State lawmakers in California are circulating legislation that would open the door for illegal immigrants to buy health insurance from Covered California, the state’s Obamacare exchange.
The move could trigger a political firestorm during a heated election year, combining two prominent issues—Obamacare and illegal immigration—that have received great scrutiny and been the subject of lengthy debate.
State Sen. Ricardo Lara introduced the bill to pave the way for illegal immigrants to purchase health plans from Covered California, Kaiser Health reports. The legislation was approved by the California Senate last year and on Tuesday made it through the state Assembly’s Committee on Health. The Assembly’s Committee on Appropriations will take up the bill next.
Illegal immigrants are excluded from the Affordable Care Act as well as Medicaid, and they cannot buy a health plan from any state exchanges or the federal marketplace, a provision that was necessary for Congress to pass the law.
Lara’s proposal would reverse this aspect of Obamacare and potentially set a precedent for other states to follow suit, although the California bill would not allow undocumented immigrants to receive federal dollars to purchase health insurance, unlike other Obamacare participants.
Many people believe this move to not grant money makes the legislation mainly symbolic because most illegal immigrants would not practically be able to pay for health premiums on their own, according to Kaiser Health.
Lara’s bill is expected to pass through the legislature, but it would still need to be signed into law by Democratic Gov. Jerry Brown. Even if it becomes law, however, Covered California would still not necessarily be able to sell health care coverage to illegals because the bill does not actually do that. Instead, the legislation would essentially be a formal request to the federal government to exempt California from the provision that forbids sales to illegal immigrants, putting the ultimate decision in the feds’ hands.
The Affordable Care Act allows states to seek an "innovation waiver" to let them modify parts of Obamacare to expand coverage, but only with approval from the federal government.
If the California bill is signed by the governor and approved by the feds, then California would have the first state exchange in the United States from which illegal immigrants could purchase health insurance.
A different California law set to take effect this month allows illegal immigrant children to sign up for and receive the full benefits of Medi-Cal, California’s version of Medicaid.
"Last year we really made history in ensuring that over 170,000 children across the state have access to health care," Lara said, referring to the newly implemented law. "Again we’re taking another bite at the apple, and we’re not going to rest until we get health care for all."
Covered California staff personnel presented an analysis of the proposed legislation to the organization’s board last month and estimated that enrollment would increase by 50,000 if illegals could buy through the exchange.
Covered California’s executive director, Peter V. Lee, has not taken a position on Lara‘s bill, but he said exchange officials are ready to help the legislature, adding, "The ball is in their court."
Proponents of the bill argue that broader access to health care is the right thing to do and fosters a sense of inclusion. They say opening the exchange will simplify the enrollment process and make it easier to get coverage.
"It’s a modest step forward, but important for the goal of healthcare for all," said Anthony Wright, executive director of Health Access, a consumer advocacy group.
Some advocates are concerned that not giving illegal immigrants subsidies will prevent many of them from buying coverage even if the bill becomes law, especially because Coverage California plans are expensive.
Another issue is the cost of the legislation. Some analysts believe this issue is not a big deal, however.
"The [Lara] bill, at least in its current state, doesn’t have a large price tag, so it seems possible [Brown would] approve it," said Shannon McConville, a research associate at the Public Policy Institute of California. "But you can never know for sure."
Others disagree, including Sen. Joel Anderson, who voted against the bill last year.
"The state has failed on its commitment to health care providers and their patients, and my budget priority is to take care of them first before expanding the pool," Anderson said.
Other opponents are principally against the bill and do not think the state or federal governments should provide benefits to those who broke the country’s laws and are here illegally.
Ira Mehlman, a spokesman for the Federation for American Immigration Reform, said the Lara bill would be "tantamount to excepting their unlawful presence in the country."
He argued "this is just the first step in eventually getting subsidized coverage" as California would set a precedent that other states would soon follow.
Supporters of expanding health care coverage acknowledge that permitting illegals to make purchases on the state exchange will not necessarily make coverage more affordable for them.