For Ericka Salvatierra, an undocumented immigrant from Guatemala, the challenge of taking her four-year-old and her eight-year-old to the doctor’s office starts when she’s handed the bill.
“Sometimes they ask me for pay stubs to give me a discount, and sometimes they just will not see them for an appointment if I don’t pay the full amount up front,” Salvatierra, a member of Hartford Deportation Defense, said during a webinar hosted by the Husky 4 Immigrants coalition last week.
State Sen. Matt Lesser, D-Middletown and State Rep. Jillian Gilchrest, D-West Hartford also attended the webinar.
Both said that healthcare should be seen as “a right” rather than “a privilege.” Gilchrest highlighted the importance of healthcare for women and Lesser emphasized the need to prioritize extending HUSKY to children through the age of 18. He called the expansion a “moral issue.”
“I don’t want to tell a nine-year-old that they can’t get access to needed care,” said Lesser.
HUSKY 4 Immigrants is pushing for the state of Connecticut to extend HUSKY benefits to undocumented immigrants of all ages in Connecticut.
Last year, a law passed in the state legislature made young children eligible for coverage under the state medical beginning in 2023. But the law only covers children up to the age of eight, and both parents and pediatricians who spoke with CT Examiner say this isn’t sufficient to make sure that children receive the medical and psychological attention they may need.
Salvatierra’s son, for instance, is at the point of aging out of coverage.
“It worries me that my child, next year, will not be able to access those benefits because he is 9 years old,” she said.
Dr. Jody Terranova, a pediatrician and assistant professor of pediatrics at the UConn School of Medicine told CT Examiner that she didn’t understand why the state legislature decided to only insure children through the age of eight.
“It was a very random number. I’m not sure where that came from — that a nine-year-old doesn’t deserve to receive the same care or have care paid for than an eight-year-old or a seven-year-old,” said Terranova.
Pediatricians who spoke with CT Examiner said that for families with children who suffer from chronic health problems — everything from asthma to type 1 diabetes — paying for their medication without insurance is prohibitive.
Terranova said that she saw children with asthma who had difficulty paying for inhalers, and children suffering from childhood obesity that could benefit from access to nutrition counseling. Dental care, she said, would be another important area that HUSKY could help cover.
In addition to challenges with physical health, the pediatricians also underscored that getting treatment for mental health has become a serious issue for children, particularly in the aftermath of the pandemic. Terranova said she was seeing more children with anxiety and depression, as well as suicidal thoughts.
Dr. Gunjan Tiyyagura, a pediatric emergency medicine physician at Yale, told CT Examiner that they were seeing a “crazy mental health crisis” in the emergency room where she works. She said she was particularly concerned about undocumented families, who might not have the ability to go to doctors who could diagnose them early with mental health disorders.
“We have patient upon patient in the ER for, you know, some behavioral crisis,” said Tiyyagura. “And I worry deeply that a lot of our undocumented patients are not getting any mental health care referrals… they’re not even getting to see primary care physicians, so nobody can even screen them for some of these issues that we’re seeing in all of our other patients.”
One mother of a six-year-old who spoke to CT Examiner on the condition of anonymity, and is affiliated with the nonprofit Make the Road CT, said she wasn’t able to get therapy for her son, who was showing signs of depression after witnessing domestic violence in the home. The mother said she had lost her job during COVID, and that her immigration status prevented her from qualifying for health insurance.
“I was searching everywhere. I went to the clinic and everyone told me that if I wanted the child to have therapy, I had to pay $150 per session,” she said.
The mother said her son would come to her and tell her that he wanted to die. She said he would refuse to eat, that he wanted to be alone, and that he would wake up in the middle of the night in distress. Her son’s hair also began falling out in clumps — she said a doctor prescribed treatment, but it didn’t work.
“I’m not a psychologist, but it was noticeable, because he was very happy and [he had] a very sudden change,” she said. “He is very depressed, he spends time crying and crying and crying … It’s not normal. I know my son, and he’s not like that.”
The mother said that the doctor she brought him to at a clinic told her that there was nothing wrong with her son, and that she believed she wasn’t taken seriously. The doctor didn’t speak Spanish, and although they sometimes brought a nurse in to translate, she was given very little information. She also spoke to school officials, who gave her son academic support but denied that he had any emotional problems.
