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Thursday, July 23, 2015

California’s Historic Decision to Extend Health Coverage to Every Low-Income Kid

Yasmin Peled

Health Equity Intern

Erika Ramirez

Medicaid Intern

Update: May 16, 2016: California begins enrolling all low-income children in Medi-Cal, regardless of immigration status

With June's Supreme Court ruling affirming that the Affordable Care Act (ACA) is here to stay, advocates and decisionmakers can turn to building on the law’s success, such as closing the Medicaid gap, improving the value of care, and eliminating the “family glitch.” Another top priority in this next phase of health reform is making good on the promise of health care for all, regardless of immigration status. This includes the approximately 11.2 million undocumented immigrants who live and work in our country.

Last month, California, the state with the most undocumented immigrants, took a momentous leap in that direction.  

California gets closer to coverage for all by including undocumented immigrant children in Medi-Cal  

On June 24, Governor Jerry Brown signed a budget allocating state funding to provide health insurance to all low-income undocumented children under Medi-Cal, the state’s health insurance program for low-income residents that includes Medicaid enrollees. This coverage extension is fully funded by state dollars, since, by law, federal funds cannot be used for this purpose. Coverage is slated to begin in May 2016. 

California’s decision to invest in providing Medi-Cal coverage to undocumented immigrant children brings it one major step closer to universal coverage. This victory was fueled by the “#Health4All” campaign, a coalition of advocates including Health Access California and the California Immigrant Policy Center with support from the California Endowment, which sought coverage for all undocumented immigrants. Although the final deal did not go as far as State Senator Ricardo Lara’s bill, SB 4, intended, it is a huge accomplishment, as an estimated 170,000 children will gain access to health coverage.

California is the largest state to decide to cover low-income undocumented children, joining New York, Illinois, Massachusetts, Washington, and Washington D.C. In addition, several counties in California provide medical coverage to undocumented adult immigrants.

Undocumented immigrants contribute to our economy, yet are unfairly excluded from health care programs

Undocumented immigrants contribute substantially to the economy, by working and paying taxes, yet their access to health care services is severely constrained. In California alone, where roughly one-fifth of the nation’s undocumented immigrants live, they produced an estimated $130 billion of the state’s GDP in 2012. 

At a national level, in 2010, undocumented immigrants contributed $13 billion in payroll taxes, according to the Social Security Administration. A study published in the June edition of the Journal of General Internal Medicine found that, in 2011, undocumented immigrants paid an estimated net of $3.5 billion into Medicare (for which they are not eligible), prolonging the trust fund that finances Medicare by one year. 

Even so, undocumented immigrants lack fair access to health care. They are ineligible for Medicaid, nor are they allowed to purchase ACA marketplace coverage with their own money. In fact, in the vast majority of states, even most authorized immigrants must wait five years before they can enroll in Medicaid. 

Typically, undocumented immigrants seeking health care have few options. They may seek care at a Federally Qualified Health Centers (FQHCs)—if they are lucky enough to live near one with capacity. One exception is Washington, D.C., which offers affordable coverage to all low-income individuals—including undocumented immigrants. Or they may be forced to visit an emergency room. 

Considering the extent of undocumented immigrants’ contribution to the national economy, their growing importance in our future workforce, and the persistence of racial and ethnic health disparities, continuing to exclude them because they are undocumented defies logic. 

Investing in immigrants is an investment in our future

To achieve a high-value, equitable, and sustainable health care system, everyone must have reliable, affordable access to care. Not only does this align with our American values of equal opportunity and building a shared future, there are compelling reasons why an inclusive health care system advances the common good: 

America needs a health care system that covers everyone

As our population ages and the workforce becomes “majority minority”, for America to thrive, our health care system must do a better job of improving the health of people of color, including undocumented immigrants. 

Finally, covering everyone is critical to public health and bending the health care cost curve. When a sizeable segment of the population lacks reliable access to affordable care, this creates a significant barrier to addressing public health challenges–from outbreaks of infectious diseases to the explosion of chronic illnesses. 

Ensuring everyone gets preventive and primary care saves money by delaying the onset of chronic conditions, detecting them early, and better managing them to avoid costly complications. Without affordable access to primary care, people’s conditions worsen until the only choice left is an expensive emergency department, which drives up health care costs for everyone

The future of our health system and our country requires health care for all. California embarked on a path that should culminate in coverage for everyone, regardless of immigration status. We hope more states realize investing in immigrants is an investment in our future and follow California’s lead.

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