Opinion

Should California provide health care to all undocumented immigrants? Influencers weigh in

Immigrant advocate praises plan for health care coverage for undocumented adults

Carolina Gamero of the California Immigrant Policy Center in May 2018 praises a plan to provide health care for low-income undocumented immigrant adults. The plan stalled, but lawmakers are trying again in the 2019-20 session.
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Carolina Gamero of the California Immigrant Policy Center in May 2018 praises a plan to provide health care for low-income undocumented immigrant adults. The plan stalled, but lawmakers are trying again in the 2019-20 session.

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California Influencers this week answered the question: What is California’s obligation in terms of providing health care to undocumented immigrants? Below are the Influencers’ answers in their entirety.

“Our health is interlinked with everyone in our communities”

Richard Pan - California State Senator (D-Sacramento)

Providing health care to undocumented immigrants serves both our self-interest and humanity. Our health is interlinked with everyone in our communities.

Unmet health needs increase societal costs, and for infectious diseases, increases the risk of illness throughout the community. While the uninsured usually defer care, ultimately the care they can access is not as cost effective, such as emergency room care. This extra cost is passed on to the rest of us.

With ACA implementation, California cut the number of uninsured by over half, with undocumented immigrants accounting for 40 percent. Expanding health care coverage to more people more fairly distributes risk and expenses and reduces unmet health needs.

California provides health care coverage for all low-income children. But many parents and family members of those children remain uninsured. We place barriers to immigrants even purchasing insurance through Covered California. Affordable coverage options for undocumented immigrants reduces the number of uninsured individuals relying on taxpayer-funded county indigent programs and other safety-net services.

We currently provide untimely, costly health care to anyone who makes it to an ER. It is humane and our self-interest to provide quality health care for all Californians, including undocumented immigrants.

“It just doesn’t make sense to expand a program that’s not doing a good job at its current size”

Marie Waldron - California State Assemblywoman (R-Escondido)

It would be wonderful if California could give away quality health care to every person who needs it, but unfortunately, that’s just not the case. With that in mind, the question should be: How do we distribute our limited resources to make sure they’re doing the most good? If we look at things that way, it’s clear that we need to ensure our safety net health care programs are serving current enrollees before we expand the programs any further.

It’s frustrating that in this debate many people consider access to care and access to coverage to mean the same thing. They don’t. An insurance card doesn’t do much good if you can’t get in to see a doctor when you need to.

Just this year, an audit of the Medi-Cal program found that 2.4 million kids aren’t getting the care they’re entitled to. That utilization rate is worse than 39 other states. Low payments to providers and other barriers to accessing care need to be addressed before we add thousands of additional people to Medi-Cal. Until then, it just doesn’t make sense to expand a program that’s not doing a good job at its current size.

“This is a moral question – one that asks: Who are we as Californians?”

Autumn Burke - California State Assemblywoman (D-Marina Del Rey)

This is a moral question – one that asks: Who are we as Californians? We are the 5th largest economy in the world and undocumented immigrants have undoubtedly helped us achieve this level of success. At the very least, if we are going to build a state on the backs of immigrants, we have a responsibility to protect their human dignity by providing health care.

“Caring for every Californian is the human thing to do”

Carmela Coyle - President and CEO of the California Hospital Association

Providing health care to undocumented individuals with the same dignity and respect with which we all want to be treated is our obligation and the right thing to do.

Put simply, no one should ever be denied health care services because of where they were born. Caring for every Californian is the human thing to do.

When people forgo care because they don’t have insurance, seeking care in hospital emergency departments becomes the only option, raising costs for everyone. And when people put off care until illnesses advance to a more serious stage, treatment becomes more expensive for us all.

If we can get undocumented individuals the coverage and timely access to the care they need, we can treat everyone in the most appropriate and cost-effective way possible, before conditions becomes more serious – and expensive.

That benefits every Californian.

“Everyone benefits when everyone is covered”

Anthony Wright - Executive Director of Health Access California

All Californians should have affordable, comprehensive health coverage, regardless of the location or circumstance of their birth. As we advocate to provide all low- and moderate-income families more help to better afford health coverage, we must also seek to remove the unfair exclusions in Medi-Cal based on immigration status.

