When Congress passed President Obama’s health care overhaul, a critical compromise provision was that immigrants living in the United States illegally would not be allowed access to publicly subsidized health insurance. Even now, as lawmakers in Washington are debating an overhaul of immigration laws, leaders from both parties are arguing that no federal money should be spent on health care for immigrants on their way to obtaining citizenship.
But not in California, where there are an estimated 2.6 million illegal immigrants. Here, public health officials, elected representatives and advocacy groups are going in the opposite direction, trying to cobble together ways to provide preventive care for such immigrants, who are expected to make up the largest share of the remaining uninsured once the state’s expanded Medicaid program takes full effect....
While other states are resisting efforts to expand Medicaid, California has already begun public campaigns to encourage more residents to enroll in subsidized health plans.
But in counties with large immigrant populations like Los Angeles, officials say that not including immigrants in coverage, regardless of their legal status, will only cost local government more in the long run. So they are lobbying state and federal officials to find ways to pay for preventive health care, rather than rely on emergency rooms to care for them....
In the current system, illegal immigrants in California rely on a patchwork of community clinics, whose services and availability vary across the state. Few offer comprehensive coverage, and those that do often struggle to find government money to pay for the services they offer. Some advocates worry that as more people get insurance or enroll in Medicaid, the clinics will be inundated with new patients and forced to squeeze out anyone — including illegal immigrants — who cannot pay for care.
Nowhere is this issue more pressing than in California, which has more illegal immigrants than any other state.
“California has really acknowledged that all immigrants who are here are part of our present and our future, so we need them to be healthy and included in any effort we make to expand health care,” said Daniel Zingale, a senior vice president with California Endowment, a health care foundation leading the charge to persuade the state to pay for comprehensive care for all immigrants. County leaders, immigrant advocates and labor unions have formed an unlikely alliance to press for change....
While the state budget does not explicitly earmark any money to pay for health care for illegal immigrants, it also does not forbid counties from using state money to do so, something Mr. Zingale and others count as a victory.
This year, the California Endowment began running television advertisements showing young illegal immigrants pleading for health care. To Mr. Zingale’s surprise, the foundation faced almost no public outcry....
When the federal government began offering subsidies for the early expansion of Medicaid, Los Angeles and other counties began to seek out more residents to enroll in low-income health programs, using money from the state to pay for it....
