California is one step closer to becoming the first state to let undocumented immigrants use the state's health insurance marketplace.
Earlier this month, Democratic Gov. Jerry Brown signed a bill, S.B. 10, that prompts the state to apply for a waiver from the Affordable Care Act's ban on letting undocumented people access state marketplaces.
Despite California’s gains in cutting its uninsured population in half, there are still projected to be up to 3.4 million uninsured Californians by 2019 -- at least half of whom will likely be undocumented, according to a University of California, Berkeley study.
Even if the feds give California a green light, though, undocumented immigrants would still not be able to apply for subsidies.
“While they wouldn’t be getting economic help, it’s an important step. Just giving them that opportunity is key,” said Steven Lopez, manager of the health policy project at the National Council of La Raza, a Latino advocacy organization.
The bill passed handily in the state Senate, 28-10, but not all Californians are happy about the new law. We the People Rising, a far-right anti-immigration group, told the Los Angeles Times that it "encourages illegal immigration."
If California is granted a waiver, health officials in the state hope it will force others to rethink their laws.
“I think it’ll make lawmakers think about what aspects of the law are germane for their own state -- and what aspects would have enough political will to pass,” said Lopez.
But the probability of other states passing a law similar to California's isn't high. S.B. 10 is undoubtedly a liberal policy, and other states with high numbers of immigrants tend to be much more conservative. Florida and Texas, for example, are two of the 19 holdout states that refuse to make more lower-income people eligible for Medicaid. Allowing undocumented immigrants to use their health-care systems would be a giant policy leap for those states.
Across the country, health-care options for undocumented immigrants are few and far between. Many don't get it through their employer and can't afford to buy private insurance. Their only option for nonemergency health needs are typically federally-qualified health centers, where insurance is often not accepted and payments are usually on a sliding scale.
For emergencies, hospitals are required under federal law to treat people with life-threatening conditions regardless of their ability to pay or immigration status. But a 2013 study from UCLA found that undocumented immigrants were less likely to visit the emergency room than their naturalized counterparts.
Even when an immigrant becomes naturalized and has the means to obtain health coverage, many still opt for their neighborhood federally-qualified health center, said Alejandra Gepp, associate director for the Institute for Hispanic Health at the National Council of La Raza.
“They feel more understood, and they get care in a place where people speak their native language,” she said.
For its part, the Obama administration has made it easier for some undocumented immigrants to get health care. Pregnant women and children immigrants who are lawfully residing in the U.S. can now apply for Medicaid benefits instead of waiting five years to do so. But while 30 states have opted in to that policy, some states with significant immigrant populations -- Arizona and Nevada -- have not, while Florida is waiving the five-year wait for children only starting July 1.
California's legislation comes on the coattails of several progressive laws aimed at aiding undocumented populations. Earlier this year, the state passed a law to offer all low-income children -- regardless of their immigration status -- the opportunity to enroll in California’s Medicaid program. It’s the fifth state to do so, after Illinois, Massachusetts, New York, Washington state and Washington, D.C. Last year, California also started offering undocumented immigrants the ability to obtain driver’s licenses.
Regardless of what the federal government decides about California’s dreams of offering health care to all immigrants, Miranda Dietz, co-author of the UC-Berkeley study, calls the law a “symbolic step.”
“Like covering all children and allowing everyone to obtain driver’s licenses," she said, "it’s just another step California is taking to protect all of our residents."
*This story has been updated to reflect a change in Florida's policies starting July 1.