California Could Be Model for Extending Health Coverage to Undocumented

Compared with other states, California is ahead in terms of expanding health care coverage to undocumented immigrants, and some experts say it could spur other states to follow suit, the Los Angeles Times reports.

According to the Times, there are about 2.6 million undocumented immigrants in California.

California Efforts

In the last year, California has taken several steps to provide low- or no-cost coverage to undocumented immigrants in the state (Karlamangla, Los Angeles Times, 10/2).

For example:

  • Contra Costa County in September became the 47th state to provide non-emergency care to local undocumented adults (California Healthline, 9/23);
  • In June, Gov. Jerry Brown (D) signed a $167.6 billion state budget that includes funding to expand Medi-Cal to about 170,000 undocumented immigrant children under age 19 starting in May 2016 (California Healthline, 7/7); and
  • State Sen. Ricardo Lara (D-Bell Gardens) introduced a bill (SB 4) that also would offer coverage to low-income undocumented immigrant children.

While Lara removed from the bill language seeking a federal waiver to enable undocumented immigrant adults to purchase coverage through Covered California, he said he will pursue separate legislation (SB 10) to extend health coverage to all immigrants, regardless of status, next year (California Healthline, 9/9).

California as a Catalyst for Reform

According to the Times, expanding coverage to undocumented immigrants is likely to become a major issue in the country, as well as during the 2016 presidential campaign.

So far, though, experts seem split as to whether California will serve as the catalyst for health care reform among undocumented immigrants.

Steven Wallace, a health policy professor at UCLA, said, “I’m sure we’ll inspire other states,” adding, “I think it’s inevitable.”

However, Randy Capps — director of research for U.S. programs at the Migration Policy Institute — said, “I wouldn’t mistake momentum inside California for momentum outside of California.”

According to the Times, only four other states — Illinois, Massachusetts, New York and Washington state — and Washington, D.C., have permitted undocumented children to receive health coverage.

Wallace noted that if more states were to expand coverage, they likely would start with undocumented kids because doing so is “politically attractive, and not terribly expensive.”

Some states could view California as a testing ground for such reforms, the Times reports.

Mirna Castro, of the Servicios De La Raza in Denver, said watching how California finances and manages medical care for undocumented immigrants will “definitely inform Colorado … to maybe take a step in that direction.”

Other states, such as Oregon, also have viewed California as a model for expanding coverage to undocumented immigrants. Earlier this year, a bill to include undocumented immigrant children in its Medicaid expansion died in the Oregon Legislature. However, Alberto Moreno, executive director of the Oregon Latino Health Coalition, said he intends to pursue the legislation again next year.

He said, “We hope to follow California’s suit.”

Challenges Remain

According to the Times, there are several barriers to expanding medical care to undocumented immigrants in California and across the country.

In California, voters appear split on the issue (Los Angeles Times, 10/2).

Last month, a poll commissioned by the Times and the University of Southern California’s Dornsife College of Letters, Arts and Sciences found that:

48% of respondents said undocumented immigrants should be eligible for low- or no-cost coverage through Medi-Cal; and
47% said undocumented immigrants should not be eligible for such coverage (California Healthline, 9/15).

Nationally, and in California, many stakeholders have expressed concerns about costs. In California, expanding health coverage to undocumented adults could cost the state $1 billion annually, the Times reports.

Gabrielle Lessard, an attorney at the National Immigration Law Center, said that “the only conversation about this [issue] has been about cost.”

Advocates say that providing health coverage to the 11 million undocumented immigrants in the country would be less costly by providing them with primary care to help avoid serious issues that send them to the ED.

However, Ira Mehlman, a spokesperson for the Federation for American Immigration Reform, cited a 2009 Congressional Budget Office report that found expanding preventive care typically led to higher spending.

States that have not expanded their Medicaid programs under the Affordable Care Act also seem hesitant to extend coverage to undocumented immigrants before insuring their low-income residents, the Times reports (Los Angeles Times, 10/2).