For many fellow Californians, this issue is life and death. Undocumented Californians are a crucial part of the fabric of our economy and society, yet the only access to health services many have is the emergency room – the most inefficient and expensive way possible to provide care. Everyone benefits when everyone is covered, getting primary and preventive care.

Governor Newsom has boldly proposed extending Medi-Cal up to age 26, regardless of immigration status. We also support legislation and budget investments like AB4 and SB29 that would take additional steps forward. The Senate’s budget proposal would also cover undocumented seniors over age 65 in Medi-Cal, recognizing those who made major contributions over their lives and who have the greatest need, with a plan to eventually cover all income-eligible Californians. Such an expansion would benefit not just the families directly affected, but our communities and our health system as a whole.

“It is important to remember that providing health care coverage may not translate into the kind of access that patients with life-threatening illness need”

Joseph Alvarnas - Vice President of Government Affairs and Senior Medical Director for Employer Strategy for City of Hope

As a practicing hematologist, I have cared for many patients who have been diagnosed with life-threatening diseases, like leukemia and lymphoma. Some of these patients found me after they were denied access to the kind of expert care that would have helped them achieve a better outcome for their serious diagnosis. It is important to remember that providing health care coverage may not translate into the kind of access that patients with life-threatening illness need. As a physician, it is both my obligation and avocation to treat the person before me with compassion, empathy, and to apply the best knowledge and skills of myself and my health care team to help them, regardless of who they are, where they come from, or how they got here. It is not my role to opine whether California has an obligation to provide health care to undocumented immigrants. There are, admittedly, no easy answers as our leaders navigate the many policy, community, financial, infrastructure and human considerations that surround this complex question. Instead, I want to remind readers that access to quality cancer care, including early detection and proactive early treatment, will save lives and significantly reduce suffering and economic costs.

“Medicare For All is the best solution for this crisis. The time is now”

Bonnie Castillo - Executive Director of California Nurses Association/National Nurses United

If health care is a human right, as most of our politicians proclaim, every resident of our state has a right to humane medical care, no matter how they got here. Our undocumented neighbors comprise up to 45 percent of the uninsured; they are far more likely to postpone needed care, even as the undocumented pay taxes subsidizing all Californians.

The consequences are severe. Chronic diseases, such as high blood pressure, heart disease, and asthma, go un-diagnosed undermining long-term health. Communicable illnesses can go untreated, posing a risk of exposure to others. Fear of deportation by the Trump Administration makes it worse, even for legal residents swept up in racial profiling raids. Even those lawfully present have a higher propensity to avoid medical care.

Children are especially vulnerable to the trauma of lack of care and fear of deportation, which can stunt normal physical and mental development and health. It also places a huge financial burden on our safety net public hospitals and community clinics and on public budgets when patients present with preventable conditions. Medicare For All is the best solution for this crisis. The time is now.

“Physicians should not be concerned with a patient’s immigration status”

Dustin Corcoran - CEO of the California Medical Association

Physicians should not be concerned with a patient’s immigration status when that patient needs health care. CMA has long supported including the expansion of Medi-Cal to income-eligible adults regardless of immigration status. We have made great strides through our state’s Medi-Cal expansion under the Affordable Care Act, but we still have more work to do to get to universal coverage. The governor’s proposal is an important step to extending access to care to the remaining uninsured population.

“California’s smart move is to extend coverage to all Californians, including our undocumented neighbors”

Mark Ghaly - Secretary of the California Health and Human Services Agency

Given that California has a significant obligation to provide emergency services to all under federal law (EMTALA), and that Medicaid funds these services when an uninsured income-eligible patient, including those undocumented, cannot pay, I think we are asking the wrong question. The question should be, what should California do given our clearly defined minimum obligation under federal law? Should we stop there or should we take it a relatively small step further by ensuring the full benefits of a health care system built on the backbone of primary and preventive care rather than emergency and hospital care? I vote the latter. By providing access to primary and preventive care, we do a lot to ensure our health system is more efficient and works well for all of us. We also help diversify our overall risk pool, making care more affordable, while ensuring more of our population is healthy enough to work, making a priceless contribution to society and our economy. So it’s clear to me that California’s smart move is to extend coverage to all Californians, including our undocumented neighbors. Governor Newsom’s budget proposes extending coverage to all undocumented 19-26 year olds. This is a great step.

