The 2010 health care law, Affordable Care Act (ACA), bans undocumented immigrants from enrolling in Medicaid. And not only are they barred from getting subsidies to buy private insurance on the health insurance exchanges, they can’t buy the Obamacare plans with just their money.
California lawmakers and activists are spearheading a first-in-the-nation plan to let undocumented immigrants buy Obamacare health insurance.
Supporters say the California proposal, which would need federal approval and couldn’t start until 2017, is the next logical step in expanding health insurance to a population that was intentionally excluded from the president’s health-care law. But uniting the two highly combustible issues of Obamacare and immigration could reignite a fierce health-care reform controversy.
There’s no guarantee the California plan still winding through the state’s legislature will succeed, even with Democrats in control of the statehouse, the governor’s mansion and the White House. California Gov. Jerry Brown isn’t commenting on the legislation, which has been approved by the state Senate but not by the Assembly. But just last month, Brown agreed to spend millions in state dollars to provide health care to undocumented children, mirroring similar efforts in a handful of other liberal states.
For the Obama administration, the California effort could mark the return of a sore point in the early days of the Obamacare debate. Republicans never trusted Democrats’ repeated assurances while the law was being drafted that the Affordable Care Act wouldn’t cover undocumented immigrants. That built up to Rep. Joe Wilson’s infamous “You lie!” moment, when the South Carolina Republican interrupted President Barack Obama’s 2009 health care address to Congress.
National anti-immigration forces are taking note of the bill in California, home to the country’s largest population of undocumented immigrants. To Dan Stein, president of the Federation for American Immigration Reform, which was a leading voice against the comprehensive immigration reform bill that stalled in Washington two years ago, the California proposal signals a weakening in enforcement of immigration laws.
The bill’s sponsor, state Sen. Ricardo Lara, acknowledges the political risk. But he remains optimistic that the Obama administration, if given the chance to review California’s proposal, would see it as an opportunity to move immigration reform forward before its second term wraps up. Supporters are hoping to submit the plan for federal review in 2016, to avoid the uncertainty that would come with a new president the following year.
This effort in California, home to roughly 2.5 million undocumented immigrants, could turn out to be largely symbolic. Undocumented immigrants can already buy private health plans not sold through the Obamacare exchanges, and those who have already struggled to afford insurance probably wouldn’t find it easier to buy exchange plans since they wouldn’t be allowed to receive federal subsidies.
Mixed-status families with a combination of legal residents and undocumented immigrants may have been reluctant to buy health insurance because of misguided fears about deportation. Opening the state’s exchange to everyone could assuage those worries and boost insurance sign-ups.
The California bill wouldn’t immediately open the state’s exchange to undocumented immigrants, who are primarily Latino. Instead, it would direct California to seek permission from the federal Department of Health and Human Services through an Obamacare waiver program that allows states to shape their own health care reforms.
However, the administration hasn’t spelled out the guidelines for the “state innovation waivers” program, which doesn’t start until 2017, and it’s unclear whether the White House would rethink its Obamacare coverage ban for undocumented immigrants. An HHS spokesperson said the department hasn’t discussed the California proposal with state officials and declined to comment on the bill.
Some states, including California, are putting up their own funds to insure more undocumented immigrants, but not through Obamacare programs. The bill Gov. Brown signed last month will provide Medicaid coverage to roughly 170,000 undocumented children at an estimated cost of $132 million per year.
California’s Medicaid program, like New York’s, also uses state money to cover so-called “DREAMers”, the young undocumented immigrants who were protected from deportation under the White House’s 2012 deferred action program. Massachusetts, Illinois, and Washington also already use state money to cover undocumented children, while the District of Columbia funds coverage for undocumented children and adults.
Supporters argue that providing access to comprehensive health care is better for the individuals and the entire health care system. Without it, people will wait to get care until there’s a medical crisis, raising costs for everyone.
NYC Wins When Everyone Can Vote! Michael H. Drucker
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