Marisol Pantoja Toribio found a lump in her breast in early January. Uninsured and living in California, with no legal status and no family, the usually carefree 43-year-old quickly realized how limited her options were.
“I asked, ‘What am I going to do?’” she said in Spanish, quickly becoming emotional. She immediately worried that she might have cancer. “I went and came back – I have [cancer], I don’t have it, I have it, I don’t have it. And if she was sick, she added, she wouldn’t be able to work or pay the rent. Without health insurance, Pantoja Toribio was unable to find out if he had a serious problem.
Starting this year, Medi-Cal, California’s Medicaid program, expanded to include immigrants without legal residency, a timing that could have worked out perfectly for Pantoja Toribio, who has lived in the Bay Area city of Brentwood for three years. But her Medi-Cal application was quickly rejected: As a farmworker earning $16 an hour, her annual income of about $24,000 was too high to qualify for the program.
California is the first state to expand Medicaid to all eligible adults regardless of immigration status, a move celebrated by health advocates and political leaders across the state. But many immigrants without permanent legal status, especially those who live in parts of California where the cost of living is higher, earn a little more money to qualify for Medi-Cal.
The state is footing the bill for Medi-Cal expansion, but federal law prohibits those it calls “undocumented” from receiving insurance subsidies or other Affordable Care Act benefits, leaving many employed but without viable options. of health insurance.
Now, the same health advocates who fought for Medi-Cal Expansion say the next step to achieving health equity is to expand Covered California, the state’s ACA marketplace, to all immigrant adults by passing AB 4.
“There are people in this state who work and are the backbone of so many sectors of our economy and contribute through their labor and even taxes… but they are excluded from our social safety net,” said Sarah Dar, policy director at the Center of California Immigrants. Policy Center, one of two organizations sponsoring the project, dubbed #Health for all.
To qualify for Medi-Cal, an individual cannot earn more than 138% of the federal poverty level, which currently amounts to nearly $21,000 per year for a single person. A family of three would need to earn less than $35,632 per year.
For people above these limits, the Covered California marketplace offers several health plans, often with federal and state subsidies, yielding premiums as low as $10 per month. The hope is to create what advocates call a “mirror marketplace” on the Covered California website so that immigrants, regardless of status, can receive the same health plans that would be subsidized solely by the state.
Despite an absolute Democratic majority in the legislature, the bill may have difficulty passing, with the state facing a projected budget deficit for next year of between $38 billion and $73 billion. Governor Gavin Newsom and legislative leaders announced a US$17 billion package begin to reduce the disparity, but significant spending cuts appear inevitable.
It’s unclear how much it would cost to extend Covered California to all immigrants, according to Assemblymember Joaquin Arambula, the Fresno Democrat who introduced the bill.
The Immigrant Policy Center estimates that creating the market would cost at least $15 million. If the law passes, sponsors will then need to secure funding for the grants, which could amount to billions of dollars annually.
“It’s a difficult time to ask for new expenses,” Dar said. “The initial cost of the mirror market is a relatively very low number. So we are hopeful that it is still within the realm of possibility.”
Arambula said he is optimistic that the state will continue to lead in improving access to health care for immigrants who do not have legal residency.
“I believe we will continue to rise up as we work to make this a California for everyone,” he said.
The bill passed the Assembly last July by a vote of 64 to 9 and now awaits action by the Senate Appropriations Committee, Arambula’s office said.
An estimated 520,000 people in California would qualify for a Covered California plan if not for the lack of legal status, according to the University of California-Berkeley Labor Research Center. Pantoja Toribio, who emigrated alone from Mexico after leaving an abusive relationship, said she was lucky. She learned about alternative health care options when she made her weekly visit to a food pantry at Hijas del Campo, a Contra Costa County farmworker advocacy organization, where she was told she could qualify for a plan. for low-income people through Kaiser Permanente.
Pantoja Toribio signed up just before open registration closed at the end of January. Through the plan, she discovered that the lump in her breast was not cancerous.
“God heard me,” she said. “Thank God.”
This article was produced by KFF Health Newswho publishes California Health Linean editorially independent service from California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the primary operating programs of KFF – an independent source of health policy research, surveys and journalism. Learn more about KFF.
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