AUGUSTA — Immigration advocates gathered at the State House Tuesday to support a bill that would allow income-eligible noncitizens to receive health coverage under the state’s Medicaid program.

The bill sponsored by House Speaker Rachel Talbot Ross, D-Portland, is facing opposition from Republicans, who are looking to roll back welfare benefits and criticized what they say is the proposal’s $7 million price tag.

House Speaker Rachel Talbot Ross talks during a press conference on Jan 17. Brianna Soukup/Staff Photographer

Low-income noncitizens are currently eligible for only a limited scope of emergency health services. They do not have access to routine or preventive care.

About four dozen immigrants, including several testifying with the help of a translator, joined advocates in urging the Health and Human Services Committee to support the bill, framing it as a moral and practical imperative. Better preventive health care for all Maine residents would result in lower overall health care costs in the long-term and a healthier workforce.

Talbot Ross noted how at one point during the pandemic Maine had the highest racial disparity in COVID-19 infections, because Black residents are more likely to work front-line, low-paying jobs that do not provide health coverage.

“We currently have a two-tiered health care system in Maine – one divided along complex and ever-evolving immigration lines,” Talbot Ross said. “L.D. 199 is straight-forward legislation that would eliminate the injustices embedded in that tiered system. … Simple in language, yet wide-reaching in impact, this bill provides life-altering benefits for the individuals who gain coverage as well as their families, their communities and places of employment.”

Democrats serving on the Health and Human Services Committee already have signaled support for the bill, recommending that funding be included for L.D. 199 in the biennial budget. Their recommendation did not indicate how much the move would cost.

Committee Republicans, however, argued that Maine can not afford another MaineCare expansion and said extending the coverage to noncitizens would cost $7.2 million. MaineCare is the state’s version of the federal Medicaid health insurance program.

“The Republican members of the committee noted that Maine is the third highest taxed state and covering noncitizen medical care with state funds is an obligation that is not responsible,” the members said in a minority report, which also opposes proposed changes to General Assistance that could help provide housing to asylum seekers. “Maine citizens should not be subsidizing the housing of noncitizens.”

The hearing on MaineCare coverage took place as a record number of asylum seekers are arriving in Portland and surrounding communities, straining an emergency shelter system as housing prices and a lack of available housing have made it difficult for people to find permanent homes. The city’s shelters are full, as are temporary shelters operated by community partners.

Portland officials say that nearly 900 asylum seekers have arrived since January and the city will open the Portland Expo as a temporary shelter for about 300 people next month. Officials say the Expo will remain open until a new shelter for asylum seekers opens this summer.

Asylum seekers cannot work for at least six months after filing their application for asylum and it can take years for their cases to be decided because of case backlogs in the immigration system.

One man who testified, giving his name as Henoc, said he came to the United States in 2018 to escape persecution in the Democratic Republic of Congo, where he was a health care worker. Yet, when he applied for MaineCare, he was denied because of immigration status. A local hospital provided him with coverage for six months while he awaited work authorization.

“When I got the work permit, I was working as a CNA,” Henoc said. “In March 2020, I got sick and my employer demanded that I resign because of my illness. Despite my health conditions, for six months, I went without insurance. Can you imagine how excruciating and heartbreaking it was?”

Forty states have federal options to cover lawfully residing children or pregnant women, or provide prenatal care regardless of immigration status, or use state funds to cover certain immigrants, according to the National Immigration Law Center. But it’s unclear how many states cover all noncitizens who would otherwise qualify for Medicaid.

Maine provided public health benefits to noncitizens up until 2011, when former Republican Gov. Paul LePage eliminated their eligibility.

Talbot Ross sponsored a similar bill in the last legislative session, but it died in committee after Gov. Janet Mills included a more limited expansion in her supplemental budget. That expansion granted MaineCare benefits to pregnant women and people under 21, regardless of citizenship. Other noncitizens were excluded.

During Tuesday’s hearing, advocates noted that immigrants play an important role in the state economy, especially in the fields of health care, agriculture, lobster processing, construction, tourism and hospitality.

Westbrook resident Evelyn Hernandez, who works at a seafood processing plant, said she recently gave birth and the costs were covered under the expansion passed by the previous Legislature, but that’s all it covered, leaving her without coverage for important postpartum care.

“Postpartum care is so critical,” Hernandez said. “Mothers need care so they can be their best for their babies. How can we take care of babies while ignoring their mothers?”

COST OF CARE AN OBSTACLE

Glenda Machado, of Portland, said she worked throughout the pandemic cleaning hotel rooms without breaks, sick pay or health insurance, which prevents her from seeing a doctor even when she is feeling very sick.

“Sometimes, if I’m in a grave condition, I will go,” Machado said. “Even then, I rarely am able to obtain the prescriptions they give me, because I cannot afford the medication. Most of the time, I stay home and stick it out. It causes so much stress to think about the bills I might get, that I would rather suffer at home.”

Machado’s story is not unique, said Hannah Miller, the director of Maine Mobile Health Program, which offers medical and behavioral health and nursing care to farm workers, seafood processors and their families. She recalled one woman who had trouble breathing but was worried about going to the hospital because of the cost.

“Fear of oppressive financial consequences for both emergency and routine is a concern I witness again and again,” Miller said.

Groups supporting the proposal include Maine Equal Justice, Maine Center for Economic Policy, Presente! Maine, Maine Coalition Against Sexual Assault, the ACLU of Maine, American Cancer Society Cancer Action Network, Maine Chapter of the American Academy of Pediatrics, American Heart Association and the Maine Council of Churches.

Democrats controlled both legislative chambers last session, plus the Blaine House, and could have passed the bill without Republican support. But such a move would have been fodder for Republicans during an election year in which Democrats were facing national headwinds.

An official with the Department of Health and Human Services was neither for nor against the proposal in written testimony.

But Anthony Pelotte, director of the agency’s Office for Family Independence, cautioned that extending coverage would need to be paid for out of the state general fund without any federal funding because federal law does not allow for a waiver or an amendment to cover noncitizens. The proposed effective date of Jan. 1, 2024, isn’t feasible, Pelotte said, since it would take up to 18 months to implement.

“Finally, while some states provide coverage to certain age groups within this population, most do not and we are unaware of other New England states that cover this population,” Pelotte said, adding that noncitizens ineligible for MaineCare are “provided limited coverage of emergency medical services.”