Illegals deepen benefit debate

Oakland Tribune
April 17, 2006
By Rebecca Vesely

The large step Massachusetts Gov. Mitt Romney took last week by signing a universal health care law is a gaping crevasse in California, health policy experts said.

That does not mean that universal coverage could not happen in this state. But any meaningful reform would have to somehow address another political flash point: undocumented immigrants.

"One of the big issues in achieving universal health care would be the size of our undocumented population," said Marian Mulkey, senior program officer of the California HealthCare Foundation. "In California, it's more about the political environment and who the uninsured are."

In Massachusetts, one out of every 10 people is uninsured, compared with one out of five in California. And Massachusetts ranks among the top 10 states nationwide in health coverage, while California is among the bottom 10.

It is unknown how many of California's 6.5 million uninsured are here illegally. Among all noncitizens, legal and illegal, 45 percent are uninsured, according to the California HealthCare Foundation.

Latinos, who make up the majority of the nearly 3 million people living in California without a valid visa, are 21/2times more likely to be uninsured than non-Latino whites. More than half of the uninsured in California are Latino, Mulkey said.

Studies show that the rising cost of health care and the declining benefits for workers — not illegal immigrants — are the chief reasons why Americans are uninsured. An estimated
79 percent of the nation's 45 million uninsured are citizens.

Still, in California, insuring the undocumented "definitely makes the problem (of universal care) more difficult," said LarryLevitt, vice president of the Kaiser Family Foundation.

"You have to either deal with the politics of including undocumented workers in the health care system or the realities of not including them when they are using services anyway," Levitt said.

The Massachusetts plan requires all residents who make certain income requirements —
$60,000 for a family of four — to purchase health care by July 2007 or face penalties.

Expanded government programs would cover the poor, and insurance reforms would bring down coverage costs.

Romney vetoed a provision that would penalize employers who do not provide insurance at a cost of $295 a year per worker, but the state Legislature is expected to override the veto.

California lawmakers have proposed bills that echo aspects of the Massachusetts compromise — individual insurance requirements, expanding existing programs such as Medicaid, and employer mandates. A single-payer plan that would create a government-run universal insurance program has the support of unions.

But how to include undocumented immigrants has not been in the forefront of the debate.
And yet, insurance programs serving the undocumented are proving extremely popular.

Alameda County's Healthy Kids plan launched last October and aims to insure children whose parents make too much money to qualify for state/federal public insurance programs Medi-Cal or Healthy Families.

Eighteen counties statewide have Healthy Kids programs, funded by foundation grants and tobacco settlement funds.

Children enrolled in Healthy Kids can have household incomes of up to 300 percent of poverty level, or $60,000 for a family of four. All children under age 19 are eligible regardless of immigration status.

Of the 1,100 children enrolled in Healthy Kids in Alameda County, 95 percent are undocumented.

The remaining 5 percent enrolled because their parents' incomes are above the cutoff point for Medi-Cal or Healthy Families.

Ingrid Lamirault, chief executive officer of the Alameda Alliance for Health, which administers Healthy Kids, said she was surprised how many enrolled children are undocumented.

"But at the same time, most of the kids who are documented would qualify for Medi-Cal or Healthy Families," she said.

Efforts to provide health insurance to all children — regardless of immigration status — appears to have to most political momentum of any health initiative in Sacramento.

"Covering all children is the most likely thing to happen," Levitt said. "Everyone loves kids, and they're also cheaper to cover."

Close to 90 percent of children in the state have some form of health coverage, but that still leaves between 800,000 and 1.1 million uninsured kids.

Nearly 70 percent of uninsured children are in families in which the head of household works full time, according to the California HealthCare Foundation.

"The way to get to the last 10 percent of kids is to make the commitment to cover all children," said Anthony Wright, executive director of Health Access of California, a consumer group.

A statewide initiative proposed for the November ballot would raise the tobacco tax by $2.60 cents to bankroll health insurance for all children and fund emergency hospital care and other programs. The tax is expected to raise $391 million a year.

Last fall, Gov. Arnold Schwarzenegger vetoed two bills that would have provided comprehensive health care to all children. A similar bill, SB 437, is pending in the Legislature.

As an alternative, the governor has proposed spending $72 million to boost enrollment of children who qualify for Medi-Cal and Healthy Families.

Addressing undocumented people's use of the health care system mainly has focused on penalties.

In February, President Bush signed a law that requires Medicaid recipients (called Medi-Cal in this state) to produce birth certificates, passports and other documents that prove they are here legally. The new requirement begins July 1.

Some health care proposals could help the undocumented obtain insurance.

Assemblyman Joe Nation, D-San Rafael, is proposing an individual and employer mandate that has elements of the Massachusetts compromise.

AB 1952 would require residents to have health insurance, and employers to provide it. It would create a purchasing pool for low-cost insurance, and insurance companies no longer would be allowed to deny applicants based on pre-existing conditions.

Nation said that while his bill is silent on the issue of undocumented immigrants, those working in legitimate jobs would have more opportunities to get health insurance.

"A number of people here illegally are part of the above-ground economy; they work, they even pay taxes," Nation said. "If you are part of the above-ground economy, you would have health insurance."