Maryland lawmakers are on track to allowing undocumented immigrants to buy health insurance on the state’s insurance exchange — though they’ll still need to pay full price and won’t get any government subsidies.

The Maryland Senate gave approval to the change on a 34-13 vote on Friday afternoon. That followed approval in the House of Delegates on a 101-34 vote in late February.

A few largely procedural steps remain — each chamber passing the other’s version — before the measure goes to Gov. Wes Moore for his consideration.

The goal of the change is to help make a dent in the state’s population of people who lack health insurance.

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About 6.1% of state residents are uninsured, and officials estimate that about 30% of them — 112,000 — are immigrants who lack legal documentation. They’re currently banned from using the state health insurance exchange to shop for and purchase insurance plans.

“It helps some people who get sick, get better. Nothing wrong with that,” said Sen. James Rosapepe, a Prince George’s County Democrat, as he explained his vote on Friday.

”We’re excited that, pending approval from the federal government, all Maryland residents will be able to use Maryland Health Connection to compare and purchase private health plans,” said Michele Eberle, executive director of Maryland Health Benefit Exchange.

The health exchange already has a version of the site in Spanish and a Google Translate feature for other languages, as well as a call center capable of offering help in more than 200 languages — all in an effort to make buying insurance as accessible as possible.

If the bill withstands the final steps of the legislative process and is approved by the governor, the state would have to ask the federal government for a waiver to allow undocumented immigrants to use the health exchange. If that waiver is granted, it could take until 2026 for the health exchange to begin accepting undocumented immigrants, according to a nonpartisan analysis of the bill.

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Opening the health exchange to undocumented immigrants would not initially cost the state any money, as no subsidies are involved and the exchange reported that it can accommodate any increased demand with existing staffing and resources.

Members from several organizations held a rally on Lawyers Mall outside the State House in Annapolis on Monday, Feb. 26, 2024. They advocated for a series of bills to address health care access and affordability.
Members from several organizations held a rally on Lawyers Mall outside the State House in Annapolis on Monday, Feb. 26, 2024. They advocated for a series of bills to address health care access and affordability. (Pamela Wood)

The bill spurred contentious debate in the House of Delegates, with Del. Mark Fisher, a Calvert County Republican, calling it an “absurdly ridiculous bill.”

Del. Joseline Peña-Melnyk, chair of the health committee, said it’s the latest step in attacking the state’s rate of uninsured residents. Before the federal Affordable Care Act — dubbed “Obamacare” by many — the state had 756,000 people who were uninsured.

Peña-Melnyk described a series of subsequent actions that have brought the number of uninsured people down to 350,000: Expanding Medicaid; funding plans on the health exchange with a tax on insurance companies; expanding subsidies for young adults; and using tax returns to connect eligible people to the exchange.

Helping people get insurance plans means better care for them and lower costs for the whole system, said Peña-Melnyk, a Democrat whose district includes parts of Prince George’s and Anne Arundel counties.

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“Where are these people going to get their care? You know where they go?” she asked. “They go to the emergency room. Maryland has the worst emergency wait times in the entire nation.”

The Access to Care Act was supported by four of the key caucuses in the General Assembly: the Asian American Pacific Islander Caucus, the Maryland Legislative Latino Caucus, the Legislative Black Caucus of Maryland and the Maryland Legislative Jewish Caucus. The caucus leaders wrote in a letter of support that the bill is “a financially responsible solution to improve healthcare access and affordability.”

They also noted that the bill will help families of mixed status, meaning some are legal residents and others are not. “This inclusive approach recognizes the diverse makeup of our communities and addresses the logistical and emotional barriers these families face in securing health coverage,” the caucus leaders wrote.

In the Senate, some Republicans raised concerns that Maryland has continually made the state more welcoming for people to come here illegally.

“We’ve done everything imaginable to have a flashing neon sign that says, ‘Hey, come here!’” said Sen. Justin Ready, a Carroll County Republican. The state’s infrastructure just can’t handle the needs of more undocumented immigrants, he said.

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“We can’t continue to throw out a welcome wagon and add more and more cost to our citizens,” he said.

But supporters counter that the measure will actually save money.

When people without insurance need care, they go to emergency rooms that are required to help them regardless of ability to pay. The costs of that uncompensated care are spread out among everyone else who has insurance.

“What that means is all of us end up paying for their care,” said Sen. Clarence Lam, a Democrat representing Howard and Anne Arundel counties.

Over the last 10 years, reducing the uninsured population from 13% to 6% has resulted in a savings of $460 million in that uncompensated care, according to a recent study, said Vincent DeMarco of Maryland Health Care for All.

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“This is a great day for Maryland because we all benefit when more people have access to health insurance coverage,” he said.

While the debate was civil in the Senate on Friday, the bill sponsor, Sen. Antonio Hayes, said the rhetoric has been worse beyond the State House.

“Outside of here, I’ve gotten really scathing messages, including personal threats to me,” the Baltimore Democrat said.

Traci Kodeck, CEO of HealthCare Access Maryland, a nonprofit that works to increase health plan enrollment, said the bill could help many people.

”I’m excited about the potential of this bill,” Kodeck said. “We are already working with the community, so I don’t feel like it’ll be a difficult challenge for us to connect with them.”