State health insurance exchange weighs new way to insure immigrants

Covered California officials are looking into a way that the state might be able to offer health insurance coverage to immigrants who are in the U.S. illegally and now barred from obtaining coverage under the federal Affordable Care Act.

Last week, the state health care exchange produced an analysis on possibly applying for a federal waiver, known as the Section 1332 State Innovation Waiver. 

The waivers to the Affordable Care Act seek "to modify certain provisions of the Affordable Care Act based on guidelines set forth by the federal Department of Health and Human Services," according to the California exchange.

The general idea is to allow states to pursue new strategies for improving coverage for residents under Obamacare.

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One option would allow immigrants in California who don't have legal status to buy health coverage at their own expense without government help. "These non-QHPs would not be subsidized with federal premium assistance or cost sharing subsidies," according to the exchange analysis.

Health care advocates back the idea.

“This exclusion never made sense to us," said Anthony Wright, executive director of Health Access California, an advocacy group. "It’s in our interest to have as many people covered as possible.”

State officials pointed to testimony from experts who weighed in during a forum in February that enrollment could increase if the waiver is approved.

"Expert opinion was that there could in theory be an increase in overall enrollment in Covered California due to mixed families being more likely to apply through one- stop shopping and because of reduced fears related to immigration status of undocumented family members," according to the exchange.

But it's an iffy process. State health officials would need to apply to federal health officials, who may or may not grant the waiver. Before the state can even apply for it, the California Legislature must clear the way. A bill that would authorize it passed the Senate last year 28-9, but has been pending in the Assembly since last June.

There's likely to be opposition to the idea of including those immigrants living in the country without authority under a government program, even with the insurance premiums borne by those who would be insured.

Opponents of SB 10, the bill that would authorize the state to seek a waiver, have questioned the legality of extending coverage to immigrants not here legally, and asked what administrative costs could be incurred in implementing the idea.

Covered California spokesman James Scullary said there's no cost estimate yet for administration, but one could be developed if the legislation moves forward. It's also unclear what financial impact there would be on California participants if the insured pool increases; this would depend on the health of those newly insured, he said.

Immigrants who would be most affected are adults with no option for coverage through the state exchange. Starting in mid-May, a new California law will allow youths under 19 to obtain full state-subsidized medical coverage under Medi-Cal, regardless of their immigration status.

According to the exchange analysis, Section 1332 waivers can take effect as early as Jan. 1, 2017.

This story has been updated.