Thinking About the Strangers to the Affordable Care Act: California SB 4

High on my list of urban legends surrounding the Affordable Care Act is the perception that undocumented individuals will be eligible for expanded Medicaid or eligible for subsidized health insurance purchase through the Exchanges. I usually am asked about this pretty early in presentations made to the general public here in Missouri, for those of you keeping track.

My response is that, however you feel about it, undocumented individuals are strangers to the ACA – both in terms of eligibility for expanded Medicaid and in terms of eligibility for subsidized purchases through the Exchanges.  I then point out that documented non-citizens (think green cards) are treated differently, though not  the same as citizens, under the ACA.  Finally, I also point out that some states do use state Medicaid dollars to offer things like emergency Medicaid (restricted scope Medi-Cal) and could use these same funds to extend expansion Medicaid (full-scope Medi-Cal) to the undocumented if they chose.

Well, here comes California's SB-4, proposing just some of that. Income eligible undocumented individuals could be eligible for full-scope Medi-Cal. SB-4 is part of a package of ten pieces of of legislation of interest to California's undocumented. 

Undocumented immigrants are, of course, eligible to obtain driver's licenses in California. They have moved to do so in large numbers, though even that number is expected to triple by the end of 2016. So we know public outreach on these things can produce a powerful response. After all, in September of 2014, 115,000 enrollees were disenrolled from ACA-facilitated health plans because of inability to verify legal immigration status.

What does California currently offer the undocumented? Well, it is up to the counties. That means coverage varies greatly. So, California SB-4 would both standardize and formalize state government funded health insurance for eligible undocumented immigrants. Sounds a little like the goals of the original ACA Medicaid expansion, writ small? it should.

When I discuss the need for younger robust people to buy into health insurance markets, I often point out the irony of working so hard to keep younger robust undocumented immigrants out of our health insurance pools.

Be careful what you ask for — you might get it.

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