Expanding Health Coverage Access Through State-Based Marketplaces: A Path Forward for Undocumented Immigrants

Nearly half of the estimated 11 million undocumented individuals in the United States lack health insurance, leading to a crisis of delayed care, poorer health outcomes, and financial hardship. Several states have expanded state-based insurance marketplaces to individuals regardless of immigration status, providing an innovative and feasible roadmap for responsibly and equitably expanding access, even in the absence of federal action. Early evidence from Colorado and Washington shows that expanding marketplace access through the Affordable Care Act's Section 1332 State Innovation Waivers has led to the successful enrollment of tens of thousands of previously uninsured individuals while reducing state healthcare expenditures. We aim to describe why state-based coverage expansion is both economically prudent and advantageous for public health. We, as leaders of the Society of General Internal Medicine Immigrant and Refugee Health Interest Group, urge policymakers to support these state-level marketplace initiatives and champion federal legislation enabling undocumented individuals' participation in Affordable Care Act (ACA) marketplaces, ideally subsidized to expand access.