In summary

The bill would expand Medi-Cal to low-income undocumented immigrants age 65 and older starting next July — and would inch California closer to covering all immigrants in the state illegally.

Update: The author announced on Sept. 14 that she was holding it over until 2020.

Democratic legislators are advancing a bill that aims to provide free health care to low-income undocumented seniors — an idea that they floated earlier this year, but which failed to make it into the state budget because of concerns over its cost.

The bill, authored by Los Angeles Democrat Maria Elena Durazo, would expand Medi-Cal — the state’s version of federal Medicaid  for low-income residents — to undocumented immigrants age 65 and older starting next July. That would inch the state closer to providing health care to all immigrants in the state illegally.

It faces a floor vote in the Assembly and then, if it passes, would return to the Senate for a final vote before landing on Gov. Gavin Newsom’s desk. Legislators are in a mad scramble this week to wrap up all bills by the Friday deadline.

The governor hasn’t indicated whether he would sign this bill, despite his previous support for universal health care. Experts note that he might object to its attempt to lock him into new spending for next year’s budget.

Newsom could see that as premature and a preemption of his powers, said Rob Stutzman, GOP consultant and former senior official during the Schwarzenegger administration.

“If he signs it, he’s agreeing to a strange budget process where you allow the Legislature to present certain budget issues before you get to the budget,” he said. “I would be surprised if the governor would want to cede that authority and prerogative to the Legislature and away from his office.”

The Newsom administration’s Finance Department opposes the bill, estimating it would cost an additional $163 million in next year’s budget and $255 million the following year, with costs projected to rise further as the senior population of undocumented immigrants grows. Nearly all of those costs would be born by state taxpayers because the federal government, which funds most of Medicaid, refuses to pay for services for people in the country illegally.

Sen. Durazo said the bill is a continuation of efforts to expand health care in a state where undocumented immigrants make up more than half of the unisured. 

“Seniors are some of the most vulnerable members of the population and can be prone to illnesses. Right now, we have a health system that is unfair — as many as 30,000 California residents age 65 or over don’t have primary care,” she wrote in an email today. “The governor committed to achieve universal health coverage. We know that in order to cover all Californians, we must cover seniors without distinction to status.”

This year, Newsom’s budget proposal included extending Medi-Cal to undocumented young adults, those ages 19 through 25, at an estimated cost of about $98 million annually.  Undocumented children are already eligible for Medi-Cal.

But he and legislative leaders stopped short of including other undocumented adults, including seniors agreeing on young adults only.

Big-ticket items such as a Medi-Cal expansion are typically negotiated between the governor and the Legislature each spring, before the annual state budget is finalized. But occasionally a bill like Durazo’s comes through that falls outside of the budget agreement, said Finance Department spokesman H.D. Palmer.

State Sen. Maria Elena Durazo, Democrat from Los Angeles.
State Sen. Maria Elena Durazo, Democrat from Los Angeles is carrying the bill to expand Medi-Cal to seniors in the United States without legal status.

“There may be bills that are in the pipeline that are not reflected in the budget that the Legislature may still want to pursue, and that is in their realm and right to do so,” he said. “Should those measures come to the governor, he has to consider that measure like any other on a fiscal basis and on a policy basis.”

And if Newsom signs the bill, said Palmer, it has to be included in the next budget proposal.

Opponents of the idea maintain that the governor already went too far when he approved coverage for undocumented young adults. 

Already Medi-Cal provides health care to about a third of Californians. Many of them complain now about long wait times, and report that it’s difficult to find doctors, and especially specialists, who will accept the system’s lower reimbursement rates for services.

If California were to expand Medi-Cal to cover undocumented seniors, it would make it even harder for those on the program to find a doctor and get care, said Sally Pipes, president and CEO of the Pacific Research Institute, a free market think tank based in the Bay Area. In addition, she predicted that any expansion would lead the state to raise taxes to cover the cost, all while boosting the incentive for people to migrate illegally.

Pipes sees this as an incremental work-around in response to failed Democratic attempts to get state coverage for all undocumented immigrants. A bill to expand coverage to all undocumented immigrants stalled earlier this year.

“It’s not fair to those who are taxpayers and those who are middle- and lower-income and have a lot of stress in paying for healthcare. Why would they need to pay more to subsidize these people?” Pipes said. “They (legislators) didn’t get the $3.4 billion to cover all of them. So this is a stepping stone in getting there.”

Durazo argues that undocumented people in California pay $3.2 billion in state and local taxes but are prohibited from services like Medi-Cal. The UC Berkeley Labor Center estimates that about 25,000 undocumented seniors would enroll if California offered them Medi-Cal coverage.

“The elders would be the appropriate next step,” said Anthony Wright, executive director of Health Access California, which advocates for universal health coverage and backs the bill. “It’s an opportunity for (Newsom) to commit to the next step.”

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Elizabeth Aguilera is an award-winning multimedia journalist who covers health and social services for CalMatters. She joined CalMatters in 2016 from Southern California Public Radio/KPCC 89.3 where she...