California poised to extend health care to all unauthorised immigrants

California has seen a sharp decline over the past decade in the number of residents who lack health insurance — with one major exception.

The federal Affordable Care Act helped increase coverage rates but excludes immigrants living in the country illegally, who now make up the bulk of the state’s uninsured population.

Consider this: Nearly two-thirds of immigrants living in the country illegally in California who are younger than 65 lack health insurance, compared with less than 10 percent of all Californians in that age range, according to a recent analysis from the Centre for Labour Research and Education at the University of California, Berkeley.

It’s a large, lingering disparity, and one that Gov Gavin Newsom has turned his attention toward in the new year.

In a budget plan unveiled this week, Newsom proposed allowing immigrants living here illegally to sign up for Medi-Cal, the state’s health program for low-income Californians. (This is distinct from an ongoing effort to create a single-payer health care system in the state.)

The state already allows undocumented Californians under 26 to join Medi-Cal, and those 50 and over will become eligible in the spring. Opening up Medi-Cal to the remaining undocumented population — approximately 700,000 people — would cost $2.2 billion annually, Newsom said.

“We are positioned with this budget to be able to deliver on what we’ve been promoting: universal health care for all,” Newsom said at a news briefing Tuesday. “I’m proud to be here — I hope we see this replicated across the country.”

Expanding Medi-Cal to all undocumented Californians has been a goal of health advocates for years. But actually executing that vision seemed somewhat unlikely, until the coronavirus pandemic.

How we got here

The Affordable Care Act, often referred to as Obamacare, brought down California’s uninsured rate to 7 percent from 17 percent after its rollout in 2014.

But federal rules barred California’s 2.2 million immigrants here illegally from signing up for coverage through Medi-Cal or the state’s marketplace, Covered California. The state is home to a fifth of all of the people living illegally in the United States.

“It was always a sort of clear and troublesome exclusion — that we are expanding coverage to everyone, but with one glaring exception,” said Anthony Wright, executive director of the advocacy group Health Access California.

Wright and other advocates immediately began pushing for the state to use its own funds to provide coverage to immigrants here illegally, with some success.

In 2015, legislators voted to allow undocumented children to join Medi-Cal. Four years later, they broadened eligibility to include those younger than 26.

Health and policy experts said it would be difficult to pass coverage expansions beyond those age groups. Compared with adults, children tend to use few health care services, which keeps cost relatively low, and they tend to garner more sympathy from the public.

But then the pandemic hit.

California ended up with a surprisingly large budget surplus that gave the state more flexibility to invest in new programs. And living through a public health crisis revealed to people something that had always been true, Wright said.

“Our health is connected to our neighbors, to our community, including the people who deliver our food, the people who drive the bus, the people who make the society function,” he said. “I think it changed hearts and minds.”

A poll conducted by the Public Policy Institute of California in March found that 66 percent of Californians supported offering health care coverage to immigrants here illegally. That was up from 54 percent in 2015, the last time the institute asked the question.

In July, state legislators voted to expand Medi-Cal coverage to immigrants here illegally over 50, a change that will take effect in May.

Newsom’s proposal announced this week would cover people between 26 and 49 and, if approved, take effect in January 2024. The governor said Tuesday that the state’s immigrants here illegally made up 10 percent of our workforce and that most had lived in the state for more than a decade.

Though the budget won’t be finalized for months and opponents of the plan have already begun speaking out, many advocates say they are hopeful.

“We are going to be the first in the nation, the United States of America, that is finally going to recognise our immigrants and to give them the kind of health care that they need,” the labour leader Dolores Huerta told reporters.

This article originally appeared in The New York Times.

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