Will Covered California Sell Health Coverage To The Undocumented?
By Ana B. Ibarra
April 26, 2016 - Kaiser Health News
California legislators are attempting to clear the way for undocumented
immigrants to buy health insurance through the statefs insurance exchange —
potentially setting a national precedent.
The fusion of illegal immigration and the Affordable Care Act, two of the
most highly charged elements on the periodic table of U.S. politics, could
engender a combustible reaction, especially in an election year.
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.
Larafs bill was approved by the Senate last year, and it will be taken up
Tuesday by the Assemblyfs 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. Itfs 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.
Therefs no apparent legal reason why the feds wouldnft 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.
gI can almost guarantee in the right wing media, this would play a pretty big
role,h he said. gThis would become a case of ewe told you sof that Obamacare
would help undocumented workers.h
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. gItfs just another distribution channel,h she
said.
Before Larafs proposal even makes it to the federal level, it must first get
through the legislature and past the desk of Gov. Jerry Brown.
Some health policy experts believe the bill has a decent shot of getting
through Californiafs political hierarchy.
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.
gThe [Lara] bill, at least in its current state, doesnft have a large price
tag, so it seems possible hefd approve it,h McConville said. gBut you can never
know for sure.h
At the federal level, the Affordable Care Act provides for an ginnovation
waiver,h 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 Larafs bill.
An analysis of the waiver proposal, presented by Covered
California staff members to the exchangefs board earlier this month, estimated
that enrollment would increase by about 50,000 if immigrants without papers
could buy coverage through the exchange.
Covered
Californiafs 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.
gThe ball is in their court,h Lee said.
Although undocumented immigrants would not qualify for financial help under
the proposal, they would still benefit from the considerable investment Covered
California has made in infrastructure to inform and enroll consumers, McConville
said.
Some opponents of the plan think selling to immigrants without papers should
not be a high priority for Covered California. gThe state has failed on its
commitment to health care providers and their patients, and my budget priority
is to take care of them first before expanding the pool,h said state Sen. Joel
Anderson (R-Alpine), who voted against the bill in the Senate last year.
Others simply believe that neither the state nor the federal government
should confer any benefits on people who are in the country illegally.
Ira Mehlman, a spokesman with the Federation for American Immigration Reform,
said that providing coverage to undocumented immigrants under the Affordable
Care Act is tantamount to accepting their unlawful presence in the country.
He predicted that if California is allowed to do it, states like Illinois and
New York might follow.
And, he argued, this is just the first step in eventually getting subsidized
coverage.
Without subsidies, it is uncertain whether many undocumented immigrants would
actually buy Covered California plans.
After all, they can already buy private plans through brokers or directly
from insurers, but they are not rushing to do it, said Alex Hernandez, an
insurance agent in Merced. gCost is always what drives them away,h he said.
The plans sold by Covered California carry very similar price tags.
Hernandez calculated that a person in her mid-20s, making around $45,000 a
year, would pay $304 per month for a standard Anthem-Blue Cross plan through
Covered California. That same plan purchased directly from Anthem by the same
person would cost $303.30, he said.
Advocates for expanding health coverage concede that allowing people without
papers to purchase it on the exchange wonft necessarily make it more affordable
for them, but they say it would open the door to broader access and a sense of
inclusion.
People in mixed-status families — ones with some members who are in the
country illegally and others who are legal residents or U.S. citizens — would
benefit most, consumer advocates say. Data discussed at a Covered California
meeting in February showed that 74 percent of households headed by undocumented
immigrants have family members who are citizens.
Proponents of the plan believe that if some family members already interact
with Covered California or Medi-Cal, it could encourage others in their
household to seek coverage.
Opening the exchange to the undocumented, they say, would simplify enrollment
for the entire family by creating a gone-stop shoph for all household
members.
gItfs a modest step forward, but important for the goal of health care for
all,h said Anthony Wright, executive director of Health Access, a consumer
advocacy group. He said supporters of the bill are fully aware that people will
continue to face affordability issues, but there also thousands who may be able
to afford it.
Maria Galvan, an undocumented resident in San Fernando, California is not one
of them. She does not think she would purchase coverage without subsidies. She
knows how expensive it can be, even for small business owners like herself and
her husband.
Galvan, said she does not seek much preventive care. When she gets sick, she
usually weathers it out with home remedies. If it gets serious, she goes
straight to the emergency room at Olive View- UCLA Medical Center in Sylmar, her
nearest hospital.
gMaybe one day the system will improve for us,h Galvan said. gMaybe one day
we will receive financial assistance.h