Undocumented May Get Coverage
California legislators are attempting to clear the way for undocumented immigrants to buy health insurance through the state’s insurance exchange — potentially setting a national precedent.
Immigrants living in the country illegally are excluded from the insurance-expanding provisions of Obamacare. They are not eligible for Medicaid (called Medi-Cal in California), and they are not allowed to purchase a health plan from the federal marketplace or any of the state exchanges.
Without that provision, Congress would not have approved the health reform law to begin with.
Now, however, some California families and advocates are pinning their hopes on a bill by state Sen. Ricardo Lara, D-Bell Gardens, that would open the door for undocumented immigrants to buy health plans from the Covered California exchange. Unlike most exchange customers, however, they would get no federal dollars to help them do so.
That, many observers say, makes the proposal a largely symbolic gesture, since most undocumented immigrants would not be able to afford the premiums without financial assistance.
Lara’s bill was approved by the Senate last year, and it will be taken up Tuesday by the Assembly’s Committee on Health.
The bill faces a number of hurdles.
It would not actually allow immigrants without papers to buy insurance through the state exchange. It would only request that the federal government exempt California from the rule that forbids such purchases. It’s the feds who make the call.
If the feds were to greenlight the plan, Covered California would be the first exchange in the country to sell insurance to undocumented immigrants — a prospect that is not welcomed by critics of illegal immigration.
There’s no apparent legal reason why the feds wouldn’t sign off on such a request, said Tim Jost, a professor emeritus of law at the Washington and Lee University in Virginia. But it could generate some significant political fireworks, especially in a presidential election year, he said.
“I can almost guarantee in the right wing media, this would play a pretty big role,” he said. “This would become a case of ‘we told you so’ that Obamacare would help undocumented workers.”
But Katherine Hempstead, a senior advisor at the Robert Wood Johnson Foundation, said the fact that no federal dollars would be involved makes it less of a hot button issue. “It’s just another distribution channel,” she said.
Before Lara’s proposal even makes it to the federal level, it must first get through the legislature and past the desk of Gov. Jerry Brown.
Shannon McConville, a research associate at the Public Policy Institute of California noted that while Gov. Brown has been fiscally conservative for the most part, he did sign a law — scheduled to take effect next month — that allows undocumented children to get full Medi-Cal benefits.
“The (Lara) bill, at least in its current state, doesn’t have a large price tag, so it seems possible he’d approve it,” McConville said. “But you can never know for sure.”
At the federal level, the Affordable Care Act provides for an “innovation waiver,” which allows states — with federal approval — to modify certain sections of the health reform law in order to expand coverage. Such changes must have no net impact on the U.S. budget, which is why federal subsidies are excluded from Lara’s bill.
An analysis of the waiver proposal, presented by Covered California staff members to the exchange’s board earlier this month, estimated that enrollment would increase by about 50,000 if immigrants without papers could buy coverage through the exchange.
Covered California’s executive director, Peter V. Lee, did not stake out a position on the plan, but he said exchange officials stood ready to assist the legislature in pursuing this option.
“The ball is in their court,” Lee said.
This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.
