By Richard Hernandez
The State of California has completed the first phase of what is ultimately planned as an expansion of Medicaid California, also known as Medi-Cal, to an estimated 764,000 illegal immigrants in the Golden State, even as more than two million of the state’s residents with full U.S. citizenship have no medical insurance coverage whatsoever.
This summer, California made its largest stride yet in providing taxpayer-subsidized medical assistance to those in the state illegally. Since 2014, there has been an effort in the California legislature to extend Medi-Cal benefits to illegal aliens, promoted by then-Assemblyman Ricardo Lara. Lara’s initial bill failed to gain passage, but in 2016 legislation was passed and signed into law by then-Governor Jerry Brown that extended Medi-Cal coverage to children without legal residency status. In 2019, Senate Bill 104, by which Medi-Cal was extended to cover low-income illegal aliens aged 19 to 25, passed into law and was signed by Governor Gavin Newsom, going into effect on January 1, 2020. With Governor Newsom’s signing of the 2022-23 $307.9 billion operating budget on June 30, California became the first state to guarantee free health care for all low-income immigrants living in the country illegally. It is projected that generosity will provide coverage for an additional 764,000 illegal and unregistered immigrants in California, costing California and by extension U.S. taxpayers roughly $2.7 billion per year.
The 2022-23 California budget signed by Newsom does not extend to all of the calculated 764,000 impoverished and undocumented aliens living in California at once, but stands as a commitment to make all low-income non-citizens living here eligible for the state’s Medicaid program by 2024.
This represents a milestone for immigration activists, even though it simultaneously will serve as a form of registration, which many of those activists have long resisted. The provision of medical care to a substantial portion of the population living in the state illegally was a trade-off those advocates of the undocumented population were apparently willing to make.
There is concern, however, that federal immigration officials will find a way to tap into the data banks relating to those to be offered Medicaid coverage, and for this reason, the undocumented applicants for Medi-Cal assistance are being advised to fudge on that portion of the application on which they are required to provide their address or place of residence.
Medicaid is a U.S. federal program which is commonly coordinated with state governments to provide free or low-cost health care to a select group of low-income residents, primarily the elderly and/or families/women with children. It is generally not available to able-bodied men, defined as those under the age of 65. Nor does the federal government extend coverage to individuals who are not citizens residing in the country illegally. Over the last decade, however, there has been a move on in some states, particularly those with a substantial number of Latino legislators, most notably California, to augment federal funds with state funding to bypass the prohibition against using federal money to defray health care expenses for low-income immigrants.
While California is at the forefront of the effort to provide health care to immigrants, including those who have violated federal law to come into the country, seventeen other states have initiated some form of medical assistance to those who are living in the U.S. without having complied with its immigration laws. Prenatal care is the most common form of assistance in this regard, with 18 states now offering that service to pregnant women and their soon-to-be offspring. California is included among Illinois, New York, Oregon and Washington and the District of Columbia in providing low-income families or households headed by at least one adult with dubitable immigration status with medical care. California and one other state, Illinois, now provide Medicaid benefits to illegal immigrants living within their borders who have achieved a certain age, variably 50 or 65.
On June 27, in response to the preparations for Governor Newsom to sign the 2022-23 budget with its provision to expand Medi-Cal to large numbers of illegal immigrants in the state, Anthony Wright, executive director of Health Access California, a statewide consumer health care advocacy group, said, “This budget commits to fully remove the exclusion in Medi-Cal based on immigration status, opening up this coverage program by January 2024 to over 700,000 income-eligible Californians ages 26-49, many of whom are essential workers contributing in so many ways to our economy and society. With the urgency of the ongoing pandemic, we will continue to advocate to take this and other steps to universal health care as soon as possible. This will represent the biggest expansion of coverage in the nation since the start of the Affordable Care Act in 2014. In California we recognize everybody benefits when everyone is covered.”
