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Q&A: Efforts To Extend Health Coverage To Undocumented Immigrants

California’s decision to withdraw a request for federal government permission to sell unsubsidized health plans to immigrants without papers has many wondering about the future of their health coverage in the state.

Sen. Ricardo Lara, D-Bell Gardens, was the state lawmaker who made that request for a federal waiver from the rules — then pulled it back over fears that the new Trump administration would use immigrants’ information to deport them.

Lara, who has become one of the most recognized voices for immigrants in the state, said that despite the setback, he and state legislators will continue efforts to protect the state’s undocumented communities and expand their health insurance options.

Lara spoke with California Healthline about his decision to withdraw the request and what’s on his health care and immigration agenda this year.

The Golden State, home to an estimated 2.6 million immigrants without papers, for years has led efforts in expanding services and opportunities for this population. In 2015, Gov. Jerry Brown approved a bill that granted immigrants in the state illegally the right to apply for driver’s licenses. He also signed legislation allowing undocumented children under the age of 19 to sign up for comprehensive Medi-Cal coverage, affecting an estimated 200,000 children by the end of this year.

While the Affordable Care Act cut California’s uninsured rate by half, another 2.7 to 3.4 million Californians were expected to remain uninsured in 2019, according to the UC Berkeley Labor Center. Half of those would be immigrants without legal authorization.

Q: Why did you decide to withdraw the waiver application? Even if It didn’t have much of a chance to be approved under the Trump administration, why not wait it out?

I did not want to put the information and privacy of this vulnerable community at the hands of an administration that has pledged to be anti-immigrant. The future of the waiver was going to be determined by the Trump administration, and within the law we would have to provide the names and personal information of individuals who would be buying plans on the exchange. Even though there would be no subsidies, the law requires that we send over [consumer] information to the federal government. It was a tough decision, but I felt it was better to withdraw the waiver now. We didn’t want to wait for [President Donald Trump] to possibly act on what he said during his campaign — that he would do everything he could to deport people.

Q: Will California’s efforts to expand health care for adult immigrants have to take a pause for at least the next four years?

Not at all. We actually invested more money on this [year’s] budget to accommodate more undocumented children. Where we run into difficulty is where we have to coordinate with the federal government. We can create a state-run program to offer health care for our undocumented community — one that we know we won’t get any federal support for — that can move forward in the state. We know that providing health care for folks is less costly than having people going to emergency rooms.

Q: What’s in the works at this point to address this issue?

We’re going to introduce legislation this year to work on Health for All. It’s early in the legislative process, but we’re doing our research to ensure that we find what would be most cost-effective for us: Either we focus on preventive care or target those folks who are in most need now, given that it will be the most ill who are in the emergency rooms.

Q: But the Health for All initiative was attempted before and the effort had to be amended to only cover children. That’s how California ended up with the Health for All Kids program. Why would the effort to cover undocumented adults be successful this time around?

In order for us to manage the cost, we selected the most vulnerable out of the group, which were the children. So now we move forward with a strategy that will include our adult population.

The attitude of our legislators has always been to minimize our uninsured rate. We’re going to be careful and see what happens to the Affordable Care Act. It’s something that California will have to do alone and we understand that.

Q: Health for All Kids will be a year old in May. Given all the talk about all the possible changes in health care programming and funding, is there any reason why people should be concerned about the future of this program?

No. Last year, Gov. Brown provided $188 million and this year he’s giving us $279.5 million to provide benefits to undocumented children. We’re proving that not only is there a need, but that this program is successful. I can’t tell you what will happen in the future, but as far as we can see, this governor continues to make this a priority and I hope this continues to be the case.

Q: You also do a lot of work with recipients of DACA (Deferred Action for Childhood Arrivals). Last year, Gov. Brown signed one of your bills that allows undocumented medical students to compete for state scholarships and participate in loan repayment and forgiveness programs regardless of their immigration status. You’ve said this is one way to relieve provider shortage. Could this program experience setbacks in the current political climate?

No. That bill is being implemented to the full extent of the law. The grants and the loan deferments are going to be available to them. I know there is a lot concern at the national level on issues regarding health care and immigration, but California will remain resolute. We are going to continue to implement the programs that were signed into law. One election is not going to change our values or how we legislate in this state.

Q: Democrats have been calling on their Republican colleagues to defend the Affordable Care Act. How are those conversations going?

At the state level, we’re making it very clear that a lot of the folks who will be impacted by the loss of health care are in Republican districts. I do have to say that Republicans in the state are very different than those in Congress; we continue to have good dialogue and hopefully they [can] help us convince some of their colleagues in the federal level.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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