House Bill 588, which would have allowed immigrants without documentation to gain access to health coverage through the Maryland Health Benefit Exchange, failed to gain approval in the General Assembly this year. This unfortunate result spells trouble for many state residents who are at high risk for delaying essential care. While advocates regroup to try again next session, what are families to do?
Nonprofit hospital systems can put into place a stopgap measure to help people who are ineligible for health insurance, such as people without documentation. These health systems can develop a robust charity care program, modeled on a program called The Access Partnership at Johns Hopkins Medicine. If adopted across the state, these programs can form a bridge to a true policy fix that would help thousands gain coverage.
At Hopkins, we routinely encounter patients and families in situations such as that of Verónica del Cid Gaitán. The Baltimore Banner reported that she delayed going to the hospital out of her fear of the costs. Recently, an Eastern European woman came to our hospital suffering from heart failure. Fluid filled her lungs and legs. She had run out of her diuretic (i.e., water pill) a month prior but waited until she could barely breathe to seek medical attention in the emergency room.
Our current system is penny-wise and pound-foolish. When people can’t get inexpensive care for conditions such as heart failure, then predictable complications are costly both in health and economic terms. Avoiding this scenario was a guiding principle of TAP when it was founded in 2009. The program was created to serve uninsured residents of zip codes near Johns Hopkins Hospital in East Baltimore. With the passage of the Affordable Care Act in 2010, and subsequent Medicaid expansion in 2014, most TAP patients obtained insurance — but not everyone.
Undocumented patients continue to rely on the program due to their exclusion from federal health care benefits. Providers at affiliated community clinics can refer patients who require specialty services such as radiology, ophthalmology and even surgery to TAP. Bilingual patient navigators help patients apply for the program and schedule appointments at Hopkins, where the fees are waived. Between January 2020 and December 2022, nearly 4,000 patients utilized TAP for more than 40,700 health care visits. Nine out of 10 patients identified as Latino, and Spanish was their preferred language.
Other hospitals could implement programs like TAP — using resources required to be spent on community benefits to maintain their nonprofit status. Such an approach would create a basic safety net for many more Maryland families than have support today. A network of hospital-based programs could help plug a gap that will remain a serious risk to health and the state’s economy until a policy solution is in place. Ultimately, affordable, comprehensive insurance for undocumented immigrants remains necessary to achieve health security for all. Until then, let’s keep moving forward.
Edward W. Corty is a second-year resident in combined internal medicine and pediatrics at Johns Hopkins. Carolina Lopez-Silva is a third-year medical student at the Johns Hopkins University School of Medicine. Kathleen R. Page is an associate professor of medicine at Johns Hopkins with a specialty in infectious disease.