That is just it, many observe, as not everyone in California is covered. While exact figures are dodgy, it appears that roughly 11 percent of California’s 39.538 million residents – something approaching 4.35 million – have absolutely no health insurance whatsoever. It is estimated that at present, there are 2.6 million illegal immigrants residing in California. Estimates are that of those, 13 percent to 16 percent have medical coverage they or their parents have paid for. Thus, it would seem, somewhere between 2.184 million to 2.262 million of California 4.349 million residents without health insurance are illegal aliens. Thus, something like 2,087,000 to 2,165,000 of California’s residents with full U.S. citizenship have no health coverage and virtually no prospect of getting any assistance from the state. They must face an existence without the prospect of medical care. Most have come to accept that reality.
What is more, a set of draconian U.S. laws that came in with the Universal Health Care Act, augmented by accompanying California laws, financially penalize those who do not have health coverage, simply because they cannot afford it. The federal penalty for not having health insurance is $695 per uninsured adult and $347.50 per uninsured child, up to a maximum of $2,085 per family. The State of California layers on top of that a fine of $800 per adult and $400 per dependent child under the age of 18 in the household. It is worth noting that these penalties are levied exclusively against U.S. citizens. Those residing illegally in the United States are not subject to these fines.
The practical effect of this is that it has driven those impoverished U.S. citizens in California without any means of obtaining medical insurance further underground. Already incapable of securing health insurance, they are discouraged from exploring what health insurance assistance they might be eligible for because in making such inquiries or applying for that assistance or coverage, they risk being assessed a financial penalty they can ill afford. Moreover, bearing the cost of those penalties further diminishes their ability to pay for health insurance.
Providing medical benefits to illegal aliens in California diminishes the availability of money to support assistance programs to provide medical assistance to impoverished U.S. citizens residing in California.
U.S. citizens residing in California meeting low-income criteria become eligible for Medi-Cal upon eclipsing their 65^th birthday. Legislation introduced by California Senator Maria Elena Durazo (D-Los Angeles) and Assemblyman Joaquin Arambula (D-Fresno) two years ago placed $1.3 billion into California’s 2021-2022 budget to provide Medi-Cal overage to illegal aliens over the age of 50. Thus, illegal aliens become eligible for California’s health care benefit at an age 15 years below that of U.S. citizens.
“Health care is a human right,” Arambula, a former emergency room doctor said. “All Californians should have the right to healthcare, regardless of immigration status.”
Arambula did not respond to questions as to whether he thought the same human rights extended to illegal aliens should be extended to U.S. citizens in California.
Former Assemblyman Lara, who led the original effort to provide health insurance to illegal immigrants in California eight years ago, has been termed out of the legislature and is now California’s insurance commissioner. He was asked if he thought that the federal government should waive the $695 per uninsured adult and $347.50 per uninsured child penalty and if the State of California should waive the $800 per adult and $400 per child state penalties imposed on those who cannot afford to pay for health insurance.
Lara offered no response.
Governor Gavin Newsom has justified the extension of health care to non-citizens as part of a larger effort to integrate the estimated 2.6 million illegal aliens residing in California into society.
His office was asked whether the governor believed that the 2,087,000 to 2,165,000 of California’s U.S.-born residents with full U.S. citizenship who also are not fully integrated into society, whose inability to pay for health care leaves them without doctors, dentists and access to medicine, therapy and treatment, should be excused from the $800 per adult or $400 per child state penalties imposed on them for not having insurance so that they can use that money to make a contribution toward securing for themselves or their families a health insurance plan. One of Newsom’s spokeswomen pointed out that those penalized for their failure to purchase health insurance brought that punishment upon themselves by their deliberate decisions to disobey the law and not purchase health coverage. The health coverage mandate had been well-publicized, she pointed out. As to their now being included among those eligible for health care benefits, she said, would depend upon their making an application for whatever benefits they might be qualified for and meeting the qualifications. Some people can be expected to fall into the cracks, she said.
“We can’t help everyone,” she said.