Analysis: Why California Should Expand Health Coverage to Undocumented Seniors

Photo by iStock/Marcos Elihu Castillo Ramirez

For Sarah Dar, the success of California’s Health4All Campaign is a “life-or-death issue” for the state’s undocumented seniors.  If the expansion to cover undocumented seniors is legislated, it would be the first time in California’s history, says the public benefits director at California Immigrant Policy Center.  

While President Barack Obama’s 2010 health reform bill, the Affordable Care Act, greatly expanded insurance access, it excluded undocumented immigrants across the country. This likely contributed to COVID-19’s disproportionate impact on undocumented Californians—an example of how institutional inequity can have life-altering consequences.

Health equity and immigrant rights advocates have been urging California leaders to broaden health coverage for nearly a decade. Health4All began in earnest in 2013 when advocates first introduced legislation designed to expand Medi-Cal coverage to undocumented immigrants in California. Medi-Cal is California’s low-income health insurance program. Then in 2015, Gov. Jerry Brown signed SB 75 into law, expanding Medi-Cal access to undocumented children under 18 in the Golden State. And in 2019, Gov. Gavin Newsom expanded Medi-Cal coverage further to young adults up to age 25, regardless of immigration status.

But that hasn’t helped older adults like Pedro Montes Vargas, a former farmworker. Montes Vargas, 76, has been in California’s Central Valley since 1975. He worked in the fields as a repairman for decades, fixing irrigation systems and farm equipment, along with other related tasks. In recent years, Montes Vargas has been forced to slow down because of his age and health challenges. He has high blood pressure, diabetes, and high cholesterol, which have made it difficult for him to use his hands and continue to work.

Montes Vargas, who shared his story through an interpreter, now relies primarily on recycling to gain a modicum of income to support himself and his elderly wife. Because he is undocumented, he doesn’t qualify for Medi-Cal. He receives limited medical care from a local community clinic but is often unwilling to go because he has to pay out of pocket. Montes Vargas has already accumulated medical debt and receives regular calls from debt collectors. 

Pedro Montes Vargas. Photo from Central Valley Immigrant Integration Collaborative (CVIIC).

California has hundreds of thousands of other immigrants like Montes Vargas. If the state expanded Medi-Cal to all undocumented immigrants, they would be eligible to receive potentially life-saving health care.

Undocumented immigrants make up the single largest group of uninsured people in the state. Projections show that, if nothing changes, by 2022, undocumented Californians will comprise roughly 38% of California’s uninsured population. The lack of access to health care has likely contributed to higher mortality rates in occupations that undocumented Californians tend to hold, especially during the COVID-19 pandemic. For example, agricultural workers died at a 55% higher rate during the pandemic compared to pre-pandemic times. Mortality rates among California’s construction laborers and cooks soared by 49 and 60%  respectively. In comparison, Californians in general ages 18 to 65 experienced a 22% increase in mortality between March and October 2020. 

Undocumented immigrants have been instrumental in keeping California running during the pandemic. Not only do we rely on their work, but also their contributions to the economy and tax system. In 2018, undocumented Californians paid an estimated $3.7 billion in state and local taxes, and $7 billion in federal taxes. Ironically, some of their tax dollars fund Medi-Cal, the very program they’re excluded from. 

Health4All coalition members are now calling for the state to expand full Medi-Cal coverage to undocumented elders like Montes Vargas. They see this as the next critical step toward eventually expanding coverage to all undocumented adults.

Newsom included funding for undocumented seniors ages 65 and older in his January budget proposal for fiscal year 2020-21, but state leaders failed to include the expansion in the final budget, citing the economic downturn created by the COVID-19 pandemic. 

Beginning in 2018, I served as a campaign coordinator for the Health4All campaign for two years. I saw firsthand how determined residents in the Inland Empire were to find health care for their elderly relatives and neighbors. I remember community members from TODEC Legal Center passionately advocating for immediate coverage of undocumented elders in their community during a legislative visit to state Sen. Richard Roth’s office. After years of organizing and storytelling, their work was so powerful that it led Roth to agree to co-sponsor the senate bill for Health4All Seniors in 2019. Moments like these remind me that the stakes of organizing for health equity are not theoretical—they are life-altering.

Newsom has shown a willingness to lead on the defining issues of our era. He’s taken concrete steps to make health care more affordable and accessible. It’s time for the governor to prioritize expanding health care to one of our state’s most vulnerable groups. 

The momentum is present, the economic rationale is clear, and the moral reasons are indisputable. It is now up to our state leaders to decide whether or not community elders who have sacrificed their working lives to support California’s economy deserve to live and age with dignity.

This story was produced in partnership with Yes! Magazine.

Denzel Tongue writes a column for the California Health Report about the intersection of racial justice, public policy and health equity. He is a master of public policy candidate at The Goldman School of Public Policy and a California Initiative for Health Equity Fellow.

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