California is exploring private insurance for immigrants without legal status. But is it affordable?

A doctor found cysts in Lilia Becerril’s right breast five years ago, but the 51-year-old has no health insurance. She said she couldn’t afford the imaging to find out if they were cancerous.

Becerril earns about $52,000 a year at a nonprofit in California’s Central Valley, which puts her and her husband, Armando, at more than double the limit to qualify for Medi-Cal, the state Medicaid program for people with low income and disabilities. Private insurance would cost $1,230 a month in premiums, the money needed for their mortgage.

“We resorted to home remedies to overcome the pain,” Becerril said through a Spanish translator. Her husband needed hernia surgery for 20 years. “It’s frustrating because we pay our taxes, but we can’t reap any of the benefits of where our taxes go,” she added.

While many Californians who earn too much to qualify for Medi-Cal can obtain subsidized coverage through Covered California, approximately 460,000 residents are barred from obtaining insurance through state-run insurance plans under the Affordable Care Act because they have no legal status. A Democratic lawmaker says it’s a small but glaring gap and is crafting a bill that could test Democratic Gov. Gavin Newsom’s commitment to achieving universal health care.

“We’re going to have to find a way to provide universal coverage to everyone who lives in this state,” said the bill’s author, Assemblyman Joaquin Arambula. “This is an area where our state hasn’t done enough to provide coverage for those who don’t have papers. »

Arambula’s bill would direct the state to ask the federal government to allow immigrants living in the state without permission to purchase insurance through Covered California. Arambula sees this decision as the essential first step in expanding coverage. If approved, the Fresno lawmaker intends to seek state grants to help pay for the insurance.

Both are critical for immigrants without legal status, said Jose Torres Casillas, a policy and legislative advocate with Health Access California, a consumer health group working with Arambula’s office on the measure.

“Access is one thing, but affordability is another,” said Torres Casillas.

Since taking office in 2019, Newsom has approved extending Medi-Cal to all qualified residents, regardless of immigration status. In doing so, the politician who was rumored to be gearing up for a presidential bid, described the state as moving “one step closer” to universal health care. But in January, Newsom announced a government deficit of $22.5 billion and made no mention of new proposals for the state’s roughly 3 million uninsured residents.

Newsom’s health secretary, Dr Mark Ghaly, acknowledged the pressure to go further, but would not commit to a timetable.

“So far we’ve had so many other things to focus on,” Ghaly said. “That will become, frankly, one of the next biggest issues that we will address. »

California needs federal permission to open Covered California to immigrants without legal residency because it’s currently closed to them, and Arambula said he’s in talks with Newsom administration officials about how to structure the bill.

Once the federal government opens Covered California to all migrants, the state could earmark funds for grants. About 90% of California Covered enrollees are eligible for financial aid, which is paid with state and federal funds. Since 2020, the state has spent $20 million a year on these grants, a fraction of the cost as Congress gave states a cash injection during the pandemic.

Previously, lawmakers allocated about $300 million to reduce insurance premiums for California enrollees. Any financial assistance for people living in the state without permission would likely have to come from public funds, and costs could vary widely.

For example, Colorado enrolled 10,000 of these immigrants in a new insurance program designed just for them at a cost of $57.8 million in public funds, said Adam Fox, deputy director of the Colorado Consumer Health Initiative. The program covered the full cost of insurance for enrollees.

In Washington state, immigrants without legal status can take advantage of a state fund next year to help all income-eligible state residents pay for their insurance, said Michael Marchand, director of marketing. from the Washington Health Benefit Exchange. State lawmakers added $5 million to the immigrant fund without legal authority.

“This would serve as an incentive for further undocumented immigration to our country,” said Sally Pipes, president and CEO of the Pacific Research Institute, a think tank that has opposed Medi-Cal expansion. immigrants without legal status. “And put taxpayers on the hook for the extra government health care costs and the inevitable higher tax bills to pay for them.” »

California officials previously considered allowing all immigrants to purchase insurance through its state-run program, submitting a request to the federal government in 2016. But the state rescinded its request after taking office. of President Donald Trump, given his anti-immigration rhetoric and policies. .

The Biden administration in December approved an exception to the federal law for Washington state — a game-changer in the eyes of immigration advocates, said Rachel Linn Gish, spokeswoman for Health Access.

“Seeing what other states have done and the overrides that are happening under Biden, it makes a huge difference in our approach,” she said.

But even if lawmakers pass a plan to open California’s insurance market to all immigrants, regardless of status, advocates said the state will have to wait until Jan. 1, 2024, to seek permission from the federal government, and it could take six months or more. more time to get a response.

That means it could be years before Becerril can get coverage. Instead, she prepares for the worst.

“I pay for funeral insurance,” she said. “It’s cheaper than paying the premium for health coverage. »