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California is considering expanding health insurance subsidies to all immigrant adults

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 otherwise cheerful 43-year-old quickly realized how limited her options were.

“I said, 'What should I do?'” she said in Spanish, quickly becoming emotional. She immediately feared she might have cancer. “I went back and forth – I did [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 could not afford to find out if she has a serious illness.

Starting this year, Medi-Cal, California's Medicaid program, expanded to cover undocumented immigrants — timing that could have worked out perfectly for Pantoja Toribio, who has lived in the Bay Area town of Brentwood for three years. But her application for Medi-Cal was quickly rejected: As a farmworker earning $16 an hour, her annual income of about $24,000 was too high to qualify for the program.

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

The state is footing the bill for Medi-Cal's expansion, but federal law bars those it calls “undocumented” from receiving insurance subsidies or other Affordable Care Act benefits, leaving many employed but not sustainably employed Have health insurance options.

Now, the same health advocates who fought to expand Medi-Cal say the next step in achieving health equity is to expand Covered California, the state's ACA marketplace, to all immigrant adults through the passage of AB 4.

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

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

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

Despite a Democratic supermajority in the Legislature, passing the bill could be difficult as the state faces a budget deficit of $38 billion to $73 billion next year. Gov. Gavin Newsom and legislative leaders announced a $17 billion package to narrow the gap, but significant spending cuts appear inevitable.

According to Rep. Joaquin Arambula, the Fresno Democrat who introduced the bill, it's not clear how much it would cost to extend California coverage to all immigrants.

The Center for Immigration Policy estimates that establishing the marketplace would cost at least $15 million. If the bill passes, sponsors would have to secure funding for the subsidies, which could amount to billions of dollars annually.

“It’s a difficult time to request new spending,” Dar said. “The start-up costs for the Mirror marketplace are comparatively very low. So we are confident that they are 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 undocumented immigrants.

“I believe we will continue to stand up and work to make California a California for everyone,” he said.

The bill passed the Assembly last July by a vote of 64-9 and is now awaiting a decision from the Senate Appropriations Committee, Arambula's office said.

According to the University of California-Berkeley Labor 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 alone from Mexico after leaving an abusive relationship, said she was lucky. She learned about alternative health options while attending a weekly food bank at Hijas del Campo, a farmworker advocacy group in Contra Costa County, where she was told she might be eligible for a low-income plan through Kaiser Permanente.

Pantoja Toribio applied just before open enrollment ended at the end of January. Through the plan, she learned that the lump in her breast was not cancerous.

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

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.


This article was reprinted from khn.org, a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling and journalism.

Anna Harden

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