December 27, 2014
As seen in:
Ventura County Star
OXNARD, Calif. – Estela Gamino sets aside money from her wages as a housekeeper for eye surgery and waits for her chance at health insurance.
The 49-year-old Oxnard woman is living in the country illegally. She’s one of as many as 1.6 million California immigrants eligible for deportation protection because of an executive order issued last month by President Barack Obama.
Lawyers and advocates say California law means the people who receive deferred status through Obama’s order will also qualify for state-funded Medi-Cal insurance if they meet income standards. State officials won’t confirm or deny the expansion, saying they’re studying the issue.
Motivated by the president’s move, state Sen. Ricardo Lara, D-Bell Gardens, revived a bill this month that would give people living in the country without legal permission but not covered by the executive order a chance at insurance.
The moves pour gasoline on the fight over whether the government should help California’s 2.6 million immigrants living here illegally obtain health insurance.
“I think it’s premature to consider any expansion of Medi-Cal,” said Dick Thompson, president of the Ventura County Taxpayers Association. “The big question is: Where is this money going to come from?’ ”
The exact price is unclear. But analysis of a similar bill introduced by Lara nearly a year ago estimated that offering coverage to all of those living in the country without legal permission could inch toward $1 billion a year.
Advocates for expanding insurance say the price is offset by possible savings, citing the burden on taxpayers for covering emergency room care. California hospitals accrued about $1.4 billion last year in care for those living in the country without legal permission, according to calculations by the California Hospital Association.
Born in Romito, Mexico, Gamino walked across the border with her 4-year-old son 26 years ago. Her two youngest children are U.S. citizens, a primary reason she qualifies for the president’s executive order.
She’s a widow. The $15,000 she makes a year cleaning houses isn’t nearly enough for private insurance.
But her immigration status blocks her from Covered California. Medi-Cal coverage for most people living in the country without legal permission has been limited to care that includes certain emergencies and pregnancies.
“The law should change,” she said in Spanish. “It’s very important for a person to have health insurance. It’s necessary.”
Doctors operated three years ago on her right eye in a surgery that cost $3,500. She needs the same procedure for her left eye.
“It’s taken forever to raise the money,” said her 23-year-old son, Julio.
Obama’s order excludes the newly protected immigrants from federal health benefits. But California law allows for state-funded Medi-Cal coverage for people with deferred immigration status, such as children and young adults labeled as “dreamers” and protected through a 2012 executive order.
The executive order issued last month means between 950,000 and 1.6 million more Californians will have deferred status. If half of Ventura County’s undocumented population qualifies, matching statewide estimates, about 35,000 people could be protected.
The only way legislators could block those people from Medi-Cal eligibility is to change California law, said Anthony Wright, executive director for Health Access California.
“It would take an act to undo it,” he said.
Officials at the California Department of Health Care Services said they’re waiting for guidance from the federal government regarding details of Obama’s executive order. Wright said he was told an announcement on the next step won’t come until January.
The costs of coverage would be absorbed solely by the state. Estimates are difficult because it’s unclear how many people would enroll in Medi-Cal. Some of the people living in the country without legal permission have jobs and won’t meet income standards, or already receive insurance through their employers.
Other people won’t go through what could be the complicated process of applying for deferred status.
Lara’s bill would eliminate immigration status as a barrier to insurance. People living in the country without legal permission not covered by the executive order could still qualify for state-funded Medi-Cal if they met income standards.
People who make more money would have a chance to buy insurance through a marketplace modeled after Covered California.
Details of the proposal are still in the works, but an earlier version of the bill that died in a Senate appropriations committee offered the same kind of subsidies as in Covered California.
A UC Berkeley Labor Center study on the bill that stalled in committee said the proposal could carry Medi-Cal costs of at least $350 million a year. A Senate committee analysis said the subsidies could cost as much as an additional $400 million a year.
Observers say costs in the new bill will be significantly less.
Still, the financial burden is huge. Thompson, of the Ventura County Taxpayers Association, cited the struggle over funding needs at University of California campuses.
“That’s only one of many issues in the state where funding is tight,” he said, questioning how California residents would prioritize the need to spend hundreds of millions on insurance expansion.
“I just don’t believe medical care for undocumented immigrants is going to be very high on that list at all,” he said.
SEEN AS ‘Unfair’
Bruce Einhorn, a retired federal immigration judge, is now a professor at the Pepperdine University School of Law. He said current laws push immigrants living in the country without legal permission to rely on emergency rooms where care costs more. Hospitals pay more and so do taxpayers.
Society can’t turn its back on people who need care, he said, arguing that insurance programs where costs are shared between the government and immigrants make the most sense.
“What are we going to do with them?” he said. “If we’re not going to let them die in the street, if we’re not going to continue our crisis of emergency room care, what are we going to do?”
Others see insurance as not a right but a gift.
“I think to reward people who have knowingly broken immigration law with entitlements is wrong,” said Joe Guzzardi, spokesman for a Santa Barbara group, Californians for Population Stabilization. He noted that many legal citizens remain uninsured despite the Affordable Care Act.
“It strikes me as unfair,” he said. “It’s called ‘Health Care For All,’ but that’s really an incomplete title. It’s ‘Health Care for All Illegal Immigrants.’”
Jose and Yesenia Alvarez, of Camarillo, have three children. The eldest has seizures because of epilepsy. When he or his siblings need care, they see doctors.
When the parents get sick, it’s different.
“We don’t go to the doctor when we should go,” Yesenia said in Spanish, trying to convey the magnitude of their medical costs.
“When you see your bill, you get more sick,” she said.
The president’s executive order means they don’t worry as much about being separated from their children. It means they dream about owning a business, maybe a restaurant.
And it may bring a chance at insurance. Jose works in construction. Yesenia cooks at a restaurant.
They likely wouldn’t qualify for Medi-Cal. He wants to pay for coverage, just like he pays taxes. He just wants a price he can afford.
Asked through an interpreter why he wants insurance, Jose shrugged. He wants to protect his family like everyone else.
Like “the whole world,” he said.
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