The bill (S.2237) was approved in the state Senate recently by a 40-21 vote, largely along party lines. Versions of the bill were first introduced in 2019 and haven’t made it out of committee the four previous times it was introduced. The legislation will be forwarded to the state Assembly for consideration before the end of the state legislative session in June.

Democrats in the Senate want to direct the state health commissioner to modify what is known as the 1332 waiver program to allow state-backed health coverage for certain undocumented individuals living in New York. The bill would authorize the health commissioner to enroll 240,000 individuals now while also allowing coverage for more people if money is available.

“Although not every single person that does not have insurance and winds up in an emergency room is an undocumented person, a whole bunch of them are,” said Sen. Gustavo Rivera, D-Bronx. “Just last year, in 2023, the numbers say that in state share alone, if we’re going to talk just about that we’re talking about, $428 million of state spending. So if we are to use federal money to extend the Essential Plan, therefore providing basic health coverage to undocumented folks, the same individuals who would potentially maybe wind up in an emergency room, we would save ourselves all of those dollars. So we’re looking at a savings potentially of up to $428 million.”

Rivera’s legislative justification for S.2237 says more than $1 billion is spent on Emergency Medicaid. Allowing 240,000 undocumented immigrants to sign up for state-backed health care coverage, Rivera said, would save state and local governments at least $400 million. He then says the program is likely to save the federal government another $400 million while, over five years, the Waiver Trust fund balance would grow to be more than $1.3 billion over five years.

State Sen. George Borrello, R-Sunset Bay, spoke against the expansion. He pointed to other states that are pausing similar expansions, including Illinois and the state of Washington. Last year Illinois Gov. JB Pritzker paused enrollment in a state-funded health care program for certain immigrants aged 65 and older in an attempt to cap spending on the program. Costs had been more than budgeted since the coverage began being offered in 2020. Illinois has a similar program for younger undocumented immigrants.

“New York state, unfortunately, it’s bad at a lot of things but probably something that we are the worst at is learning from other states’ mistakes,” Borrello said. “What we hear is that Washington, Illinois and other states did this and Illinois just said we had to pause the enrollment. At what point do we say there’s an issue? Here, the issue is we continue to draw people around the world to come to New York state because you make it better and better for them to come here at the expense of the taxpayers.”

According to the Kaiser Health Foundation, as of March 2024, 12 states and Washington, D.C., provide fully state-funded coverage for income-eligible children regardless of immigration status, six states and Washington, D.C., provide fully state-funded coverage to some income-eligible adults regardless of status, and most states have taken up options in Medicaid and CHIP to expand coverage to lawfully present immigrant children and pregnant women. The foundation notes uninsured rates have decreased with those programs, with immigrant adults in states that provide more expansive coverage half as likely to be uninsured as those in states with less expansive coverage (11% vs. 22%). But, uninsured rates remain high among noncitizen immigrants, with 18% of lawfully present immigrant adults and half of likely undocumented immigrant adults reporting being uninsured. The foundation also notes it’s not known yet if there will be continued movement to expand coverage for immigrants going forward and if existing expansions will be sustainable over time.

Borrello also took issue with the idea that allowing undocumented immigrants to access state-backed health coverage will help unclog emergency rooms.

“Now the argument was brought up that these people aren’t going to go to the emergency room if they have health care coverage,” Borrello said. “Speak to any hospital, whether it’s in New York City or in my district, and they will tell you that the biggest problem that they have is people on Medicaid using the emergency room as if it’s their primary care physician. It blocks it up. It clogs up our emergency rooms and costs a lot of money because there is no constraint. They can just walk in for the sniffles or hangnail and be treated because it’s Medicaid, because they have no obligation to pay for it. At some point we have to say we’re going to roll up the welcome mat. At some point we have to say New York is not going to be the landing spot for anyone in the world that wants to come to the United States and live off the taxpayers. That’s what this bill will do and that’s why we have to vote no.”