canada africa partner reservation California is pushing to expand health insurance subsidies to all adult immigrants

California is pushing to expand health insurance subsidies to all adult immigrants


Gov. Gavin NewsomGov. Gavin Newsom
Story by: By Jasmine Aguilera, El Tímpano, KFF. Photo: 2024 Governor of California Gavin Newsom

Marisol Pantoja Toribio discovered a lump in her breast in early January. Uninsured and living in California, without legal status and without her family, the usually carefree 43-year-old quickly realized how limited her options were.

“I said, ‘What am I going to do?’” she said in Spanish, quickly becoming emotional. She was immediately concerned that she might have cancer. “I went back and forth – I have (cancer), I don’t have it, I have it, I don’t have it.” And if she were sick, she added, she wouldn’t be able to work or pay her rent. Without health insurance, Pantoja Toribio couldn’t afford to find out if she had a serious condition.

Early this year, Medi-Cal, California’s Medicaid program, was expanded to include immigrants without legal residency, timing that could have worked out perfectly for Pantoja Toribio, who has lived in the Bay Area city of Brentwood for three years. But her application for Medi-Cal was quickly denied: Because she earned $16 an hour as a farm worker, her annual income of about $24,000 was too high to qualify for the program.

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California is the first state to expand Medicaid to all eligible adults regardless of immigration status, a move being celebrated by health care advocates and political leaders across the state. But many immigrants without permanent legal status, especially those who live in parts of California where the cost of living is the highest, earn a little too much money to qualify for Medi-Cal.

The state is footing the bill for the Medi-Cal expansion, but federal law bars those it calls “undocumented immigrants” from receiving insurance subsidies or other Affordable Care Act benefits, leaving many with jobs but no viable health insurance options.

Now the same health care advocates who fought for Medi-Cal expansion say the next step in achieving health care equity is to expand Covered California, the state’s ACA marketplace, to all immigrant adults by AB 4 to achieve.

“There are people in this state who work and are the backbone of so many sectors of our economy and contribute their labor and even taxes… but they have been left out of our social safety net,” said Sarah Dar, policy director at California Immigrant. Policy Center, one of two organizations sponsoring the bill, called #Health4All.

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To qualify for Medi-Cal, an individual must earn no more than 138% of the federal poverty level, which currently amounts to almost $21,000 per year for a single person. A family of three would have to earn less than $35,632 per year.

For people above these thresholds, the Covered California marketplace offers several health plans, often with federal and state subsidies, that provide premiums as low as $10 per month. The hope is to create what advocates call a “mirror marketplace” on the Covered California website so that immigrants, regardless of status, can be offered the same health care plans that would only be subsidized by the state.

Despite a Democratic supermajority in the Legislature, the bill could struggle to pass, with the state facing a projected budget deficit next year of somewhere between $38 billion and $73 billion. Gov. Gavin Newsom and legislative leaders have announced a $17 billion package to narrow the gap, but significant cuts appear inevitable.

It’s not clear how much it would cost to expand Covered California to all immigrants, according to Assemblymember Joaquin Arambula, the Fresno Democrat who introduced the bill.

The Immigrant Policy Center estimates that setting up the market would cost at least $15 million. If the bill passes, sponsors would have to secure funding for the grants, which could run into billions of dollars annually.

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“It is a difficult time to ask for new spending,” Dar said. “The start-up costs of the mirror market are relatively low. So we are hopeful that it is still within the realm of possibility.”

Arambula said he is optimistic the state will continue to lead the way in improving access to health care for immigrants without legal residency.

“I believe we will continue to stand up as we work to make this country a California for all,” he said.

The bill passed the General Assembly on a 64-9 vote last July and now awaits action from the Senate Appropriations Committee, Arambula’s office said.

According to the University of California-Berkeley Employment Research Center, an estimated 520,000 people in California would qualify for a Covered California plan if they did not have legal status. Pantoja Toribio, who emigrated from Mexico alone after leaving an abusive relationship, said she was lucky. She learned about alternative health care options when she made her weekly visit to a food bank at Hijas del Campo, a farmworker advocacy group in Contra Costa County, where they told her she might qualify for a low-income plan through Kaiser Permanent.

Pantoja Toribio signed up just before open registration closed at the end of January. The plan helped her discover that the lump in her breast was not cancer.

“God heard me,” she said. “Thank God.”

This article was produced by KFF Health Newswho publishes California Healthlinean editorially independent service of the California Healthcare Foundation.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs at KFF – an independent source of health policy research, polling and journalism. Learn more about KFF.

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