“Our healthcare policy should not be a cruel answer to poor immigration policy”

Jeannine English - Retired AARP National President

Health care for all should be a basic right. Undocumented immigrants are part of our community, they are the mothers, fathers and grandparents of our citizens, they are the workers in our homes, fields, businesses and institutions, and they are our friends and family. They are an important part of our economy. We know that high numbers of people without insurance and healthcare coverage create a higher burden of uncompensated and charity care and reduces the overall quality of care. Gaps in our healthcare system result in worse health outcomes for all.

Providing healthcare for undocumented immigrants is not just the right thing to do but it also makes good business sense. Every dollar we spend on prenatal care allows us to avoid spending at least four dollars in neonatal intensive care services. Regardless of parentage, the babies that we deliver in our hospitals are citizens, and it is important that they become healthy children who have the best chance of becoming productive and contributing members of our community. Our healthcare policy should not be a cruel answer to poor immigration policy. We need to develop a healthcare system for all that incentivizes early interventions and therefore reduces overall costs.

“The smart money is on providing preventative access to care for all who live and work here”

Robin Swanson - Swanson Communications

Some policies aren’t just the right thing to do, they are the smart thing to do. Providing health care for all Californians, big and small, old and young, documented or not; is a policy that is both ‘right’ and ‘smart.’

It’s also important to note that there’s a difference between providing health insurance and administering health care. And the way we do both of those things needs a radical shift.

In an era of Trumpian-led immigrant-bashing, California has an opportunity to stand apart and demonstrate that providing health care for all immigrants, regardless of documentation status, benefits everyone.

The fact is, the current system creates a sub-class of residents who aren’t afforded basic rights like health care. It is unsustainable. Studies have shown that high rates of uninsured result in considerable financial burdens for hospital systems, which are charged with providing care whether or not a patient who walks in the door is insured. Populations with access to care, on the other hand, are more likely to pursue both educational and job opportunities, fueling our economy.

Estimates show that nearly 1.5 million undocumented immigrants remain without health care. That’s a whole lot of people in our state who will inevitably, at some point, fall ill and need care. We can either address the issue upfront and provide basic preventative care, or we can wait until health problems become a very expensive crisis.

Whether it’s through expanding Medi-Cal benefits or opening up Covered California to our undocumented population; the smart money is on providing preventative access to care for all who live and work here.

“It is our responsibility to ensure care for all who reside in our state”

Le Ondra Clark Harvey - Director of Policy and Legislative Affairs, California Council of Community Behavioral Health Agencies

Our nation has historically prided itself on being a symbol of hope, refuge and new beginnings irrespective of a person’s religion, creed, race, ethnicity and social status. Individuals continue to migrate to our state for myriad reasons including seeking political asylum, or better economic conditions. However, regardless of some coverage afforded to low-income immigrants, 89 percent of low-income undocumented adults remain uninsured.

Poor healthcare infrastructure for undocumented immigrants can result in a lack of preventative care, overcrowded emergency rooms, an over-reliance on county indigent care and safety net systems, and poor health outcomes in general. And poor health outcomes impact more than the individual and their family – these outcomes also impact the community they reside in and ancillary systems such as the education and criminal justice systems. It is our responsibility to ensure care for all who reside in our state for the betterment of all Californians.

“While undocumented immigrants contribute approximately $3 billion in state and local taxes each year they are mostly on the periphery of our health care system”

Zach Friend - Second District Supervisor for Santa Cruz County

Undocumented immigrants make up the largest bloc of uninsured in the state and, at the county level, a significant number of those receiving care through county and community clinics. There is a real and direct cost, especially at the local level, to not providing adequate health care and coverage to undocumented immigrants. In our county, we see the costs from those that aren’t insured – from poorer health outcomes to decreased worker productivity. Coverage improves all of these outcomes.

