In summary

A Democratic bid to extend government health coverage to all undocumented, low-income adults in California has been put on hold. Lawmakers now hope to cover at least the seniors and the disabled.

Update: The proposal to allow Medi-Cal coverage for undocumented senior and disabled immigrants did not survive budget negotiations.

After shelving a plan to provide full government health benefits to all undocumented, low-income adults in the state, California lawmakers are trying to extend coverage to seniors and the disabled in that population.

An estimated 1.8 million adult immigrants live in California without authorization, and roughly 1.2 million of them are poor enough to qualify for Medi-Cal, the state’s version of Medicaid. They can get care in emergency rooms, but a proposed new law would have provided them with full Medi-Cal benefits, including preventive care.

That idea, contained in bills by Democratic Sens. Ricardo Lara of Bell Gardens and Joaquin Arambula of Fresno, took a major hit this week when the measures were placed in the dreaded “suspense file,” where bills sit in limbo and often die. Instead, Democratic lawmakers have included a vastly scaled-back version in the ongoing budget negotiations, which will conclude in mid-June.

The original plan was estimated to cost California $3 billion a year, and Gov. Jerry Brown has signaled extreme reluctance to spend such a large portion of the state’s nearly $9 billion surplus. And billions in taxpayer funds for undocumented residents may be an especially hard sell in this election year, when state Republicans are using illegal immigration as a wedge issue, hoping to drive GOP voters to the polls to support their candidates and causes.

Democratic lawmakers are now pushing for $250 million in the next budget to cover roughly 114,000 low-income seniors and disabled residents who are undocumented.

In 2016, the state extended Medi-Cal benefits to undocumented children, and nearly 250,000 have enrolled since then, at a cost to the state of about $280 million. Adults’ health care is more expensive overall than children’s.

Opponents have said it’s a mistake for the state to pay for full-scope health care benefits to any portion of the undocumented population—whether it’s adults, children or seniors—not just because of the cost but also on principle, because many people without documentation are here illegally.

John Baackes is CEO of LA Care Health Plan, the largest publicly operated health plan in the nation. Baackes said the undocumented adult population is the largest segment of people in the state without health insurance, and getting them coverage is a huge cost-saver in the long run.

“Their care right now is episodic and inefficient—and expensive,” he said. California is already paying to care for them in emergency rooms and other urgent-care facilities, so the choice is whether or not to do that in a low-cost way, he said.

Including the low-income undocumented population in Medi-Cal potentially could save federal dollars, because it would ease the financial burden of free care received at federally qualified health centers.

Lara has argued that providing full care would save the state money, both in the expense of care and in increased worker productivity, because working adults wouldn’t wait till they’re really sick and rush to get expensive emergency room care.

He and others said the Trump administration’s crackdown on illegal immigration is deterring some residents from seeking needed care. Immigration and health care advocates have speculated that’s why enrollment of undocumented children in California’s public health services has been slower than expected. Many immigrants fear that using those services could lead immigration officials to deport them or family members.

“The fear-mongering is higher now,” Lara said. But he said California needs to blaze its own path, to look at its long-term future: “Fear in the immigrant community was there before Trump, and it will be there after Trump.”

In the end, Sacramento policy shifts almost always come down to cost, said Micah Weinberg, president of the Bay Area Council Economic Institute, a nonprofit think tank based in San Francisco.

Multiple studies have shown, he said, that immigrants are a benefit to communities where they live. The real problem, Weinberg said, is that health care costs too much, so adding undocumented adults becomes a pricier proposition than it should be.

“More health care for more people costs more money,” Weinberg said. “There’s no way around that.”

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