Why California Should Expand Health Coverage to Undocumented Seniors

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

While President Barack Obama鈥檚 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鈥檚 disproportionate impact on undocumented Californians鈥攁n 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鈥檚 low-income health insurance program. In 2015, Gov. Jerry Brown signed聽聽into law, expanding Medi-Cal access to undocumented children under 18 in the Golden State.聽And in 2019, Gov. Gavin聽Newsom 聽Medi-Cal coverage further to young adults up to age 25, regardless of immigration status.

But that hasn鈥檛 helped older adults like Pedro Montes Vargas, a former farmworker. Montes Vargas, 76, has been in California鈥檚 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鈥檛 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 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.聽Projections show that, if nothing changes, by 2022, undocumented Californians will comprise roughly聽聽of California鈥檚 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聽 higher rate聽during the pandemic compared to pre-pandemic times. Mortality rates among California鈥檚 construction laborers and cooks soared by聽聽respectively. In comparison,聽Californians in general ages 18 to 65 experienced a聽 in mortality between March and October 2020.聽

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 in state and local taxes, and $7 billion in federal taxes. Ironically, some of their tax dollars fund Medi-Cal, the very program they鈥檙e 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 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 Legal Center passionately advocating for immediate coverage of undocumented elders in their community during a legislative visit to state Sen. Richard Roth鈥檚 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鈥攖hey are life-altering.

Newsom has shown a willingness to lead on the defining issues of our era. He鈥檚 to make health care more affordable and accessible. It鈥檚 time for the governor to prioritize expanding health care to one of our state鈥檚 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鈥檚 economy deserve to live and age with dignity.

This story was produced in partnership with the .

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.