All undocumented people in California will likely have consistent and reliable health care by 2024. Earlier this month, California Gov. Gavin Newsom announced he would use a state budget surplus to extend the state’s Medi-Cal program. The program already covers people under 26 years old, and those 50 years old and older will be eligible to apply beginning in May. Currently, undocumented people between 26 and 49 are only eligible for emergency care, and they will now be eligible for health coverage. Thanks to the new extension, the nearly two-thirds of undocumented immigrants in California who are younger than 65 and lack health insurance could finally be covered.
California is the first state to expand health coverage to all undocumented residents. States like New York and North Carolina offer health care to undocumented people for radiation or dialysis, 17 states and Washington, D.C., offer coverage to pregnant people, and six states and D.C. offer it to people under 18 years old, but outside of these exceptions, undocumented people are widely ineligible for health coverage. At the federal level, undocumented people are not covered under the Affordable Care Act and aren’t even allowed to purchase private health insurance through federal and state marketplaces. While undocumented people are more likely to work in high-risk environments for potential exposure to COVID-19, they are also more likely to be uninsured. More than four in 10, or 46% of undocumented immigrants, were uninsured compared to less than one in 10, or 9% of citizens. Immigration advocates hope the rest of the country follows California’s lead so that undocumented people, 3.2% of the U.S. population or 10.5 million people, will finally have one less barrier to living a stable life.
“The country treats us undocumented people like animals,” said Guillermina Aguilar, a member of ALMAS, a domestic worker organizing project in California. “We don’t have any value, we’re not worth anything to them.”
Aguilar, now 43 years old, arrived in the U.S. in 2000 from Puebla, Mexico. Since then, she has been a domestic worker in Petaluma, California, where she has raised her small family. She always considered herself a “healthy” person, choosing to treat her ailments with herbs and teas that are custom in her Mexican culture, but in 2017, when Aguilar was exposed to a severe amount of smoke from the wildfires that tore through Santa Rosa, she realized she needed to see a doctor. But, because of her age, she does not qualify for the full-scope Medi-Cal.
“My lungs became very delicate,” Aguilar said. “I don’t even like going to the doctor, but my chest was in a lot of pain, and it felt tight.”
According to UCLA researchers, in 2014, one in five U.S.-born adults visits the emergency room annually, while one in 10 undocumented adults visits the ER annually. The study also found that the average number of annual doctor visits by undocumented immigrants was almost half the amount of U.S.-born adults: 1.7 for undocumented adults compared to 3.2 for U.S.-born adults. According to a 2018 report, the reasons for this could be the fear of deportation, language barriers, and cost. But, care providers have rights. Health care providers may refuse to provide information about patients to law enforcement unless there is a warrant or court order.
Aguilar went to Petaluma Health Center, a nonprofit clinic that provides emergency Medi-Cal coverage for undocumented people. Patients are eligible for full or partial payment coverage based on yearly earnings. While Aguilar was prescribed an inhaler, she still had to pay $100 out of pocket.
“It’s not cheap,” Aguilar said. “It had to come out of my pocket, where else would it come from?”
When she began using the inhaler, Aguilar realized it was not strong enough for her symptoms. Her son, who is a U.S. citizen, also went to a doctor for an inhaler. She recounts that he was prescribed a stronger inhaler, but was billed $500 for it. When he explained they could not afford the inhaler, they gave him the same $100 inhaler Aguilar had been prescribed. According to Aguilar, regardless of her need for a stronger inhaler, she was prescribed the weakest inhaler based on price.
“The truth is that what they give us undocumented people is pure trash,” Aguilar said.
Last year, Aguilar was sick with COVID-19. She went back to Petaluma Health Center for services, which she had to pay for out of pocket. She was prescribed the same inhaler and Ibuprofen 500 mg, which she had to pay $200 for. She estimates that in the last year, she spent a total of $1,000 on medical visits and medications.
“The inhaler didn’t help me at all and it should have,” Aguilar said. “I spoke to a doctor in Mexico, and they told me that the prescribed inhaler is for a 2- or 3-year-old child. I don’t understand why they gave me that inhaler.”
After decades of not being treated equally, Aguilar is jaded and has doubts that the new expanded program will really cover her. But, she hopes the program will inspire other states to take action to protect their undocumented residents.
“As undocumented people, we are always placed on a lower level,” Aguilar said. “It’s important to include us in health coverage because we are people with feelings just like every other type of person, including white Anglo-Saxons.”
Newsom’s proposal must now be approved by the state legislature. If approved, it would begin no sooner than Jan. 1, 2024. Advocates hope the policy will additionally address longstanding racial and health disparities, including removing language barriers and allowing for interpretation services, ultimately ensuring easy and efficient access to quality health care.
