- BIOETHICS FORUM ESSAY
California’s Strides in Providing Health Care for Undocumented Immigrants
I had just turned 5 in November 1994 when my fellow Californians voted to pass Proposition 187 in a draconian attempt to restrict undocumented immigrants from receiving health care, education, and other services, as well as to require doctors, teachers, and others to report those suspected of violating immigration law to the authorities. The key provisions of this initiative were, thankfully, deemed unconstitutional before it was implemented, but it came far too close for comfort.
I bring this up because recent events indicate a paradigmatic shift in California’s response to undocumented immigrants’ need for health care that has given me cause to be quite proud of my home state. In the past month, California has become one of the foremost champions of undocumented immigrant rights. The transformation started on June 2 with the passage of SB 4 by the California Senate. SB 4 expands Medi-Cal (California’s Medicaid program) coverage to all undocumented children below age 19, and it opens up the state insurance exchange to undocumented adults. The bill remains in limbo, awaiting approval from the Assembly and Governor Jerry Brown, but on June 24, the governor signed the state budget, which included one key provision of the bill: funding to expand Medi-Cal to include all children – regardless of immigration status – beginning in May 2016.
California joins New York, Washington, Illinois, Massachusetts, and Washington DC in providing health care to all children. California is home to 22 percent of the nation’s undocumented population: 600,000 more than the aforementioned states combined, and threefold more than the next highest state on that list, New York.
The California state budget did not include any reference to the expansion of health care to include undocumented adults, which means that the majority will have to wait until the Assembly and Governor Brown take on SB 4. Meanwhile, the day that the budget was signed, 35 of California’s rural counties decided to expand limited coverage to indigent undocumented adults. This expansion marks another symbolic step forward in California’s clear commitment to changing the way it takes care of people residing in the state without authorization.
My tone might seem far too optimistic given the overarching stance our country has taken on this issue. The list of states unwilling to provide care to undocumented children is still the overwhelming majority, and no state (other than California) is close to expanding health care coverage without consideration of immigration status. The Affordable Care Act has actually helped ensure that undocumented patients would remain the most underinsured population in the country. Our unwillingness to provide health benefits to certain immigrant classes remains one of the issues upon which the left and the right are able to agree, and any drastic policy change, especially at the federal level, seems to be some time away.
The steps taken by California give me cause for excitement because it has come so far so quickly. I read Prop 187 and despaired at how far away my state seemed from getting it right. How, I asked myself, could I reasonably hope for undocumented health care to improve in California when the vast majority of the state seemed to not only think physicians should refuse treatment, but should also take a hand in initiating the deportation process? In only 20 years, we have raced to the front of the pack, showing the rest of the country just how much a state can do, despite persistent indifference in Washington. Providing undocumented immigrant health care is an essential societal pursuit, and although we still have a ways to go, I am proud that California is progressing in the right direction.
Jacob Perrin, MA, is a medical student at University of North Carolina at Chapel Hill and intern for the Hastings Center’s Undocumented Patients project and the Clinical Ethics Network of North Carolina (CENNC).
Posted by Susan Gilbert at 07/13/2015 09:54:47 AM |
|h a state can do, despite persistent indifference in Washington. Providing undocumented immigrant health care is an essential societal pursuit, and although we still have a ways to go, I am proud that California is progressing in the right direction.
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