DENVER— Armando Peniche Rosales has a crooked toe that for years predicted the weather, becoming sensitive to rain or cold.
“It never healed well,” said Peniche Rosales, who broke the middle toe of his left foot as a high school football player in Denver years ago and returned home in limping without seeing a doctor. He was living in the United States without permission at the time. From age 9, when he moved to Denver, until he was in his twenties, he had no health insurance.
The toe is a small reminder of when loved ones thought they had to “choose between your health or your future” in the United States, said Peniche Rosales, now 35. Both of his parents had to deal with this decision. Her mother chose her health, returning to Mexico to seek treatment for migraines and a thyroid problem, although it meant she had to spend a decade separated from her family. His father chose his future, working long weeks on symptoms that the free clinics said were hemorrhoids, but were actually colon cancer.
Peniche Rosales’ father is now buried in a Denver cemetery overlooking the Rocky Mountains.
“He is resting at home, as he wanted,” said Peniche Rosales. “He loved the mountains.
Nationally and in Colorado, the share of people without health insurance has long been significantly higher among Hispanics than among non-Hispanic white, black, or Asian residents. Immigrants without legal status and those with legal residency but whose families have a mix of immigration status make up a large portion of this group. Colorado recently made some of them eligible for health coverage, but advocates who work with immigrants say the state faces a challenge: undoing the chilling effects of Trump administration policies that have inflamed fears of some, even those who are eligible, that enrolling for health insurance could jeopardize their ability – or that of a member of their household – to stay in the country.
“People who may have thought about seeking health benefits, for fear of possible repercussions, either for them now or for future adjustments in immigration status, have gone back to living in the shadows,” said María Albañil-Rangel, policy and advocacy officer for the Telluride, Colorado-based Tri-County Health Network, a nonprofit that works to increase access to health care. “Trust is lost. It takes time to rebuild that.
KHN worked with the Colorado News Collaborative to review the progress of the state on addressing racial and ethnic inequalities, including in health, in recent years.
The state health department estimates that about 30% of Hispanic adults have no medical coverage. This contrasts with the state average of 12% of adults in Colorado who do not have insurance. The vast majority of Hispanic Coloradans are citizens or legal residents, but they may face barriers to registration, including language and cost.
People living in the U.S. without permission are in a special situation: They can’t get public benefits in most states — unless they land in the ER with a life-threatening illness — or buy health insurance. in Affordable Care Act markets. According to KFF, approximately a third uninsured Hispanic residents under age 65 are not eligible for ACA coverage, Medicaid, or Children’s Health Insurance due to their immigration status.
Colorado has taken steps to change that for specific groups of unauthorized residents living in low-income households. A recently passed law will provide Medicaid and CHIP coverage for pregnant women and children starting in 2025. Starting next year, a law passed in 2020 will use public funds to help select residents living below 138% of the federal poverty level purchase health insurance in the individual market. And in 2019, the state joined a dozen others who cover regular dialysis for people who would otherwise have to wait until they are so sick that they land in the emergency room.
“We no longer have 130 patients coming through the ER who need emergency dialysis,” said Dr. Lilia Cervantes, director of immigrant health at the University of Colorado School of Medicine. and leading attorney. for dialysis change, which has saved the state about $10 million a year, according to data from the state Department of Health Care Policy and Finance. But she would like to see more people get the care they need to avoid developing a chronic condition like kidney disease in the first place.
The data confirms that, on its own, expanding the pool of people eligible for health insurance is not enough to address inequalities in coverage. Nationally, after the implementation of the Affordable Care Act, coverage rates improved across all racial and ethnic groups, but inequities persisted.
“Hispanics had the largest coverage gains over this period, which helped narrow the disparities somewhat, but they still remained significantly more likely to be uninsured compared to whites,” said Samantha Artiga, director of the Racial Equity and Health Policy Program for KFF. “And then what we saw in 2017 was that uninsured rates started to climb again.”
Doctors, researchers and advocates for expanding health care access for immigrants in Colorado suspect the rebound was tied to the Trump administration’s immigration policies, including its changes to the rule of public charge. The long-standing rule determines when someone can be denied a green card or visa because they are deemed to be dependent on or already using government benefits.
The Trump administration has expanded the types of benefits that can be used to deny someone immigration status to food stamps, non-emergency Medicaid and housing subsidies.
To research published by the non-profit behavioral science group Ideas42 in the journal Health Affairs in 2020 found that the announcement of the Trump administration’s changes to the public charge rule was associated with a nationwide decrease in Medicaid enrollment of about 260,000 children from levels of 2017.
Colorado has also seen Hispanic insurance rates drop. The Colorado Health Institute found in a statewide survey that while the state’s overall uninsured rate had remained stable since the implementation of the Affordable Care Act, uninsured rates among Hispanic or Latino Coloradans had increased, especially among children. The institute estimated that about 3% of Hispanic or Latino Coloradans 18 and younger were uninsured in 2015, up from about 8% in 2021. Of children eligible but not enrolled in insurance, about half about one-third of all children in Colorado were Hispanic despite their constitution, said Erin Miller, vice president of health initiatives for the Colorado Children’s Campaign.
The Biden administration reversed the Trump administration’s 2019 public office changes in 2021 and is expected to finalize a new public office rule later this year.
“But that doesn’t change the fact that a lot of immigrants are really wary of what they can share and who they can share it with,” said Liz Tansey, senior director of the Colorado Community Health Network.
Protecting Immigrant Families 2021 Immigrant Rights Coalition Survey of Primarily Hispanic and Asian American and Pacific Islander Immigrant Families found this nationally, 40% had not heard of the reversal. Almost half of respondents whose families needed help during the pandemic said they declined to apply because of immigration issues.
Dr. Ricardo Gonzalez-Fisher, a surgical oncologist who works with the social service organization Servicios de la Raza, provides registration assistance from a health resource center at the Mexican consulate in Denver. More than half of the immigrants he sees are uninsured. He said many immigrants tell him that even if they have insurance, they won’t use it for fear of attracting the wrong kind of attention. “They say, ‘We all have at least one or two undocumented people in our homes and we don’t want them to see us,'” Gonzalez-Fisher said.
Insurance that unauthorized Coloradans are accessing due to recent state laws cannot count against them in public charge determinations, with one important exception: if children require long-term care due, for example, severe disabilities or chronic illnesses, said Rayna Hetlage, senior director of policy for the Center for Health Progress, a Denver-based health equity advocacy group.
Maria Rodriguez, health care equity and advocacy specialist with the Colorado Division of Insurance, is the state’s point person to raise awareness of the new grants to help people who are not authorized to take out health insurance. She has held meetings with community organizations to prepare for the November 1 open registration date.
In the first year of the subsidy program, the state can enroll up to about 10,000 unauthorized Coloradans, which is only a portion of the state’s unauthorized and uninsured Hispanics.
colorado again behind Washington and California by offering cancer care coverage, which could have helped Peniche Rosales’ father. Without health insurance or tens of thousands of dollars to start treatment, he was unable to get care until he found a hospital who would cover it using charity funds.
The night before Peniche Rosales had an interview with US Citizenship and Immigration Services – an interview that would grant him legal residency – he had to take his father to the emergency room again. His father told him to go home and rest.
“He was more worried about my interview than anything else,” Peniche Rosales said. He received his green card while his father was still alive. “Even though he was in pain, it brought him a lot of joy.”