Marisol Pantoja Toribio discovered a lump in her breast in early January. The normally happy 43-year-old, who had no insurance and lived in California without her legal status or her family, realized how limited her options were. I recognized it right away.
“I said, 'What are you going to do?'” she said in Spanish, quickly becoming emotional. She immediately worried that she had cancer. She said: “I went back and forth. [cancer]”I don't have it, I have it, I don't have it,” she added, and if she gets sick, she won't be able to work or pay her rent. Without health insurance, Pantoja Toribio couldn't make it. She cannot afford to find out if she has a serious illness.
Starting this year, California's Medicaid program, Medical, has expanded to include immigrants without legal residency, but for Pantoja Toribio, who has lived in the Bay Area city of Brentwood for three years, The timing could have been perfect. However, her application for Medi-Cal was quickly denied. She is a $16-an-hour farm worker, and 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 welcomed by health advocates and political leaders in the state. However, many immigrants without permanent legal status, especially those living in areas of California where the cost of living is highest, earn slightly too much to qualify for Medi-Cal.
The state has a bill to expand Medi-Cal, but federal law prohibits what the state calls “illegal aliens” from receiving insurance subsidies and other benefits from the Affordable Care Act. Many people are employed but remain without viable health insurance options.
Now, the same health advocates who fought for Medi-Cal expansion say the next step to achieving health equity is to pass AB 4, the state's ACA market, to all of immigrant adults.
“We have people working in this state who support so many sectors of our economy, donating their labor and tax dollars…but they are being shut out of our social safety net. ” said Sara Darr, policy director for the California Immigration Institute. The Policy Center is one of her two organizations sponsoring the bill, called #Health4All.
To qualify for Medi-Cal, an individual cannot earn more than 138% of the federal poverty level. This level currently amounts to approximately $21,000 per person per year. For a family of three, the annual income must be less than $35,632.
For people who exceed these criteria, the Covered California Marketplace offers a variety of health plans, often with federal and state subsidies, and premiums as low as $10 per month. The hope is to create what advocates call a “mirror marketplace” on the Covered California website that would provide immigrants, regardless of status, with the same state-only subsidized health plans. Thing.
Despite Democrats holding a supermajority in the Legislature, the state is expected to run a budget deficit of $38 billion to $73 billion next year, which could make passing the bill difficult. be. Gov. Gavin Newsom and legislative leaders have announced a $17 billion package to begin reducing inequality, but deep spending cuts seem inevitable.
Rep. Joaquin Arambula, a Fresno Democrat who introduced the bill, said it's unclear how much it would cost to expand California coverage to all immigrants.
The Immigration Policy Center estimates that establishing the market would cost at least $15 million. If the bill passes, sponsors would need to secure funding for grants, which could amount to billions of dollars a year.
“These are tough times to seek new spending,” Dahl said. “Miller said the startup costs of the marketplace are relatively very low numbers, so we hope it's still within the realm of possibility.”
Arambula said he is optimistic the state will continue to take the lead in improving health care access for immigrants without legal residency.
“I believe we will stand up to make this a California for everyone,” he said.
The bill passed the House on a 64-9 vote last July and now awaits action by the Senate Appropriations Committee, Arambula's office said.
If it weren't for the lack of legal status, an estimated 520,000 Californians would be covered by the Covered California Plan, according to the Center for Labor Research at the University of California, Berkeley. Pantoja Toribio, who immigrated alone from Mexico after leaving an abusive relationship, said she was lucky. She learned about alternative health options during weekly visits to the food pantry of Hijas del Campo, a farmworker advocacy group in Contra Costa County, where she received a plan for low-income people through Kaiser Permanente. She was told she might be eligible.
Pantoja Toribio applied just before the application closed at the end of January. Through her plan, she learned that the lump on her breast was not cancerous.
“God heard me,” she said. “thank god.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
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