Gov. Jerry Brown Friday signed first-in-the-nation legislation requesting federal approval for the state’s health insurance exchange to sell policies to immigrants living in California illegally.
The bill, written by Sen. Ricardo Lara (D-Bell Gardens), requires the state to ask the federal government for an exemption from a section of the Affordable Care Act that forbids these immigrants from buying coverage through the federal and state insurance exchanges. It cleared its final legislative hurdle earlier this month when it passed the Senate on a bipartisan vote of 27-8.
Some experts said federal approval could be hard to get.
Advocates of health care expansion hailed Brown’s decision, nonetheless. “We were very pleased with the bipartisan legislation vote and now with the governor’s signature, recognizing that our health care system is stronger when everyone is included,” said Anthony Wright, executive director of Health Access, a Sacramento-based consumer advocacy group.
The governor had not signaled his intent before today, and his office had no comment after he signed the bill.
Lara issued a statement Friday calling for federal approval. “The current policy disallowing immigrants from purchasing care with their own money is both discriminatory and outdated,” he said.
Under the terms of California’s request to the federal government, immigrants without legal standing would not qualify for government assistance to help pay for the coverage — unlike the vast majority of Covered California enrollees.
Many experts and advocates concede that this makes the measure a largely symbolic gesture, since few would be able to afford policies on their own. They are allowed to buy coverage in the private market, but many decline to do so for financial reasons, insurance industry experts say.
Consumer advocates said Brown’s approval of the Lara bill was not surprising, since it had bipartisan support and would not require additional public spending.
Betzabel Estudillo, a health policy coordinator at the California Immigrant Policy Center, said the bill likely appealed to the governor because of its tax neutrality. And, she noted, the governor has previously supported immigrant-inclusive policies, including allowing undocumented Californians to secure drivers licenses.
Brown also supported extending full Medi-Cal benefits to immigrant children who are living in the state unlawfully. They became eligible for those benefits last month.
Even with Brown’s signature, it is far from certain Covered California will ultimately be allowed to sell coverage to immigrants here without legal standing.
“Even if the Obama administration wanted to, it goes against a very specific provision of the Affordable Care Act,” said Randy Capps, director of research for U.S. Programs at the Migration Policy Institute, a nonpartisan think tank in Washington, D.C. The exclusion of undocumented immigrants was a political compromise that enabled the health reform law to get through Congress in the first place, he noted.
California is known to be a trend-setter when it comes to pro-immigrant legislation, and other Democratic-leaning states such as Washington, Illinois and New York could follow California’s lead, Capps said. But they would likely be deterred if the federal government seemed unlikely to grant the waiver, he said.
The issue of timing is also a crucial one, given the upcoming presidential election.
Kevin Lucia, a research professor at the Center on Health Insurance Reforms at Georgetown University in Washington, D.C., said the process of applying for such an exemption under the Affordable Care Act is lengthy.
After Brown’s signature, the state still has to complete the application and have a public notice period to accept comments for up to 90 days, Lucia explained. And once the application is submitted, the federal government has to do the same.
When the federal comment period closes, the U.S. Department of Health and Human Services and the Department of Treasury would have up to 180 days to make a final decision.
This could be important, because the political landscape in Washington after President Barack Obama leaves office next January is uncertain. Donald Trump, the presumptive Republican nominee, has proposed deporting immigrants who are in the country unlawfully, and he has promised to repeal the Affordable Care Act.
Hillary Clinton, the presumptive Democratic nominee, has expressed support for extending health coverage to undocumented immigrants. But, if elected, she would likely be preoccupied for the first several months of her presidency putting together an administration.
The bill signed by Brown complies with current federal guidelines for exemptions under the health reform law, Lucia said. “But because of timing barriers it is unlikely the Obama administration will make the final decision.”