“Health for All” Proposal Moves Out of the Fast Lane

The drive to expand health care coverage to all undocumented immigrants in California has moved out of the fast lane and will advance more gradually than originally envisioned by Senator Ricardo Lara, the Legislature’s primary proponent of “health for all.”

Senate Bill 4 — the main legislative vehicle for expanding coverage to undocumented immigrants excluded from care — was amended yesterday to remove a provision that would have opened the door to Medi-Cal coverage for undocumented adults. (This provision was moved to SB 10, which is now on hold until 2016.) Under this proposed change, adults who are excluded from Medi-Cal due to their immigration status could begin signing up for the program — which provides health care coverage to Californians with low incomes — so long as enough money is set aside to pay for services. Although this provision would not create an “entitlement” to Medi-Cal services for undocumented adults, there was apparently concern that Governor Brown was nonetheless opposed to it, so it was moved out of SB 4 and put on the slow track through the legislative process.

SB 4 still aims to forge — at no cost to the state — a coverage pathway for undocumented immigrants outside of Medi-Cal. Under SB 4, state officials would ask the feds to let undocumented immigrants purchase coverage through Covered California, the health insurance marketplace — or “exchange” — that California set up as part of federal health care reform. (Under federal law, exchanges are currently off limits to undocumented immigrants.) California would pursue this request under a waiver provision — Section 1332 — of the Affordable Care Act. If federal officials say “yes,” then undocumented residents could buy health insurance through Covered California, although they’d be prohibited from accessing any of the federal financial assistance that reduces the cost of coverage. If the feds say “no,” then it’s back to the drawing board. SB 4, as newly amended, will be heard by the Assembly Health Committee on July 14.

Despite the uncertain path forward, it’s worth remembering that California recently took a major step toward creating a more inclusive heath care system, as we’ve reported. The state budget signed into law by Governor Brown last month expands eligibility for Medi-Cal to children and youth regardless of their immigration status. Starting next May, undocumented immigrants under age 19 — an estimated 170,000 in all — will be able to sign up for comprehensive Medi-Cal coverage so long as they’re otherwise eligible for the program. This cost-effective investment in public health and in California’s immigrant families sets the stage for additional coverage expansions in the months and years to come, with the goal of creating a health care system that works for all Californians.

— Scott Graves