California Considers Strategies for Treating Uninsured Immigrants


California officials and health care providers are considering different strategies for treating immigrants who will remain uninsured after implementation of the federal health reform law, HealthyCal reports.


Under the Affordable Care Act, undocumented immigrants are excluded from new coverage opportunities, including state health insurance exchanges and Medicaid expansions. Lawful immigrants who have lived in the U.S. for less than five years may participate in health insurance exchanges and obtain subsidies if income-qualified, but in many states do not qualify for Medicaid.

A recent report by the UC-Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research on California residents who will remain uninsured after the ACA takes effect found that:

  • 66% of the remaining uninsured will be Latino;
  • 60% of the remaining uninsured will have limited English proficiency; and
  • 62% of the remaining uninsured will live in Southern California.

The report also found that about 50% of those still uninsured five years after the ACA takes effect will qualify for coverage under the Medi-Cal expansion or for health benefit exchange subsidies, but they will not be aware that they qualify because of poor outreach. Medi-Cal is California's Medicaid program.

Potential Strategies for Treating Uninsured Immigrants

Chad Silva -- policy director for The Latino Coalition for a Healthy California -- said he is worried that state officials do not recognize the need for grassroots efforts and resources to communicate with immigrant populations.

He said that the state must form partnerships with community-based organizations to reach such populations, adding that community health educators can help inform Latino communities throughout the state about coverage opportunities.

According to HealthyCal, community clinics can provide for patients who are part of a "mixed citizenship status" family, which includes at least one parent who is an undocumented immigrant.

Sonal Ambegaokar -- a health policy attorney at the National Immigration Law Center -- said that no one in mixed citizenship families is likely to apply for coverage once they understand that non-citizens cannot obtain coverage under ACA.

John Gressman -- president and CEO of the San Francisco Community Clinic Consortium -- said that community clinics such as SFCCC can provide care for a newly insured family member, as well as those who remain uninsured.

SFCCC is working on strategies to pay for the care of patients who will remain uninsured. Gressman said that one strategy is to reorganize the way the clinics provide treatment into a team-based care model that would reduce costs and increase efficiency.

SFCCC clinics also are trying to reduce health disparities by giving health care providers culture competency training and increasing the number of Spanish-speaking doctors.

Meanwhile, health care advocates continue to lobby legislators to remove immigration status as a qualification for new coverage under ACA. Ambegaokar said, "The simpler the system, the better the access will be" (Shanafelt, HealthyCal, 10/23).
Matt Wayt
The article has been updated to clarify that lawful immigrants who have lived in the U.S. for less than five years may participate in ACA health insurance exchanges and obtain subsidies if income-qualified, but in many states do not qualify for Medicaid. --The Editors
Philip Miller
I have to agree with Mr. Ochoa that we have to separate the immigration policy from the healthcare discussion. As someone who works in hospitals in the U.S., I can attest to the bottlenecks in Emergency Departments for non-emergent care for the uninsured and the costs that will inevitably be born by the U.S. taxpayers for expensive procedures and long-term care that results from otherwise preventative chronic disease. As far as "free healthcare" being a draw to the U.S. for Mexican illegals, a little homework on the Mexican healthcare system is in order. Universal healthcare is guaranteed in Mexico at no cost to Mexican citizens.
Clark Norwood
Mr. Ochoa "why make policy that will only make matters worse." I agree, and that is what your policies are set to do! These people, no matter how nice they are, no matter how hard they work, no matter how cute their kids are, these people are ILLEGALS. Giving them benefits is like the FDIC giving a bank robber more money because the bank did not have very much money on the day it was robbed! Like I said before they should get emergency medical care only, nothing more.
Jose B. Ochoa
Response to Mr. Norwood: We will just agree to disagree as our approach to health is at opposites. In short, if the incentives driving immgrants to come to the USA are greater than any benefits we can deny them, why make policy that will only make matters worse. History teaches us that today's undocumented immigrants are tomorrows legal residents & future citizens. Let's build a health system that promotes the best outcomes for all!
Clark Norwood
Mr. Ochoa "Not considering the most pragmatic solutions ensures our health care systems and the nation will go broke!" Yes the state and nation going broke is high on my list of concerns. Actually immigration policy is of prime importance in this discussion. Given the cost to the tax paying citizens of this country and the LEGAL immigrants, getting healthcare free as an illegal immigrant is a BIG draw to sneak into the country/state. You make it sound like you are looking at the "big picture" to save the state money. Enforcing our current laws on immigration would reduce current expenditures and decrease the load in the future also. Illegals should be provided emergency care only and encouraged to take advantage of the system to come here legally.

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