Micaela Roldan of Oxnard has lived in the United States for three decades without health insurance.
She has chronically swollen feet, and suffers from depression and insomnia stemming from the death of her son in a car accident two years ago. But the 63-year-old immigrant from Mexico avoids seeking medical care. Going to the doctor – even a low-cost health clinic – typically sets her back $25 plus the cost of medications, she said. She can’t afford that on her meager earnings selling popsicles on the streets of Oxnard.
These days, Roldan also worries about contracting COVID-19 because of her regular interactions with the public. Her older age and lack of consistent preventive care put her at high risk for serious complications and death if she gets the virus.
“I leave it in God’s hands,” she said in Spanish as she pushed her cart through traffic on a recent afternoon. “He knows I don’t want to walk the streets, but I’m out here because I have to eat and earn enough to pay my rent.”
Roldan is among an estimated 1.5 million undocumented California residents with no health insurance. About 27,000 are seniors ages 65 and older. Unless they’re pregnant or facing an emergency, undocumented people over age 25 don’t qualify for Medi-Cal, California’s health insurance program for people with limited incomes. They’re also barred from purchasing coverage through the state’s health insurance exchange, Covered California. Some counties – including Ventura – do offer discounted primary care to the uninsured, but options vary widely across the state and some counties provide no coverage beyond emergency treatment.
Now, amid the coronavirus pandemic, public health experts and immigrant advocates are calling on Gov. Gavin Newsom and state legislators to fulfill a budget proposal that would expand Medi-Cal eligibility to undocumented seniors. They argue that having thousands of uninsured elderly residents in the state puts these seniors and the broader public at risk. Back in January, the governor proposed allocating $80 million toward such an expansion in next year’s budget, but the plan looks increasingly uncertain given that the state is now projecting a $54 billion deficit because of the coronavirus.
Many of those supporting Medi-Cal coverage for undocumented seniors see it as a step toward a broader goal: extending coverage to all low-income, undocumented adults in California. (Undocumented children and young people up to age 25 can already enroll in Medi-Cal).
“It’s the smart thing to do,” said state Sen. Maria Elena Durazo, D-Los Angeles, who authored a stalled 2018 bill to expand Medi-Cal coverage to undocumented seniors. “If there are people in our state who are our neighbors, who go to church with us, their kids go to the same schools, you go to the beach together.
“To think that somehow we are not going to be affected if there are 1.5 million undocumented (residents) who don’t have access to healthcare is ridiculous.”
Opponents of expanding Medi-Cal to undocumented residents have expressed concern that it would be a burden to taxpayers, and argue that the state should focus its resources on legal citizens.
Mike Osborn, chairman of the Ventura County Republican Party, questioned the legality of expanding Medi-Cal to undocumented immigrants, and called the proposal “a political move.”
Hesitant to Access Care
As of April 8, coronavirus testing and treatment is free of charge for the uninsured, including those in the country illegally. But many undocumented immigrants don’t realize that, said Vanessa Terán, policy and communications associate with the Oxnard-based Mixteco/Indígena Community Organizing Project (MICOP). Like Roldan, these immigrants are accustomed to delaying or avoiding medical care because they don’t have insurance and fear getting hit with medical bills they can’t afford, Terán said.
Many also mistakenly believe they could be penalized under the Trump administration’s “public charge” rule if they receive government-funded care for the coronavirus. U.S. Citizenship and Immigration Services has specified that COVID-19 testing and treatment is not subject to the rule.
“It’s so confusing because for so long we were told: don’t access public benefits,” said Terán. Her organization is working to help immigrants understand that they can seek health care, “but it’s taking all of us — 60, 70 people and beyond — to reach these folks” in Ventura County, she said.
Another challenge is that, although testing and treatment for COVID-19 is covered, other ailments may not be, putting uninsured people at risk of paying for care if it turns out they don’t have the virus, said Steven Wallace, associate director of the UCLA Center for Health Policy Research. Undocumented immigrant communities tend to live by the mantra “when it doubt, go without,” when it comes to medical care, he said.
“The impulse is to avoid public services,” Wallace said.
Ventura County does provide substantially discounted primary and specialty health services to low-income, undocumented immigrants. The county implemented further discounts in April, said Dee Pupa, deputy director of managed care for Ventura County Health Care Agency. The cost of an office visit now starts at $10 including any in-clinic tests for the lowest-income individuals, and at $25 for urgent or specialty care, she said. A network of eight pharmacies supplies free or low-cost prescription drugs to the uninsured, she said.
But the extent of coverage varies widely across the state and, even where discounted programs exist, they often still require some amount of payment, which can be daunting for very low-income individuals. Federally funded community health centers provide primary care to the uninsured, but are generally geared toward women and children, and are not set up to handle the more specialized and complex needs of seniors, Wallace said. In Ventura County, lack of awareness or fear of accessing government-funded clinics means some undocumented immigrants don’t take advantage of the discounted care that’s available, Terán said.
Disparities in Deaths
Meanwhile, older Latinos are dying at disproportionately high rates from the coronavirus, according to statistics compiled by the California Department of Public Health. Latinos make up 32 percent of 50 to 64 year-olds in California, but account for half of COVID-19 deaths. Among people 65 years and older, they make up 21 percent of the population, but almost 30 percent of deaths. Not all Latinos are undocumented, but Latinos account for about three quarters of the state’s undocumented immigrants.
The number of undocumented seniors in California and across the nation is expected to grow. Many immigrants who are now elderly came to the country in their youth and obtained legal status through Ronald Reagan’s 1986 amnesty law. But those who arrived later haven’t benefited from a path to citizenship. Now, they are aging. Most pay taxes toward Social Security and Medicare, but they cannot access those benefits.
Covering preventive care allows people to get treatment early to manage chronic conditions such as diabetes and heart disease, which can improve their quality of life, Wallace said. For taxpayers, it’s also cheaper than paying for emergency care, and means hospitals and clinics don’t have to raise rates for everyone else to cover the cost of providing free and low-cost care to the uninsured, he added.
“It doesn’t have to cost more to make sure everybody has access to health care,” he said. “And it leads to a better, healthier society.”
For Roldan, getting health insurance coverage seems like a far-off dream. Even if the state extends Medi-Cal coverage to seniors 65 and older, she would have to wait two more years to qualify. A doctor she saw several months ago told her she needed therapy and depression medication. But Roldan said she’s struggling to pay for housing and food, and can’t afford anything extra. She keeps walking the streets with her popsicles, praying she can make next month’s rent.
“I don’t have anyone to support me. I don’t have any money,” Roldan said. “I have to keep going.”
This story is produced in partnership with the Ventura County Star.