State senator's bill seeks health aid for undocumented; costs unclear

In an effort to make health insurance available to undocumented immigrants who are barred from receiving federal benefits under the Affordable Care Act, state Senator Ricardo Lara (D-Long Beach) plans to unveil legislation on Friday that would commit the state to help pay for their coverage. Questions remain about how much his measure would cost taxpayers if it becomes law.

Lara’s office would not comment on the legislation before it’s released, but advocates who have been helping him draft the bill say it will include two main provisions.

First, it would allow poor undocumented immigrants to sign up for Medi-Cal, paid for by the state. Second, it would allow immigrants with incomes too high to qualify for Medi-Cal to receive a state subsidy to help with the cost of private insurance, similar to the federal subsidies available through Covered California, the state’s health insurance marketplace.

Not all undocumented immigrants will need the bill, said Reshma Shamasunder, director of the California Immigrant Policy Center, one of the groups helping to draft the legislation.

"Many undocumented, working-age Californians do have access to health insurance," she said. "This would basically cover those who’ve been excluded from care."

Experts say of the estimated 2.1 to 2.5 million undocumented immigrants in California, many buy private coverage or get it through employers. But about 1 million are believed to be uninsured.

Analysts say they need to understand who makes up that group and what their health needs are in order to sort out what Lara’s bill would cost the state.

Part of the answer lies in determining how many of the undocumented will enroll in Medi-Cal or buy private insurance, said Ken Jacobs, a UC Berkeley researcher.

Participation by the undocumented population might be lower than the general population, he said, noting fear of government, language barriers and lack of knowledge about available options.

Jacobs said the cost analysis will also hinge on calculating savings associated with providing preventive and primary care to undocumented immigrants who currently may resort to expensive emergency care as their only option.

Recent analyses have found that undocumented immigrants who do have private coverage tend to use it less frequently than the general population, said Nadereh Pourat, research director at the UCLA Center for Health Policy Research.

It’s findings like those that supporters of Lara’s bill are likely to highlight as they try to gain traction in the legislature. Lara’s office says it’s actively seeking co-sponsors for the bill.

The Democratic-controlled legislature has passed other recent immigrant-friendly laws, though none has involved the expansion of social programs. Lawmakers and the governor’s office declined to comment on Lara’s bill because it hasn’t been formally introduced yet.