In summary

We need bold legislation like SB 56 and AB 4 to end the systematic exclusion of low-income undocumented adults from Medi-Cal.

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By María Elena Durazo

State Sen. María Elena Durazo, a Democrat from Los Angeles, represents California Senate District 24,

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Sarah Dar, Special to CalMatters

Sarah Dar is the director of Health & Public Benefits Policy at the California Immigrant Policy Center,

The Biden administration’s current decisions will have dire consequences for Americans who have borne the brunt of deaths, illness and economic hardship caused by the COVID-19 crisis. 

For undocumented, uninsured immigrants, including millions of essential workers taking on disproportionate occupational risk of COVID exposure, these decisions will mean the difference between life and death.

But with no quick federal solution, it is up to states like California to step up and lead with an inclusive recovery plan for all.

California is home to 2.3 million undocumented immigrants who make up about 6% of the population and nearly 1 in 10 of the state’s workers. Undocumented Californians generate $63 billion in government revenue and $263 billion toward the state’s formidable GDP every year through labor and taxes. They are overrepresented in jobs deemed “essential,” and wage theft and exploitation are unfortunate realities for many.

Unfortunately, California Gov. Gavin Newsom’s state budget proposal is not adequately responsive to this demographic picture of our state. Our undocumented neighbors are deeply embedded in our economy, schools and communities and the cultural fabric of our state – Californians by every measure. That’s why we need bold legislation like Senate Bill 56, introduced by state Sen. Maria Elena Durazo, and Assembly Bill 4, introduced by Assemblymember Juan Arambula, a Democrat from Fresno, that ends the systematic exclusion of low-income undocumented adults from Medi-Cal, especially seniors.

Last year, Newsom included Medi-Cal for undocumented seniors in his proposed budget. But when the pandemic and ensuing economic downturn hit, Newsom withdrew his proposal, leaving a high-risk group – 65 and older – to fend for themselves without comprehensive health care. 

The state set up temporary programs for the uninsured to access COVID-19 treatment, but this barely scratches the surface. For seniors, if they are infected with the virus, it may be too late. Undocumented seniors may have gone decades without a check-up and may have unknown chronic conditions and need preventative treatment and medication for all of their health issues.

In a moment of reckoning with racial injustice and structural inequity, California has a clear choice. We can fix the systemic exclusions that brought us here, like making all Californians eligible for Medi-Cal, or we can settle for temporary, surface-level policies that return us to the pre-pandemic status quo of glaring health and economic disparities.

Comprehensive health insurance makes good public health sense in the face of a rapidly spreading virus. It makes us all safer and healthier.  

Simultaneously it protects against financial hardship. Medical debt is a leading cause of bankruptcy, and in a health care system dependent on insurance, trying to pay one’s medical bills and prescription costs out-of-pocket is a recipe for financial ruin. Why should any elderly, low-income individual have to choose between an exorbitant bill for routine doctor visits and illnesses and money spent putting food on the table and weathering this recession?

California’s Legislature and governor have taken some positive initial steps. They disbursed one-time cash assistance for workers hard hit by the pandemic who did not qualify for federal stimulus checks and unemployment insurance due to immigration status. The state also rectified the senseless exclusion of those who use an individual taxpayer identification number instead of a Social Security number to file taxes from eligibility for the California Earned Income Tax Credit, a modest rebate for low-income tax filing households. This year, the governor and  Legislature worked together on a Golden State Stimulus that includes these same tax filers in a $600 state stimulus payment.

These policies are the beginnings of an equitable recovery. The governor’s focus on economic support amid layoffs and lost wages is critical. But with families unsure how to cover next month’s rent, groceries and other bills – especially undocumented and mixed-status families who are locked out of other assistance – much more is needed for survival.

SB 56 is a critical priority in 2021. While we await a federal fix for our broken immigration system that bars so many from a pathway to status, inclusive state policies help move us closer to a true “California for All.”


State Sen. Maria Elena Durazo has also written about recommendations to help California’s economic recovery and to take action on climate.

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