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Think Tank

Should Adults Living In The Country Illegally Qualify For Full Medi-Cal Benefits?

Medi-Cal_430Within a few months, probably in May, children who live in California and are in the country illegally will gain access to full Medi-Cal benefits.

Between 170,000 to 250,000 children up to age 19 are expected to qualify.

The change comes as a result of a new law by state Sen. Ricardo Lara, D-Bell Gardens. That law originally would have extended full Medi-Cal benefits to anyone living in California regardless of immigration status, including adults, but it was narrowed to cover only children.

Now Lara is back with SB 10, which would extend Medi-Cal coverage to adult unauthorized immigrants, a much larger population.

The UC Berkeley Center for Labor Research and Education estimates that 1.26 million people would qualify. The cost to cover them would be roughly $430 million annually once the law is fully implemented, however that estimate dates back to 2014 and has not been updated, said Laurel Lucia, the center’s health care program manager. The cost would fall entirely to the state because under the law, federal money can’t be used for this purpose.

To get various perspectives on this issue, we spoke with Lara; Republican state Sen. Jeff Stone, a pharmacist who sits on the Senate Budget Subcommittee on Health and Human Services; and Daniel Zingale of the California Endowment, a nonprofit health care foundation. The transcript has been edited for length and clarity.

An Economic And A Moral Argument In Favor

It makes complete fiscal sense to allow immigrants without legal status in California to have full-scope Medi-Cal.

We are currently spending roughly $1.2 billion annually as a state for emergency room care. This is not only a problem for those folks that use emergency room care as their primary source for health care. It also puts in jeopardy folks who are actually in need of this service, especially when there is a dire emergency.

If somebody comes in with a cold that has become pneumonia, that costs the state much more money than providing them with a physician who can treat their ailment.

The estimate is that it would cost us roughly half a billion annually to cover every undocumented immigrant with full scope Medi-Cal. Even the most conservative Republican can see these figures and know it is a cost-saving measure. It also makes sense because you give people access to preventive care, which we know is much less expensive.

This is an investment that we as Californians have to make to ensure that we don’t pay more in the long run.

And quite honestly, it’s the right thing to do. As Californians, we have been at the forefront of ensuring that our immigrants are not only treated with dignity but they are incorporated into our society so they can continue to contribute at a larger scale to our economy.

They are one of the reasons we are the eighth largest economy in the world. This is a responsibility that we have as policymakers to not only promote these policies that save us money but improve the quality of life for all Californians.

That is the fiscal argument. The moral argument is that I find it unfathomable that in the richest country in the world and the most powerful state in the union, there are people to this day who forego treatment because they do not have access to health care.

It is inhumane, it is immoral and it is not who we are as Americans.

These individuals are here in the state. These individuals are working every day and these individuals are going to get sick, whether we pay for them to have access to health care or pay triple when they go to the emergency room. That’s just a reality.

Opponent: People Here Legally Should Take Precedence

We don’t have a revenue problem in the state of California right now. What we have is a spending problem.

During the financial crisis, Medi-Cal provider rates were cut by 10 percent. We also have a primary care shortage in the state of California.

The shortage is amplified even more in Medi-Cal because most physicians refuse to take Medi-Cal because the fees are so ridiculously low. A typical office visit for Medicare is about $41. A typical fee for a Medi-Cal patient is around $17.

One-third of the state of California is enrolled in the Medi-Cal program. They believe they have insurance to take care of their medical needs, but we don’t have anywhere near the number of physicians required to take care of this large population.

What are these patients doing? If they can’t find a doctor, they end up in our emergency rooms, where it costs us 20 times as much to take care of these people.

We need to take some of this excess revenue we’re receiving and give back the 10 percent cuts to physicians, hospitals and pharmacies.

I opposed the bill to extend Medi-Cal benefits to the children of undocumented immigrants. I like it when our state is philanthropic but when you can’t meet your own legal residents’ medical needs, how can you assume responsibility for people you don’t have a legal responsibility to take care of?

There should be a higher priority for people who are legally here and we should not dilute those services by giving them to people who are undocumented.

Now we’re going to see another bill to give full Medi-Cal benefits to adults not here legally. I will oppose the measure, with no question. It’s going to come at the expense of people who are legally here.

We are going to be exacerbating calls to the emergency room, burdening our hospitals and taking away from true emergencies: heart attacks, strokes, kidney failure, traumatic cases and accidents that deserve to have streamlined care.

It is a budget priority issue. With the existing revenue that the state has coming in, we could very easily restore Medi-Cal fees to an appropriate level to attract doctors to begin taking it again. Just because you’re low-income doesn’t mean you should get inferior medical care.

After we take care of all of our citizens who are here and ensure we have a system that is functioning correctly, we can start entertaining the noble idea of philanthropy and taking care of immigrant children and adults.

It Makes Common Sense, Says Foundation Executive

We support the inclusion of all Californians in Medi-Cal, including those who are waiting for Washington to take action on immigration reform.

The health and future of California depend on the health of all Californians, regardless of immigration status. Public health does not recognize a person’s immigration status when it comes to preventing illness and promoting health.

We as a society aren’t going to turn anyone away when they have a dire medical emergency. That’s federal law and that’s who we are as a state and nation. The problem with that is by denying people low-cost preventive health services, we’re then providing health care in the worst possible setting in terms of cost efficiency and health: Emergency rooms.

We have millions of people living in this state and nation who are still waiting for immigration reform. It makes no sense to provide for their health only in the most expensive settings like emergency rooms.

More than half of what ails us as a society is completely preventable. Imagine how much you can reduce the cost to Medi-Cal and taxpayers if we prevented the things that can be prevented. The only way you do that is by making prevention available to everyone.

If we look at our experience with expanding access to Medi-Cal under Obamacare, we’ve already seen an enormous increase in access to preventive care. The rates of childhood immunizations have gone up. The rates of mammograms and other low-cost preventative interventions have gone up.

All of those things are very low cost but can save the state money in the long-term by preventing other illnesses that are more costly. It’s the same with the undocumented population.

There may be some out there who would advocate turning people away in an emergency medical situation or mass deportation. We don’t think those are realistic options, nor are they the right thing to do. We need a common-sense approach to our health policy. Common sense tells you to include everyone.