Covering Undocumented Uninsured Adults in California
About 6% of Californians are undocumented. They comprise nearly 60% of California’s remaining uninsured. They live in the shadows and work very hard for little pay in low wage jobs in agriculture, the food industry, domestic services and residential construction.
The California HealthCare Foundation recently reported six interesting facts about California’s 2.5 million undocumented residents: https://www.chcf.org/wp-content/uploads/2018/06/SnapshotSixFactsUndocumentedCalifornians.pdf
· Its primarily a working adult population: seniors are only 2% and children 9%, as compared to 14% seniors and 26% children for all other California residents.
· 86% of the undocumented are Latino, 10% are Asian and 3% other.
· 65% of the undocumented have incomes below 138% of the poverty level – i.e. they are poor.
· 90% of low income (under 138% of FPL) undocumented residents are uninsured as compared to 10% of citizens and legal permanent residents.
· Nearly 3/4ths (74%) are working and/or looking for work. The rest are children, students, seniors and mothers staying home to care for their very young children.
· Nearly half (44%) have no usual source of health care.
The California Legislative Analyst’s Office estimates the net new cost to the state of California of covering 1.2 million undocumented low income uninsured adults through Medi-Cal is $3 billion. http://www.lao.ca.gov/Publications/Report/3827 $1.7 billion (federal and state funding) is already in the system to pay for restricted scope (emergencies, deliveries and prenatal care) to 1 million undocumented adults. There would be no federal match for the $3 billion difference. This coverage proposal was not adopted as a part of this year’s final state budget compromise due to its large and ongoing cost.
Another approach is to build coverage through their employers, but many undocumented work and live in the informal economy, and, as Joel Diringer, reports the Affordable Care Act provided a number of exemptions from the employer mandate to large agribusinesses employing migrant workers. https://agcenter.ucdavis.edu/blog/bleak-outlook-california-farmworker-health-coverage-prospects
San Francisco County has an interesting hybrid approach to covering its uninsured that ought to be considered. http://healthysanfrancisco.org/wp-content/uploads/2016-17%20HSF%20Annual%20Report.pdf and http://healthysanfrancisco.org/ It helps those who cannot afford the premiums and copays of Covered California coverage and helps those whose immigration status disqualifies them for full scope Medi-Cal. It helps an individual with annual income up to $60,000 annually and a family of four with incomes up to $125,000 annually. The County finances its program with county indigent health funds, participation fees from the participants and a pay or play tax (employer spending requirement) for those employers who do not offer coverage for their employees. http://sfcityoption.org/hcso-compliance/
Prepared by: Lucien Wulsin