Ventura County Star by John M. Gonzales –
March 23, 2013:
CHCF Center for Health Reporting
Clinic director Fred Bauermeister has watched them pass through his doors for decades: chronically ill, uninsured men, women and children who have delayed medical care because they are in the country illegally.
Now, however, a political deal may be in the works that, after many years, could bring health benefits to millions of undocumented people.
A bandwagon of endorsements last week by congressional Republicans have aligned with vows by President Obama and Senate Democrats to establish comprehensive immigration reform. A road to citizenship for people who entered the country illegally seems more assured by the day, but what is less clear is how the health care landscape of California and the nation would change.
Would California’s estimated 2.5 million undocumented immigrants become eligible for health benefits? How would an already burdened health system absorb them?
“We’re very interested — and very concerned — with how this is all going to work out,” said Bauermeister, executive director of the Free Clinic of Simi Valley, which seeks to keep immigrants out of expensive modes of care like hospital emergency rooms.
Obama’s commitment to move an estimated 11 million undocumented immigrants nationally “out of the shadows” would not end there. Under current law, it would also slowly open the door for them to qualify for public programs, including health reform’s massive coverage expansions.
Obama’s plan would have immigrants wait at least eight years before they qualify for health benefits. A congressional plan spearheaded by Republican senators Marco Rubio and John McCain pushes the wait to at least 10 years.
Some experts believe both scenarios would create an interim period in which even wider gaps developed between the haves and have-nots of health care.
If health reform works as intended, there will not only be a boost in the number of new people covered, but also a steady improvement in their health. Meanwhile, undocumented immigrants would sit on the sidelines for at least a decade.
“We’re going to create a two-tiered system of health, as well as perpetuate disparities in health,” said Ignatious Bau, a San Francisco-based health policy consultant whose clients include insurance giant Kaiser Permanente.
The haves will continue to be stuck with the health care bill for the immigrant have-nots, Bau said.
There is a push by several groups, including the California Endowment, to win immediate health reform benefits for undocumented immigrants. But so far, neither President Obama nor Congress has shown any interest.
Rubio, of Florida, has said immediate health reform benefits for undocumented immigrants would force him to withdraw support for immigration reform.
“Senator Rubio’s position has not changed,” Rubio’s spokesman, Alex Conant, said in an email last week. He pointed out that “the White House and Senate Democrats have agreed that undocumented immigrants should not receive Obamacare.”
Some health providers believe that the gradual approach proposed by Washington is the only way to accommodate the undocumented population, particularly in immigrant-heavy states like California.
“From a pure numbers point of view, it would allow the system to ramp up to accept these folks,” said Dr. Martin Serota, chief medical officer of AltaMed, a California clinic network that serves 150,000 families a year.
Serota said the health system also needs time to train immigrants as caregivers, filling health reform’s need for bilingual, bicultural medical staff.
Health insurance reform, which fully takes effect in 2014, consists of two coverage methods. One is the Medicaid safety net, called Medi-Cal in California, from which undocumented immigrants are generally excluded.
The other is the government subsidized insurance exchange designed to help consumers find affordable health plans of their own choosing. Undocumented immigrants cannot participate in the exchange, either.
According to a 2011 study by the UCLA Center for Health Policy Research, 84 percent of California’s 7 million uninsured will qualify for health reform coverage as it currently stands.
If undocumented immigrants were added to the mix, 100 percent of the state’s uninsured would then be eligible for some form of coverage. Still, experts say, because of language barriers and personal choice, it is unlikely every qualified immigrant would apply.
Nationally, the Congressional Budget Office reported in 2010 that more than 90 percent of U.S. residents could eventually be insured with the boost provided by health reform, leaving about 23 million uncovered. If undocumented immigrants were granted coverage, the uninsured would be slashed by an additional third.
The CHCF Center for Health Reporting (www.centerforhealthreporting.org) is an independent news organization that reports about health care issues. It is based at USC’s Annenberg School for Communication and Journalism and funded by the nonprofit California HealthCare Foundation.