Health & Human Services

California Proposal Would Extend Health Insurance to Undocumented Immigrants

Under Obamacare now, undocumented immigrants and children who are legally present under Obama’s Deferred Action program are ineligible for Medicare, non-emergency Medicaid and the Children’s Health Insurance Program.
by | January 15, 2014
In this photo taken March 25, 2010, Dr. Carlos Ruvalcaba, left, examines Paula Medrano, one of the many patients he treats, at the Clinica Sierra Vista Elm unit in Fresno, Calif. Medrano is an undocumented immigrant. Associated Press/Marcio Jose Sanchez
 

A California state senator plans to introduce legislation that would expand health coverage under the Affordable Care Act to undocumented immigrants.

“Immigration status shouldn’t bar individuals from health coverage, especially since their taxes contribute to the growth of our economy,” said state Sen. Ricardo Lara in a written statement Jan. 10. Though Lara’s announcement caused a stir among some national media outlets, an actual bill doesn’t exist yet. About 1 million undocumented immigrants in California would be excluded from health care coverage after the federal law is completely in place, Lara said.

Under the new health care law, undocumented immigrants are ineligible for Medicare, non-emergency Medicaid and the Children’s Health Insurance Program (CHIP). Children who are lawfully present under President Barack Obama’s 2012 executive order, the Deferred Action for Childhood Arrivals program, are also ineligible. However, undocumented immigrants would still be covered by emergency medical care and emergency Medicaid -- if the patients are poor.

At least 15 states and the District of Columbia already cover prenatal care, regardless of the mothers' immigration status, either through the federal CHIP option or state funds, according to a January tally by the National Immigration Law Center. Although CHIP, like Medicaid, is administered by states, its funding comes from both states and the federal government; when states want to expand coverage for certain populations excluded by federal law, such as undocumented immigrants, they can pay for it themselves. Some states, such as Massachusetts and Illinois, have also decided to provide limited coverage to all children, regardless of immigration status.

A proposal in Vermont would include the state's undocumented immigrants -- estimated to be fewer than 4,000 -- in a future single-payer health care system. Last year the Vermont General Assembly published a report estimating that the cost of including undocumented immigrants would be relatively minor, though the legislature has yet to make a decision on the policy.

Immigrants who lack citizenship status are three times as likely to be uninsured compared with U.S.-born citizens, according to a fact sheet from the Kaiser Family Foundation. They are also less likely to obtain the care they need than U.S.-born citizens. If not for the exclusions in federal law, most non-citizens would meet the income eligibility requirements to qualify for Medicaid or the premium tax credits available for purchasing private insurance on the federal or state-based exchanges.

An estimated 61 percent of the 11 million undocumented immigrants in the United States lacked health insurance coverage in 2012, according to an August 2013 report by the Center for Health Policy Research at the University of California, Los Angeles (UCLA). In California, where almost a quarter of the nation’s undocumented immigrants live, about 51 percent were uninsured, the report said. The center’s data derived from the Current Population Survey and the Gruber MicroSimulation Model, which forecasts changes in the health care system based on policy interventions.

The UCLA report's lead author, Steven Wallace, said he does not expect the California bill to be a harbinger of other state proposals addressing the health insurance needs of undocumented immigrants -- at least not this year. "My guess is for the next couple years there won’t be a lot of movement on it because everyone is digesting the current set of reforms," Wallace said. By 2016, however, "more states will look and say we made good progress, but we still have uninsured people left."

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