Supporters for the MinnesotaCare Immigrant Inclusion Act gather at the Minnesota Capitol on April 3, 2023. Credit: Unidos MN

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A bill moving through the Minnesota Legislature would allow undocumented residents to sign up for health insurance—a potential boon for thousands of front-line workers who face higher-than-average risk of illness or injury. 

The bill would make it possible for them to enroll in MinnesotaCare, the state’s health insurance program for low-income individuals and families. That program currently requires recipients to be U.S. citizens or lawful residents.

An estimated 81,000 undocumented people live in Minnesota, according to the Migration Policy Institute, a Washington, D.C., research agency. The bill’s fiscal notes say about half of that population would be eligible for MinnesotaCare because they have an income below 200 percent of the federal poverty line.

The Minnesota Department of Human Services estimates that about 67 percent of the undocumented population—about 54,000 people— were uninsured through the height of the COVID-19 pandemic. 

In 2020, the father of Emilia Gonzalez Avaloz, executive director of the Latino advocacy group Unidos MN, contracted COVID. Emilio Gonzalez, who came to the United States in 1992 and has been waiting to be considered for permanent residency status for several years, had no health insurance. He spent 76 days in a hospital.

Gonzalez Avalos recounted the harrowing situation.  

“My dad is disabled,” she said. “The problem was not only that my dad got COVID, the problem was that he didn’t have access to comprehensive health care in a way where he could have ownership of the plan, the doctor, and the hospital he could go to.”

Some undocumented immigrants are eligible for Emergency Medical Assistance, which covers some care administered in hospital emergency rooms. It excludes preventative care or treatment for chronic conditions, mental health services, and non-emergency dental and vision care. 

“In the Latino, mixed-status population, we have high rates of chronic illness like diabetes, high blood pressure, and, for women, cervical cancer,” Gonzalez Avalos said. “All of those illnesses require preventative health care and treatment. Emergency Medical Assistance might not cover all of those.”

Nearly three-fourths of the estimated population of undocumented immigrants in Minnesota come from Central and South American countries, according to the Migration Policy Institute

Nationwide, Latinos were hospitalized with COVID-19 at nearly twice the rate of white people in 2022, according to the U.S. Centers for Disease Control and Prevention. Latinos also died from COVID-19 at nearly twice the rate of white people.

Some undocumented immigrants have access to health insurance from their employers, but it can add a financial burden for low-income families, Gonzalez Avalos said.

“The [bill’s] whole package will provide access to a lot of working families that cannot afford the premium from their employer, if the employer cannot afford to provide 100 percent-paid medical insurance,” she said. “People will have access to very good health insurance.”

Four states—Illinois, New York, Oregon, and California, as well as Washington, D.C.—provide health coverage to individuals regardless of immigration status.

Addressing an ‘incredible disservice’

State Senator Alice Mann (DFL-Edina), author of the Senate version of the bill, said she is working to include the bill, formally titled the MinnesotaCare Immigrant Inclusion Act, in the health and human services omnibus bill.

“When people don’t have access to health care, they get their care in the emergency department, which is significantly more expensive,” Mann said.

Under the current system,  “an entire community of people who work in Minnesota, pay taxes in Minnesota, who keep Minnesota on its feet—we’re doing them this incredible disservice,” she said.

The House version of the bill, authored by Representative Esther Agbaje (DFL-Minneapolis), will be included in the House omnibus bill for health care spending. 

“Health is wealth,” Agbaje said. “We want to make sure we’re doing what we can to ensure that every family has a chance to see a doctor and get the care they need.”

The financial eligibility criteria for MinnesotaCare will remain the same if the bill becomes law, Agbaje said. The state breaks down income requirements for MinnesotaCare eligibility by who lives in one household. 

If the House and Senate bill packages pass with differences, a conference committee will resolve differences.

Gonzalez Avalos said Unidos MN is pushing to address one key difference between the House and Senate bills—the age limit. The Senate version would provide coverage to undocumented people under the age of 19. The House version would expand coverage to all undocumented immigrants who meet the income eligibility. 

“We’re working with them to make sure that adults can be included,” Gonzalez Avalos said. 

Because undocumented immigrants make up a substantial part of the in-person workforce, they were at higher risk of getting sick during the pandemic, Mann said.

“A lot of undocumented immigrants are front-line workers,” she said. “They’re stocking our shelves, they’re feeding us, they’re doing agricultural work, they’re cutting the meat. Minnesota would literally collapse without our immigrant community.”

Undocumented immigrants are sometimes more prone to illness and injury because “they’re stocking our shelves, they’re feeding us, they’re doing agricultural work, they’re cutting our meat.”

Senator Alice Mann, state Senate sponsor of a bill to allow undocumented immigrants access to MinnesotaCare health insurance

Legislation faces close scrutiny

While there is a path to passage for the MinnesotaCare Immigrant Inclusion Act in a state government with a DFL majority, it won’t move as quickly as other recent bills backed by progressives, such as Driver’s Licenses For All, she said. That’s because it’s a “big, expensive” bill that will need careful consideration as part of the larger health and human services budget. 

Mann expects pushback from Republican members of the Senate, but she’s ready to fight for the measure.

“People leave their lives, their language, their food, their families, their friends, their customs, everything they know, under fairly dire circumstances,” she said. “For people to turn around and say, ‘You did it wrong,’ having never walked in somebody else’s shoes—that’s not the way we should be treating people.”

Hibah Ansari is a reporter for Sahan Journal and corps member with Report For America, a national service program that places journalists into local newsrooms. She was named the 2022 Young Journalist of...