The Patient Protection and Affordable Care Act—commonly known as the Affordable Care Act (ACA)—that was passed into law in 2010 provides more options to access free or low cost health insurance. The ACA, through the New York State of Health, provided insurance to more than two million New Yorkers as of February 4th, 2015 (New York State of Health, 2015). While New York State has made important strides in providing coverage, key populations in the state remain uninsured. According to the Migration Policy Institute, there are 873,000 undocumented immigrants in New York State. Of those, more than half—approximately 457,000—are uninsured (Migration Policy Institute, 2013b). Additionally, this number of uninsured individuals may increase in the years to come, since the incoming administration has made it a priority to dismantle the ACA.
Being uninsured is linked to higher rates of chronic disease and less access to health care providers. One of the main groups of immigrants that are not eligible for health insurance are undocumented immigrants. Due to federal laws, undocumented immigrants are explicitly excluded from even purchasing full price insurance on the Marketplace and are generally not eligible for public insurance. Another group of immigrants who may remain uninsured are those immigrants that are considered to be Permanently Residing under the Color of Law (PRUCOL) with income that is too high to qualify for state funded Medicaid. These are individuals who are not permanent legal residents of the U.S., but the U.S. Citizenship and Immigration Services (USCIS) knows of their presence and has committed not to deport them. PRUCOL individuals in New York State who meet certain income requirements are eligible for state-funded Medicaid because of the 2001 Aliessa v. Novello decision (Aliessa v. Novello, 730 N.Y.S.2d 1).