California has fared better than most states in rolling out the new healthcare law. The state spent years gearing up for the launch of a new insurance exchange that has enrolled more than 625,000 people in health plans since the Affordable Care Act opened for business on Oct. 1, in addition to more than 1.2 million newly enrolled in the state’s Medicaid program.
But one group will be left out no matter how well state officials manage implementation of the ACA: undocumented immigrants, who are barred from accessing federal subsidies to buy insurance through the ACA, or enrolling in California’s Medicaid program, which is funded by state and federal funds.
A new bill proposed in the state senate this month aims to change that. Under legislation called the Health for All Act, undocumented immigrants could qualify for Medicaid coverage paid fully by the state. Those earning too much to qualify for Medicaid would be able to access an insurance exchange offering state-funded subsidies. The bill has been introduced by Democratic State Sen. Ricardo Lara.
An estimated 1 million undocumented immigrants in California are currently uninsured, and many receive health care through emergency rooms or low-cost or free clinics. But the new healthcare law will reduce federal payments to healthcare providers that provide uncompensated care to the uninsured. That’s because in theory, providers will need less compensation as more Americans get insurance through the law. But in states like California that have large undocumented populations, hospitals and clinics are worried they will not be able to make up for the lost funding.
“This is an issue that has been a concern at many clinics and non-profit hospitals and a whole host of other folks in the medical industry who feel that we’re going to have to be pro-active,” says Lara. “If we’re going to fully implement the ACA, the conversation has to include this vulnerable population.”
Coverage for undocumented immigrants was hotly contested in the debate that preceded passage of the ACA. The final law expressly forbids the use of federal funds to finance coverage for immigrants here illegally. But California has already begun offering other public services to undocumented immigrants, while federal immigration reform remains stalled in Congress. In 2013, Gov. Jerry Brown signed a law allowing undocumented immigrants to receive state driver’s licenses. The state also allows those without legal status to receive state financial aid for college.
Healthcare coverage is just another step toward recognizing that undocumented immigrants play a vital role in the state economy, says Lara, whether they have legal status or not. “We understand that ensuring that they are incorporated into our society allows them to contribute more to our economy. California has led the way where the federal government continues to fail.” Lara says his bill already has 16 co-sponsors in the state senate.