While the Trump administration continues its efforts to dismantle the Affordable Care Act and Democrats running for president make promises about guaranteed health insurance for all, California has made an incremental but important move that deserves public attention. As part of a broad state budget plan, Gov. Gavin Newsom and members of the California State Legislature are poised this week to approve limited health care coverage for low-income adults living in the country illegally.
The proposal, which is expected to win final approval before a June 15 budget deadline, would make California the first state in the country to provide such coverage to the undocumented. That is certain to generate outrage from anti-immigrant forces, including President Trump. While relatively small (fewer than 100,000 people are expected to meet the eligibility criteria), the program’s symbolic importance greatly overshadows its $98 million cost. It’s a safe bet that an administration that saw nothing wrong with separating immigrant children from their families at the southern border will decry any proposal, humanitarian or otherwise, that helps the undocumented in some manner, particularly at taxpayer expense.
But that kind thinking is not only inhumane, it’s extraordinarily shortsighted. For one thing, there are an estimated 11 million undocumented people in the United States, or roughly 3.3 percent of the population. They aren’t going away. Ignoring their health needs isn’t just harmful to those men, women and children, but, as the recent measles outbreak demonstrated, keeping them out of doctors’ offices can have adverse consequences for all of us. Hospitals treat emergency patients regardless of income or residency status (or ability to pay), so that’s a given. The real question facing society is whether to provide preventative or even palliative care like vaccinations, checkups, cancer screening, medical prescriptions and so on. The question isn’t just can Americans afford to underwrite health care, it’s also: Can they afford not to?
One of the interesting aspects of California’s proposal — as part of its “Medi-Cal” Medicaid program — is that it would be financed by taxing people who have failed to purchase health insurance. Sound familiar? That’s right, it’s the old Obamacare “individual mandate” that Republicans in Congress so happily deep-sixed as part of their 2017 tax reform package. The mandate may have been unpopular in some circles, but it was vital to keeping as many Americans as possible in the insurance pool. The more young and “healthy” people buy insurance, the more affordable insurance is for everyone. Otherwise, it’s like having a Social Security plan where nobody had to pay into the program until they hit age 60. You could still have such retirement insurance, but the premium would be astronomical.
That’s not to suggest California has the best solution to this complex problem, but we think this kind of incremental approach is just what the doctor ordered. While Sen. Bernie Sanders and others (from Julián Castro to Sen. Kamala Harris) running to be the Democratic presidential nominee tout Medicare For All, the projected cost of which varies greatly but has been estimated in the trillions of dollars, why not experiment with smaller, less expensive steps that may, or may not, ultimately lead in that direction? That philosophy was at the core of the ACA and, had Republicans not launched their great dismantling crusade, Washington would likely be encouraging such explorations at the state level. What works and what doesn’t work? Nobody has the market cornered on the answer to that question.
Ironically, President Trump’s antagonism toward the undocumented and his cavalier export-immigrants-to-sanctuary-cities rhetoric has likely fueled some of California’s Blue State enthusiasm for providing subsidized health insurance to low-income immigrants. Even so, if the Democratic Party’s cry for “heath care for all” is going to be an inclusive as “all” implies, people who are in the country illegally ought to be included. Basic health care is a right in most of the developed world. Why not in the U.S.? Will it prove too costly? Will it mean longer waits or poorer services for other Medicaid eligible patients? Those are the questions that California will soon be able to resolve — to the benefit of Maryland and other states.