Last April, the UC Berkeley Labor Center and UCLA’s Center for Health Policy Research released a report estimating that 3.2 million Californians would be left without health coverage by 2022. Separate research from the Public Policy Institute of California found that nearly half of This number were immigrants, and of them a considerable number were undocumented. In fact, Labor Center results suggest that 1.27 million undocumented immigrants in California lack health coverage.
Three million is a big number, but it is far less than it was uninsured in recent times – and it is a figure that is likely to fall significantly in the coming years, if Governor Newsoms just released the budget plan for 2022-2023 becomes a reality, and the state expands MediCal coverage to include undocumented adults of all ages.
Newsom’s proposal, which has been something of a holy grail for health reformists and advocates for immigration rights in the state for years, is the latest in a long line of reforms that California has embraced over the past decade as its political leaders have moved assertively. to close as many holes in his health umbrella as possible. The result has been that the share of uninsured in the state has gone from more than 20 percent of its population, or 7 million people under the age of 65, a decade ago – putting it in competition with states like Texas for the highest percentage. of the population lacks coverage – to just over 8 percent today.
In the wake of the Affordable Care Act, the state set up its Covered California insurance exchange and then pumped millions of dollars into public relations campaigns designed to get the message out to low-income and minority communities that health care was now affordable and within reach millions of previously uninsured individuals and families. In 2016, the state set about expanding MediCal to undocumented children under the age of 18 – a reform that FB would not pay for. In 2019, lawmakers raised the age limit to include undocumented residents under the age of 26. The reform started in 2020, just before the pandemic took root. Last summer, Newsom signed a bill that made low-income Californians 50 years and older eligible for MediCal; from one day to the next, about 235,000 undocumented residents in that age group qualified for health care.
Now that California is in the luxury position with a budget surplus of many tens of billions of dollars, Newsom proposes to expand MediCal, beginning in 2024, to cover low-income undocumented immigrants. all ages, as well as hundreds of thousands of other low-income residents, under the age of 65, throughout the state. True, it is not quite the system of universal single-pay healthcare that supporters of Assemblyman Ash Kalra’s AB 1,400 envision, a massive $ 400 billion proposal currently being discussed in Assembly committees; but it is a major step towards universal health coverage. And given the brand shock associated with converting a fragmented private healthcare system into a single-payer system, Newsom’s plan, one of many ambitious proposals contained in his $ 286 billion budget, is almost certainly more likely to survive battles in the Legislature and that get more public support over the coming year than the single payer proposal is. If it survives, and if he wins re-election, he will then have four years to seal the deal and effectively move the state toward universal coverage, albeit of a patchwork quilt type rather than a single-payer system.
If Newsom’s proposal to make MediCal available to undocumented Californians, regardless of their age, is approved by state lawmakers, it will cost the state $ 2.2 billion a year. That’s a lot of money, but given the huge perennial profits California is now sitting on – the legal analysts’ office has estimated that it’s well north of $ 30 billion this year; other estimates put the profit closer to $ 45 billion – it’s very much possible.
Across the board, Newsom’s budget proposal thinks big. It extends the state’s child tax deduction; pours money into both primary and secondary education institutions; allocates additional billions of dollars to tackle the homelessness crisis. It channels billions of dollars to combat climate change and protect the state from the scourge of forest fires, expand the state’s efforts to mitigate the effects of rolling droughts, and allocate billions of dollars to the state’s ongoing efforts to build a high-speed train. In the medical arena, it brings together investments in maternity health care, in diagnostics and services for mental health, and in the protection of reproductive services in an era where Roe v. Wade is under mortal threat. It increases state support for the 1.5 million people who purchase their insurance through Covered California. It is also seeking funding to reduce MediCal premiums for children, disabled workers and pregnant women, while investing hundreds of millions of dollars to train and employ a network of health professionals around the state. And that throws the full weight of California’s purchasing power behind an attempt to lower prescription drug costs, especially those associated with insulin.
As a whole, Newsom’s budget proposal for 2022-23 will further reshape California’s economy and its policies. Ten years ago, one in five Californians had no access to health care – a percentage that still applies today in Texas, Mississippi and many other parts of the Deep South, especially; now that number is far less than one in 10 and is still getting much lower. 25 years ago, California embraced some of the country’s toughest laws against undocumented immigrants – laws and practices that today would be all too familiar to especially Arizona or Texas residents. Now, on the other hand, it is on the verge of making all its undocumented residents eligible for some form of health coverage.
There is a lesson here: that the long game is worth playing. More than a quarter of a century ago, immigrant rights groups gathered in California to build coalitions against then-Governor Pete Wilson’s demagogic policies. At the time, it would have seemed inconceivable that a future governor would embrace the idea of providing state-subsidized health care to undocumented immigrants. Today, on the other hand, such a policy change is simply considered common sense.
Texas is today under Governor Abbott when it comes to health care and immigrant rights, much like California was in the mid-1990s. Who knows, maybe by the middle of the century, the Lone Star state will also have devised ways to provide health care to the vast majority of its uninsured population and will have learned how to treat its undocumented immigrant population with dignity and respect rather than with contempt and cruelty.
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