By Ana B. Ibarra
June 25, 2018
Advocates
of state-funded efforts to expand health insurance coverage for immigrants and
some middle-class Californians will have to wait for the next governor before
they can have any realistic hope of advancing that goal.
Several
proposals to make coverage more accessible and affordable for millions of
Californians were left out of the state’s 2018-19 budget, dealing a sharp
setback to Democratic lawmakers who fashion themselves as leaders of the
resistance against federal retrenchment on health care.
The
budget takes effect July 1 and awaits the final approval of Democratic Gov.
Jerry Brown.
Earlier
in the year, Democratic lawmakers announced ambitious efforts to adopt policies
that would bring California closer to universal health
insurance coverage.
But
until the new governor takes the reins next year, their plans — specifically,
to offer comprehensive Medi-Cal health benefits to many adults who are in the
country illegally and to provide state-funded subsidies for people who buy
coverage through Covered California, the state insurance exchange — will likely
remain little more than rallying cries.
“Nearly
every Democrat on this floor has argued that health care should be a human
right — not a privilege,” state Sen. Ricardo Lara, who is running for
California insurance commissioner, said Monday on the floor of the
Democrat-dominated Senate. The budget agreement, he said, “strips out a
common-sense bicameral proposal to finally make those words real.”
Phil
Ting, chair of the state Assembly’s budget committee, noted Brown’s well-known
fiscal prudence and suggested the cost of the coverage-expanding proposals was
too high for him to accept. Ting was optimistic the new governor would be more
amenable.
“If it
all works out, we’ll have a governor who has been a champion of not only
universal coverage but single-payer,” Ting said, referring to Democratic
candidate Gavin Newsom, who currently holds a large advantage in opinion polls over
Republican rival John Cox.
“We
would hope that proposals that move us toward that ultimate goal would be more
well-received than in this administration,” Ting said.
If
Newsom loses, however, it will be an entirely different story. Indeed, the
choice before voters in November is a stark one.
Should
Newsom become governor, “one of his first priorities will be having a
comprehensive conversation about how we guarantee health care for every
resident,” said Nathan Click, a spokesman for the Newsom campaign.
Giving
undocumented adult immigrants access to Medi-Cal, the public health insurance
program for low-income residents, and earmarking state dollars to help
consumers buy coverage through Covered California “are two major parts of any
claim to do that,” Click said.
Cox
strongly opposes such government intervention in health care and has said that
providing publicly funded care to undocumented immigrants “is objectionable on
a lot of levels.”
One of
the proposals nixed from the budget would have provided full Medi-Cal coverage
to unauthorized immigrants 65 and older, at a cost of $75 million in the
upcoming fiscal year and twice as much every year after that. Another would have
extended Medi-Cal to undocumented immigrants 19 to 25 years old, costing $125
million in the first year and $250 million annually in subsequent years.
Two
other proposed measures excluded from the budget would have offered financial
aid to consumers who buy health plans through Covered California. One of them
sought $300 million a year to supplement already existing federal premium
assistance. Another requested $250 million annually in state tax credits for
higher-income residents who do not qualify for federal help.
Democratic
legislators are not giving up on these plans. They have authored bills, pending
in the legislature, which would accomplish the same objectives as the failed
budget proposals. But policy experts say they are unlikely to succeed, since
Brown already made clear through the budget process that he wouldn’t pay for
them.
“Even
if [lawmakers] pass the bills, the governor still needs to sign them, and the
chances of signing them when there are no allocated funds … doesn’t seem
likely,” said Shannon McConville, a researcher at the Public Policy Institute
of California.
More
than half of the nearly 3 million uninsured Californians are
ineligible for full Medi-Cal benefits or to buy subsidized insurance through
Covered California because of their legal status.
Undocumented
children under age 19 whose families’ incomes qualify became eligible for full
Medi-Cal benefits two years ago, and more than 200,000 of them are now
enrolled.
John
Baackes, CEO of LA Care Health Plan, which offers managed-care Medi-Cal
coverage, said he supports the coverage expansion effort, but there is reason
to be wary of proposals to cover large numbers of unauthorized adult
immigrants. An economic downturn, which is bound to happen sooner or later,
could put unsustainable financial pressure on Medi-Cal, he said.
It is
already a huge program, with more than 13 million enrollees — about one-third
of the state’s population — Baackes noted. And coverage for undocumented
immigrants comes from state-only funds, so in the next recession, “will that
sudden drop of state revenue mean they can’t afford to cover everyone?” he
asked.
For
now, the foundation for coverage expansion has been laid, said Deborah Kelch,
executive director of the Sacramento-based Insure the Uninsured Project.
She
argued that the failure to enshrine those proposals in next year’s budget does
not compromise California’s leadership on health care expansion and
affordability. “I don’t think it takes us backwards,” she said. “If anything,
it re-energizes our collective thinking.”
California
Healthline reporter Pauline Bartolone contributed to this report.
Ana B.
Ibarra: aibarra@kff.org,
@ab_ibarra
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