SAN FRANCISCO -- According to Assemblymember Rob Bonta (D-Oakland), “There is a hole in the Affordable Care Act, in terms of access to coverage, that you can drive a truck through.”
That hole, he says, is the fact that people who are undocumented are not eligible for health care.
And in the midst of immigration reform being delayed at the federal level, he and others are gearing up to bring health coverage to everyone, regardless of immigration status – at least in the state of California.
Speaking to a group of ethnic media reporters in San Francisco last week, Bonta spoke about the future of the “Health For All” bill, which he co-sponsored in 2014. The bill failed to make it to the governor’s desk this year, but Sen. Ricardo Lara (D-Los Angeles) has announced his intent to reintroduce the bill in January when the state legislature reconvenes.
An estimated 1.4 million individuals in California are uninsured due to their immigration status, and it’s Bonta’s intent to expand health coverage to include them. While he acknowledges that Health For All “had a significant price tag attached” that will continue to be a hurdle in 2015, he says it’s one that can be overcome.
Living and dying without health care
If Health For All happens, it will come too late for the mother of Beatrice Sanchez, 25, an undocumented woman who spoke alongside Bonta at a press briefing convened by New America Media.
Growing up, Sanchez and her family never visited a doctor. She recalls dislocating her elbow as a child and having her father pop it back into place himself rather than taking her to a hospital.
“I didn’t realize it was because we didn’t have a doctor, because he couldn’t afford to take me to the hospital,” she said.
Her mother, a domestic worker, “developed diabetes but she didn’t know it ... It wasn’t until she became extremely ill with emergency symptoms of diabetes that she fell into a coma. She was in a coma for two months,” Sanchez said. “It didn't have to come to that.”
Her mother attempted to manage her diabetes on her own and went without ongoing care. Later, her health problems compounded in the aftermath of being hit by a car. She passed away a little over a year ago.
Shut out by the exchange, and sometimes clinics
Under the Affordable Care Act, the state’s health insurance exchange, Covered California, excludes recipients of Deferred Action for Childhood Arrivals (DACA), a program that gives temporary legal status to some undocumented youth who entered the United States as children. DACA youth qualify for Medi-Cal if they are low-income, but if they earn too much to qualify, they’re out of options.
“That is a hole in the federal law,” said Tanya Broder, a senior staff attorney with the National Immigration Law Center. “If a DACA grantee is earning too much for free Medi-Cal, and is not a child or a pregnant woman or a person with disabilities or a senior, they won’t be able to buy coverage in the exchange under current law.”
That’s the case for Akiko Aspillaga, a nursing graduate student and a community organizer with pan-Asian undocumented youth organization ASPIRE, who also spoke at the briefing.
“Although I’m a DACA recipient and I can get Medi-Cal, because I earn a little bit too much, I don't have access … And even though I want to purchase health care I'm not able to,” she said.
Some counties in the state provide health care services regardless of an individual’s immigration status, says Broder, but “What we’re left with in California is a patchwork of services, not a comprehensive safety net.”
And care at clinics isn’t guaranteed, according to Beatrice Sanchez. “I’ve had trouble with even free access to health services for undocumented people. I was rejected by a clinic that was supposed to accept people regardless of their status,” she said. “That feeling of rejection from health care is terrible.”
Under the Health For All bill, undocumented individuals who are low-income would be covered by Medi-Cal. Those who earn too much to qualify for Medi-Cal would be able to purchase insurance in what Broder calls a “mirror or parallel exchange,” similar to Covered California.
‘Health For All’ has a price tag, but brings savings
Assemblymember Bonta, who was born in the Philippines, lived in La Paz, California as a child, where his parents were farmworker organizers with the United Farm Workers of America. They worked alongside César Chávez and Dolores Huerta, as well as Filipino American labor leaders like Philip Vera Cruz and Pete Velasco. His father worked to create health plans for farmworkers around the country.
“I come from a family that believed in movements, and for whom movements were able to change the lives of people who needed help,” Bonta said. “I think that the legislative process can be the same. There can be a movement that we start together in partnership with advocates and leaders in the community.”
According to Bonta, Governor Jerry Brown’s fiscal conservatism is the primary hurdle to getting Health For All passed. The governor “has had his hand firmly on the purse strings of California,” which Bonta acknowledges has helped in the state’s economic recovery.
“I don’t think the legislature is really the obstacle, to be perfectly honest. The governor is going to be the one that we’re going to have to negotiate with and identify a solution with,” he said. “The governor’s pushing back and he’s saying, ‘How are you going to pay for it?’”
Bonta says that there are many potential funding streams, including self-pay mechanisms “that could be paid by undocumented members of the community to help fund this.”
Right now, he says, health care services for the undocumented cost the state $1.5 billion a year, a large amount of it due to emergency room procedures.
It’s estimated that Health For All would cost $360 million in its first year, and $450 million the following year based on population growth, he says.
“If we backed up and provided coverage from the very beginning, it would actually [cost the state] less,” he said.
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