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Newsom wants to extend health care to all undocumented immigrants

San Francisco Chronicle logo San Francisco Chronicle 1/13/2022 By Tal Kopan and Dustin Gardiner
California Gov. Gavin Newsom unveils his proposed $286 billion 2022-2023 state budget during a Monday news conference in Sacramento. The governor wants to make California the first state to cover all low-income residents under its Medicaid plan regardless of their immigration status. © Rich Pedroncelli/Associated Press

California Gov. Gavin Newsom unveils his proposed $286 billion 2022-2023 state budget during a Monday news conference in Sacramento. The governor wants to make California the first state to cover all low-income residents under its Medicaid plan regardless of their immigration status.

Gov. Gavin Newsom’s bid to make California the first state to extend health benefits to low-income undocumented residents of all ages is the fulfillment of a long progressive fight to cement the state’s place at the vanguard of immigrant rights.

The proposal comes amid a pandemic that has disproportionately harmed Latino and immigrant communities. But it puts the state further at odds with national trends at a time of partisan hostility over the issue, with reactions to the proposal highlighting the growing fissures.

During a news conference Tuesday at a health clinic in the Central Valley, Newsom said he was making good on a promise from his 2018 campaign. The governor spoke alongside labor and civil rights leader Dolores Huerta, who called the proposal “a very historic moment.”

“We are implementing our ideals,” Newsom said. “We have universal health care in this state and in this country, but it’s on the back end. It’s called the emergency room and it’s costing you, the taxpayer, a fortune.”

Pro-immigrant advocates Monday heralded the Democrat’s budget proposal, in which Newsom would expand Medi-Cal, the health care program for low-income Californians, to include all people regardless of their immigration status, starting no earlier than 2024.

They say the step, which would cost about $2.7 billion per year, is a welcome recognition that undocumented immigrants contribute significantly to the California economy and that their health and well-being matters as much as that of their neighbors.

“If you look back at the last two years, it is exceedingly clear that undocumented immigrants have played an outsize role in the response and recovery to COVID-19, particularly in a state like California,” said Ali Noorani, president of the National Immigration Forum, a centrist immigration advocacy group. “So the impact on California’s physical and economic health of the state, because of this expansion, is tremendous. ... California is being California. (But) the rest of the country is not California. And I say that as a Californian.”

Indeed, the move stands in contrast with immigration politics nationally. Among states, New York has also expanded programs for undocumented immigrants, including allowing some to vote in local elections, but many conservative-led states are moving in the opposite direction, seeking to increase restrictions in moves they argue will de-incentivize coming to the U.S.

State Sen. Jim Nielsen, a Republican from Tehama County who opposes the Medi-Cal expansion, said it would obligate the state to provide benefits to undocumented residents “in perpetuity.”

“We’re going to be assuming the burden of those individuals without necessarily providing them with opportunities to find work and, in fact, become an asset rather than a liability to our budget,” said Nielsen, vice chair of the Senate budget committee. “That’s what I call budget busting.”

The move to expand Medi-Cal coverage caps a nearly decadelong battle led by immigration advocates and progressive legislators. In 2016, the Legislature expanded the full scope of coverage — including preventive, dental and mental-health care — to all undocumented children through age 18, and young adults up to age 26 were added a few years later.


Video: Newsom pushes expanded health care for immigrants (Associated Press)

State Sen. María Elena Durazo, D-Los Angeles, who has been at the forefront of the effort to eliminate immigration status as a criteria for coverage, said proponents gradually won the votes of more legislators — using both practical and emotional arguments. She said waiting to treat an undocumented person with diabetes until the person ends up in the emergency room increases costs and, in severe cases, causes the loss of a limb due to an otherwise manageable disease.

“It didn’t make any sense on the human level or the economic level,” Durazo told The Chronicle. “It gets very emotional to think that life and death is on the line.”

As support grew, the move toward universal Medi-Cal coverage was hampered by the state’s tight finances early in Newsom’s administration, particularly at the start of the pandemic when the state projected it could face a jolting $54 billion budget deficit.

At the same time, the pandemic ripped through Latino and immigrant communities, which faced far higher rates of infections and deaths due to the virus. Latino people have accounted for more than 50% of infections and 45% of COVID-related deaths in California, where they make up less than 39% of the population, according to the state Department of Public Health.

But the economy rebounded much faster than expected, bringing two years of budget windfalls. Last summer, when the state projected a nearly $76 billion surplus, Newsom and legislators agreed to expand Medi-Cal coverage to undocumented seniors, people age 50 or older, a change that takes effect May 1.

Newsom’s proposal to close the gap for income-eligible immigrants ages 26 through 49 is part of his budget for the upcoming fiscal year, when the state expects to have a nearly $46 billion surplus, though the expansion would not take effect until at least Jan. 1, 2024.

The plan still must be approved by state lawmakers, but there’s little doubt it will sail through the Democratic-dominated Legislature. Durazo said the apparent victory reflects not only the state’s flush coffers but disparities in the health care system that were exposed by the pandemic and made it harder to protect undocumented workers, many of whom fill essential roles in the agriculture, health and transportation sectors.

“They literally were sacrificing their lives, and the numbers bear that out,” Durazo said. “They didn’t stop working. The farmworkers didn’t stop working.”

Angelica Salas, executive director of CHIRLA, a pro-immigrant-rights advocacy group based in Los Angeles, said Newsom’s decision to advance the issue despite potential political backlash could swing momentum nationally.

“You see Gov. Newsom lean into the issue of immigration, not to try to sidestep it, not to try to ignore it, but to lean in and really see it as essential to the advancement of the state,” said Salas. “I feel that that’s what’s not happening in Washington, D.C. ... What Gov. Newsom shows is we must stop just talking about immigrants as important to our country, essential to our country, to our fabric and our diversity — it can’t just be rhetorical. It has to be real changes and real policies and laws that uplift.”

Some advocates, however, wanted bolder action from the governor. Ron Coleman, managing director of policy for the California Pan-Ethnic Health Network, a multicultural advocacy group, said California should not wait until 2024 to extend coverage. In addition, he said, the state should provide subsidies so undocumented people whose incomes exceed the eligibility cap for Medi-Cal — $17,775 for an individual in 2022 — can buy coverage through Covered California, the state’s health insurance marketplace.

“We can’t afford to lose any more lives of undocumented Californians simply because of lack of access to health care,” Coleman said.

Meanwhile, anti-immigration leaders on the right seized on the proposal to attack Newsom, with Fox News declaring that he wanted to provide undocumented immigrants with state-funded abortions. Abortion is legal in California, and many undocumented immigrants pay taxes, particularly in California.

Noorani, of the National Immigration Forum, said the 2018 midterm elections that gave the House majority back to Democrats and President Biden’s election in 2020 show that the American public is receptive to more immigrant-friendly policies. Nonetheless, he fears backlash that could harm immigrants in other states, and agrees with Salas that a lack of pro-immigrant messaging from the White House contributes to polarization on the issue.

“That moderate suburban voter, what they want to make sure is we have a secure border, that immigration is controlled and that people are treated fairly and compassionately,” Noorani said. “I am hard-pressed to believe that that voter is going to look at what California is doing and say, ‘OK, this checks all those boxes.’”

Chronicle senior political writer Joe Garofoli contributed to this report.

Tal Kopan is The San Francisco Chronicle’s Washington correspondent, and Dustin Gardiner is a Chronicle staff writer. Email: tal.kopan@sfchronicle.com, dustin.gardiner@sfchronicle.com Twitter: @talkopan, @dustingardiner

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