“I told the doctor. I told various people. Nobody listened to me. Nobody,” she said.
She said she believes her son will qualify for health insurance next year under the new legislation, which will mean he will be able to go to therapy. Otherwise, she said, it could come down to a choice between paying to take her son to the doctor and buying food.
Dr. Julia Rosenberg, a pediatrician at Yale who also spoke at the press conference, told CT Examiner that when a child without insurance comes into the clinic, they try to make the cost as low as possible, but because the system is so complex, they can’t guarantee that there won’t be out-of-pocket fees.
Rosenberg said the children who go untreated for chronic conditions that could be managed by regular check-ups — like asthma — sometimes land in the emergency room. These children end up missing school, she said, and sometimes the consequences are even more severe.
Tiyyagura said she treated one patient in the emergency room, a teenager who came in with appendicitis, who had waited to come in because his guardian did not have insurance and was worried about how to pay for his care.
“It’s totally illustrative, I think, of why older kids need to have HUSKY coverage,” she said.
Tiyyagura said that delaying care is emblematic of patients without health insurance. She also said it’s risky. In the case of appendicitis, for example, not getting care immediately might mean that the appendix perforates.
And even after the urgent problem is addressed, she said, physicians worry about how these children will continue getting care after they leave the ER, especially if the problem is a chronic condition that requires expensive medication.
Laura Nally, a pediatrician at Yale School of Medicine who specializes in endocrinology and diabetes, told CT Examiner that when undocumented children come into the hospital with type 1 diabetes, she sometimes has to keep them there for weeks until she’s able to find a way for them to get the medicine they need.
Nally said that a diagnosis of type 1 diabetes can mean 14 different types of medication, including two or three different types of insulin that cost $200 to $400 per vial. Insulin pens, another form of delivering insulin, cost about $100 to $200 each. Beyond the medication, diabetes patients also need glucose level monitors, blood testers and syringes, all of which have their own cost.
“Diabetes medications are very expensive out-of-pocket, so it’s not really feasible for anyone to be able to obtain them,” said Nally.
When patients can’t afford their medication, Nally said, she connects them with the community organization Favor, a non-profit that, among other things, helps young people without insurance access medication.
Amanda Knef, program director for the CT Medical Home Initiative at Favor, said they were currently helping 25 children under the age of 18 pay for medication. Knef said that the organization partners with Walmart, which offers diabetes medications at low cost.
Knef said that diabetes is the most common diagnosis among the children she helps, followed by epilepsy. She also helps children who have spina bifida, liver disease, are transplant recipients or have autoimmune disorders.
Knef said the only other way for these patients to immediately get the medicine they need would be through a hospital emergency room. Hospitals, she said, can provide the patients with certain brands of medication, but only for a year. After that, the patient has to go to a different hospital.
“There aren’t a ton of programs for people in Connecticut. Some of these people moved to Massachusetts and Pennsylvania because they can get their kids on their insurance in those states,” said Knef.
The pediatricians and advocates don’t stop at simply recommending that HUSKY be available for all children, up through the age of 18 — they also point out the connection between the health of the parents and the well-being of children.
“The connection of family health to children’s health is so intertwined,” said Rosenberg.
“A child’s care is a hundred percent very closely linked to the parent’s care. And if a parent is not getting medical care, mental health care, all these kinds of things, then the child is suffering,” added Tiyyagura.
Another mom who spoke at the press conference, Veronica Martinez, has a six-year-old son who is in a motorized wheelchair. Martinez, a member of Make the Road, and an immigrant from Guatemala who works as a building cleaner, has diabetes, and said that in the last year she has had problems with the tendons in her hands and feet that makes it hard to cook or tie her children’s shoes. Without insurance, she said, there was no way to get treatment or follow-up care for her diabetes.
“My children need a mother who is 100% healthy,” said Martinez, adding that insurance would make it possible for her to get the care she needed for herself and her son.
Salvatierra also pointed out the importance of having health insurance for herself and her spouse.
“Without health, we cannot work in order to bring our family forward,” added Salvatierra.
Editor’s note: the original version of the story provided incorrect affiliations for Martinez and Salvatierra. They have been corrected.