California becomes first state to give young undocumented adults health care. But is that enough?

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The health care system failed Ana because of her immigration status: she’s undocumented.

Ana’s last two pregnancies were riddled with complications. But her lack of insurance exacerbated her health problems. She didn’t qualify for full-scope Medicaid, even though she was eligible by income, but the state did offer her pregnancy-related Medicaid, a public plan that covers every pregnant resident regardless of immigration status, but comes with an expiration date (60 days after labor) and only pays for some services.

“Giving birth is very painful and it doesn’t just end after the baby is due,” said Ana, who spoke to ThinkProgress on the condition of not disclosing her last name.

For her, the contractions were stronger after labor, but her plan didn’t cover the medications she needed for long, so eventually she just had to deal with it. Her insurance also only covered postpartum care for 60 days, even though the American College of Obstetricians and Gynecologists recommends comprehensive postpartum evaluation 84 days after delivery.

She had an especially challenging time after she gave birth to her youngest: she developed a painful infection of her breast tissue (mastitis) and her newborn acquired an infection of the mouth. Ana couldn’t feed her newborn, which she said was “a horrendous thing for both of us.” Her plan wouldn’t cover her doctor’s visit, so she had to go to the emergency room. There, she was given antibiotics for her baby but was told to just use cold water in the shower for herself.

On Tuesday, California Gov. Gavin Newsom (D) signed legislation that would have helped Ana through two of her four pregnancies. The new law will, beginning in January 2020, cover undocumented adults ages 25 and younger through Medicaid, public insurance for low-income people. That means roughly 90,000 more residents will have health insurance.

The law is a victory for immigrant rights and health activists, who have been have been fighting for California to cover all residents, regardless of their immigration status. The undocumented are the largest uninsured group in California; estimates suggest somewhere between 1.4 and 1.5 million lack coverage. Nationwide, immigrants are the largest segment of the uninsured population and are also the only community barred by federal law from receiving subsidized insurance, regardless of medical need or income.

California does offer various health plans to undocumented immigrants. Since 2016, the state has offered Medicaid to undocumented immigrants up to age 18. Others, like Ana, can qualify for pregnancy-related insurance.

Ana said it always seemed unfair to her that she was only able to get some kind of insurance when she was a mother. “Human value shouldn’t be placed on whether you have kids or not,” she said. “Health care should just be available for many.”

The new law still doesn’t cover everyone due to its age restriction, including Ana, who is now 29 years old and raising her four children. Some lawmakers have been introducing bills to close the gaps: there’s legislation to cover undocumented seniors, legislation to make undocumented immigrants eligible for Obamacare subsidies, and legislation to move California into a single-payer system where everyone is included. But so far this legislative session, activists have scored just the one win for young adults.

Ana now has real health insurance through the Violence Against Women Health Act, and she credits it for a lot of her success. Four years after the birth of her last child, Ana is now getting a degree in health science. She’s going to school to become a breastfeeding counselor and doula. She had challenging pregnancies, and wants to help others through theirs. 

“You just start to feel better — you start to feel motivated because you are seeing things change… so you are not just there,” said Ana, referring to what it’s like to have insurance.

Ana was happy to hear her home state of California was the first state to cover some undocumented adults. Maybe it means lawmakers were willing to eventually cover everyone, regardless of their immigration status, she thought aloud. The conflicted feelings Ana describes are shared by many within the blue state that’s otherwise leading the country on health care.

“For California’s immigrant communities, [it] is bittersweet,” said Cynthia Buiza, the executive director of the California Immigrant Policy Center, in a statement.

“Our leaders must treat all Californians with the same compassion we would hope for when we need it. We call upon Governor Newsom to honor this principle with an investment for #health4all,” she added.

The idea of giving undocumented immigrants health care is gaining traction nationally. Nearly every Democrat running for president supports it. The Democratic debates made it clear that the idea is less controversial than moving everyone into one government plan where patients pay nothing in premiums and close-to-nothing in cost-sharing.

However, it’s unclear how hard Democrats are willing to fight for this. Former Vice President and Democratic presidential nominee Joe Biden wouldn’t respond to a debate question about why the Affordable Care Act excluded immigrants. Medicare for All legislation, supported by candidates like Sens. Bernie Sanders (VT) and Elizabeth Warren (MA), does not explicitly say it’ll cover the undocumented, though it is implied.

Public health experts studying this issue say covering the undocumented at large is a no-brainer if the party believes health is a human right.

“Health care for all means health care works better for everyone,” said Medha D. Makhlouf, who’s written about the issue for Penn State’s Dickinson Law. “We are a very well-off country. We have the means to provide a basic level of health care for all and we’re not doing it.”

Acting on this idea during a time when the Trump administration has been pursuing xenophobic policies also signals something more to immigrants. Officials have been actively trying to exclude the community from benefits and threatening mass deportations.

“It’s a way of saying we’re all sort of in it together, everybody contributes what they’re able, and an insurance system inherently just distributes the costs among the entire community,” said Makhlouf. “So it’s a way of bringing them into the community.” 




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