Health Care Hangs in Balance for NYC’s DACA Recipients

In the late 1990s, Dale St. Marthe and his father left their native St. Lucia on a medical mission: to find treatments for the severe immune deficiency St. Marthe was born with. They tried Barbados and parts of Europe, but their journey led to the United States and ultimately Brooklyn, where they found hope.

St. Marthe, 22, is now healed and his illness long gone: a remarkable fact when considering he didn’t have regular health care access until three years ago.

That’s when everything changed for him. Along with becoming eligible to get a job legally and a college scholarship, he signed up for health insurance. These benefits were made possible because he enrolled in DACA, short for Deferred Action for Childhood Arrivals, the policy that the administration of Donald Trump announced last week it would phase out.

This means that St. Marthe may lose his health insurance, provided by MetroPlus, the insurance arm of the public hospital system in New York City. The city’s 30,000 DACA recipients are generally eligible for Medicaid and can obtain those benefits through a MetroPlus plan.

“I don’t know what I’d do without MetroPlus,” St. Marthe said. “I’d just have to be extra healthy or suffer the consequences.”

DACA, enacted in 2012 by a directive from former President Barack Obama, provides protection from deportation and work permits to immigrants who were illegally brought to the United States as children. Participants must have entered the country before the age of 16 and never committed a serious crime, among other requirements. They can renew their DACA status every two years, provided they remain eligible.

What will now happen to the nearly 800,000 immigrants nationwide who are enrolled in the program remains to be seen. In a statement, Trump said ending the program would “provide a window of opportunity” for Congress to craft immigration reform through legislation. But in a series of tweets Thursday, Trump contradicted reports that a deal had been made with Democrats over the future of the program, while calling its recipients “good” and “educated.”

“I’m not sure what the next steps are for me,” St. Marthe said. “It’s unfair how he [Trump] is able to toy with our lives like that.”

St. Marthe, a Brownsville resident who is studying computer science at York College, said his academic and professional plans would be in jeopardy without DACA or something similar. He hopes to one day land a lucrative IT desk job and, because of health concerns, avoid the kinds of construction jobs his undocumented father often works.

St. Marthe still suffers some effects of his childhood illness, including hair loss, stiffness in his arms, and an arch in his back due to scoliosis, a curvature in his spine.

“A lot of jobs undocumented immigrants do are physically intensive and with my medical background, I wouldn’t be able to keep up really,” he said.

With the medical visa that he and his father used to enter the United States long expired, MetroPlus now offers St. Marthe routine check-ups, immunizations and money for prescription glasses. He pays no monthly premium.

Dale St. Marthe after a recent rally in support of DACA in Washington Heights.

“MetroPlus afforded me more consistent benefits. I can just go to the doctor any time I want and it doesn’t have to be a big deal,” he said.

Seth Diamond, chief operating officer at MetroPlus, said DACA opened an easy path to insurance coverage for the city’s DACA recipients, although it was unclear how many had actually enrolled.

“In order to obtain insurance, you must have some legal immigration status in the United States,” he said. “It may have been the case that an undocumented insurance applicant could find another route to gain that status, but DACA provided one that everybody knew about.”

Diamond said he expects MetroPlus to be as aggressive as legally possible with efforts to continue offering coverage to DACA recipients, even as the program is wound down.

“Because of DACA, we were able to extend our coverage further than we had been before. We would like very much to be able to continue that,” he said. “Whether we will be able to given the change is something that is going to have to be looked at. But if, at the end of the day, they’re not eligible, they should still seek care through the New York City Health and Hospitals system.”

That system treats patients in its emergency rooms and ambulatory care centers regardless of immigration status. Diamond acknowledged that without public insurance plans to provide regular care, DACA recipients in the city would be more likely to visit these facilities, where treatments are costlier to provide than at routine doctor visits.

There are few alternatives, however. DACA recipients nationwide are barred from buying insurance on the health exchanges created through the Affordable Care Act. They are eligible to obtain coverage through their employers, but their work permits generally will not be renewed as the Trump administration ends the program.

Diamond noted another challenge that might make it less likely for DACA recipients to visit the city’s public health facilities.

“We have heard from individuals and community organizations who say some undocumented immigrants are nervous to visit us because they are scared of the immigration enforcement climate since Trump took office,” he said.

St. Marthe said if Congress has not acted by the time his current DACA benefits expire next summer, he will ask MetroPlus if he might maintain his coverage.

For now, he feels that he is managing his health issues well. He is also focused on good habits, like drinking lots of water, to try and stave off health scares. It is a determined approach that mirrors his outlook on an uncertain, post-DACA future.

“Undocumented people are some of the hardest working people I’ve ever met in my life and that resilience isn’t going to go away,” he said. “We’ve always been able to get by. I know how to survive.”