While undocumented immigrants contribute approximately $3 billion in state and local taxes each year they are mostly on the periphery of our health care system. With a fixed immigration system it’s possible some of this debate would be moot – as many undocumented would be eligible for coverage under federal regulations. But until that point (and it’s unclear when, if ever that will occur), it makes sense for the state to showcase how health outcomes can be improved, costs can be controlled and coverage provided for everyone in our state.

“Chronic diseases are far more expensive seen in the emergency room”

Bruce Chernof - President and CEO of The SCAN Foundation

As a physician, it is abundantly clear that everyone who lives in California needs access to healthcare. We breath the same air, ride the same public transportation, go to the same sporting events…the list goes on. The reality is that major epidemic illnesses like the flu, measles, or tuberculosis don’t check residency status. Good prenatal care actually saves money by decreasing hospitalizations for high-risk moms and babies. Chronic diseases are far more expensive seen in the emergency room than managed appropriately in an outpatient setting. Our health, and the health of our families that includes older loved ones, is shaped by all those living in our communities.

“Disease and accidents do not discriminate based on immigration status”

Kassy Perry - President and CEO of Perry Communications Group

California’s progress toward universal healthcare coverage for all Californians is not a result of a legal obligation, but rather a fundamental belief in health equity and public health.

Chronic diseases, such as diabetes, COPD, cancer, depression, obesity, and heart disease, are the leading cause of death and disability and account for the vast majority of health care spending. Disease and accidents do not discriminate based on immigration status, and the cost of emergency treatment is born by hospitals operating on thin margins due to low Medi-Cal and Medicare reimbursement rates.

California does have a financial obligation. It is to protect the integrity of its hospitals. The real responsibility here rests with Congress, whose inability to reach across the aisle in the spirit of bipartisanship and for the good of the nation is appalling. Our challenge is how do we move Congress to pay for the care provided to those living and working in California without legal status, as only Congress and the Federal Government control immigration. It’s a question that has been debated in the Capitol for decades and will continue for the foreseeable future.

“Studies show that undocumented residents contribute far more to the California economy than any perceived taxpayer burden”

Robert Ross - President and CEO of the The California Endowment

While I understand how the question of health care for the undocumented is bound in political and ideological controversy, this is a straightforward policy issue for all of us at our foundation. We believe that ALL Californians, no matter your status, deserve access to quality health care.

There are three reasons for our straightforward, uncomplicated support of this policy position: the humanitarian reason, the public health reason, and the economic reason.

On humanitarian grounds, we believe that access to quality health care is a fundamental human right for all, and not a privilege for some.

On public health grounds – and this is tapping into my experience as a former county public health official – protecting the public’s health is an inclusive, “for all” enterprise; 90% may be great score for a high school math test – but not good enough in protecting the public’s health and safety. As recent outbreaks of the measles virus will attest, our society is playing with fire when aspects of our community are excluded from – or exempt from – public health protections. With disease outbreaks like flu, hepatitis, whooping cough, tuberculosis, or foodborne illness, you don’t want a (sizable) portion of the community marginalized from accessing needed care.

On economic grounds, for all the inflammatory rhetoric about the costs of caring for the undocumented, studies show that undocumented residents contribute far more to the California economy than any perceived taxpayer burden. The estimated taxes undocumented Californians pay into our state annually is $3.2 billion, according to the California Budget and Policy Center. Contributors to our state’s economic well-being deserve – from the standpoint of California’s social contract – access to health care, because a healthy workforce is a more productive and reliable workforce.

California’s undocumented residents are our neighbors, our schoolchildren, our families, our employers and our employees. We are morally and civically obligated to include them and all Californians in our health system, and I hope our leaders in Sacramento act to make Health For All a reality.

Dan Schnur, a veteran analyst and longtime participant in California politics, is director of the California Influencers series for McClatchy.
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