California is poised on the brink of expanding Medi-Cal (the state Medicaid program) to cover illegal immigrants 19-26. When I read that, my first thought was aren’t they already covered in California?
It turns out that previously they only had been covered to the age of 19, and this new move would place Medi-Cal coverage in compliance with the ages of Obamacare coverage, which goes to 26.
When Goveror Newsom was inaugurated back in January, he proposed the change:
California already covers undocumented children until they turn 19, with Newsom’s plan increasing the age cut-off to mirror that of the Affordable Care Act, which allows young adults to stay on a parent’s health insurance plan until turning 26.
“It’s the right thing to do,” Newsom said in a Facebook Live feed announcing the proposal. “It’s the fiscally conservative thing to do. It’s the moral thing to do … When we talk about universal healthcare, it means everybody. When everybody pulls together, it means lower costs to each and every one of you.”
If you’re somewhat puzzled by the “fiscally conservative” statement of Newsom’s, you wouldn’t be alone. The idea is to pay for this through the following:
A legislative proposal last year pegged the cost of extending Medi-Cal to undocumented immigrants under 26 at $250 million a year. That cost would fall solely to California, despite the mix of federal and state money that typically comprises Medi-Cal funding because the Affordable Care Act prohibits the use of federal dollars for covering immigrants who are in the U.S. illegally.
So although Medi-Cal in general is partly federally-funded, this proposal would not be.
More:
Newsom’s proposal would also create an individual mandate in California to thwart predicted drops in the state’s health insurance market after the federal government removed financial penalties for uninsured consumers beginning this year. The requirement that consumers have health insurance or face financial penalties propped up the Affordable Care Act, or Obamacare, and its elimination is expected to drive up premiums.
Without the individual mandate, all consumers will experience rate increases this year, said officials for Covered California, the state’s official health insurance marketplace. Covered California Executive Director Peter Lee said Newsom’s proposal would bring stability to the market and is a critical step toward reaching universal healthcare.
Newsom’s plan to create a individual mandate for Californians could be a heavy lift, even in the Democrat-dominated state Legislature, where such a requirement could require a two-thirds vote.
That was back in January, but now the proposal is before the legislature, tasked with approving a budget by June 15:
Republicans on the legislative committee negotiating the budget voted against the proposal, arguing it was not fair to give health benefits to people who are in the country illegally while taxing people who are here legally for not purchasing health insurance.
Republicans in California are essentially powerless, however.
There are plenty of Democrats in California who won’t stop at having Medi-Cal cover illegal immigrants up to the age of 26, however, and are eager to cover all of them throughout life. I will add that Medi-Cal only covers very low-income people, so (assuming that illegal immigrants would be disproportionately represented in the low-income Medi-Cal eligible group), this could and probably will stick in the craws of legal residents and citizens who are above the poverty level, are struggling to make ends meet, must provide their own health insurance or remain uncovered, and also be taxed and/or penalized to support illegal immigrants who are poorer than they.
The reality, however, is that California can do what California wants to do. There is nothing to stop it. And there is nothing to stop plenty more illegal immigrants from flocking there for the free ride on health care. There is also nothing to stop more middle-income (or higher) people from fleeing the state, although California still has its natural beauty and climate to attract others.
Another reality is that in California and across the nation, taxpayers are already paying for the health care of illegal immigrants through requirements that they be treated in emergency rooms. I believe that may be the origins of Newsom’s otherwise puzzling “It’s the fiscally conservative thing to do” statement. The argument goes something like this: because it is mandated that we cover people who go to the emergency room and cannot pay, illegal immigrants are using that service both for emergencies and for health care that would ordinary take place in a doctor’s office. They also lack preventive care. The “fiscally conservative” argument is that providing regular health coverage for them would actually reduce costs because it would prevent illness through making preventive care more available, and it would also reduce emergency room visits which tend to be far more expensive than regular doctor visits.
I have no idea whether the above argument would pan out in California if this measure were to pass, but my guess is that it wouldn’t reduce emergency room visits as much as thought, or prevent illness as much as hoped, and that it would be more expensive than projected—as well as drawing more and more illegal immigrants to the state.
[NOTE: I’ve previously written here about Medi-Cal policy in covering illegal immigrants, and emergency room coverage in general.]
