I spent several summers in college organizing and doing outreach in my beloved community of South Central Los Angeles to help expand health care access to low-income and undocumented communities. In my conversations with community members, it became clear that the increasing xenophobic rhetoric, perpetuated by today’s administration, has inflicted fear among these groups. Several undocumented folks ignore their excruciating pain, medical concerns and avoid seeking health care because they fear two things: deportation and medical expenses.
As part of my work in community organizing, we aimed to recruit and retain patients at our community-based health centers to ensure community well-being and help address social determinants of health. This meant targeting the many vulnerable communities in South Central Los Angeles, particurlarly undocumented folks who are ineligible for Medicaid and Medicare, Social Security, and subsidized commerrcial health plans available through Covered California. Often left without health care coverage, undocumented folks bear the burden of having to cover high medical costs, and in turn avoid health care until they eventually cannot any longer. When medical care becomes inevitable, it is often accessed in the emergency room, where medical expenses then are vastly greater. Today, in the face of the COVID-19 pandemic, the stakes are even higher. Many undocumented folks are working on the frontlines, in agriculture, food processing centers, and other service-oriented industries that put them at a high risk of exposure, and thus a greater need to access health care.
According to the Public Policy Institute of California, there are 11 million immigrants in California. Approximately 27% of this population is “foreign-born” without any documentation, such as a work permit or Deferred Action for Childhood Arrivals (DACA) status. These populations compromise at least one-third of the population in large counties such as Los Angeles, San Francisco, and Alameda, and approximately half of California's youth are children of an immigrant parent. According to the California Budget and Policy Center, California’s undocumented population contributes over $3 billion in state and local taxes annually through local property taxes and state and excise taxes. However, it has been extremely difficult for this population to receive federal stimulus packages and mutual aid resources.
Though no protection is afforded at the federal level, California has taken steps to expand access to healthcare for the undocumented population through the California Advancing and Innovating Medi-Cal (CalAIM) initiative. This new measure signed by Governor Newsom allots state government-subsidized benefits to cover undocumented individuals under the age of 25 through Medi-Cal coverage, making California the first state to expand health-care coverage to undocumented adults. While it is imperative to have this new policy in place, it is critical that we consider the impact of the COVID-19 pandemic on Governor Newsom’s initial projected budget and the CalAIM expansion. In May, Governor Newsom’s budget proposed cuts to Medi-Cal services and postponed the Cal-AIM expansion that would allow low-income and undocumented elders over the age of 65 to qualify for health care coverage. In the midst of a pandemic, it is imperative to invest in our health systems and in communities where social determinants of health--poverty, crowded housing, and environment amplify risk to exposure. Low-income and undocumented elders are at greater risk of contracting COVID-19, whether they are an essential worker or live in crowded multigenerational housing where social distancing is not an option.
In June, California lawmakers defended their obligation to prioritize health care, and negotiated a state budget that did not postpone CalAIM nor cut safety-net programs. This expansion is timely and critical, as elders are particularly vulnerable to contracting coronavirus. However, the expansion still excludes the remaining undocumented population, aged 26-64, which is the age group reporting the largest amount of COVID-19 cases within the state.
Universal health care coverage is pivotal to the health of our nation today, and it is feasible. In the face of widespread calls to defund the police, we have the opportunity to reallocate state funding to ensuring health, education and other resources are available for low-income, Black, and undocumented populations. By addressing coverage gaps and social determinants of health, we can mitigate racial health inequities that are exacerbated by COVID-19. Thus universal health care should not merely be proposed-- it should be guaranteed to ensure that we all have access to medical treatment and testing in the face of a pandemic.
Community-based health centers and community-based non-profit organizations, like the ones I have spent my summers working with, have increased accessibility to health care through community outreach and by offering sliding scale fees to make healthcare more affordable. Such organizations also have the unique opportunity to partner with locally funded healthcare expansion programs and expand their impact. For example, in 2014, Los Angeles County implemented the My Health LA program, a medical coverage alternative program for those who are uninsured and do not qualify for full-scope Medical. Similarly, the Healthy San Francisco program, launched in 2007, serves a similar purpose. Both the My Health LA and Healthy San Francisco programs allow their county residents who are under the Federal Poverty Level to apply, regardless of immigration status. These programs increase health care access for low-income uninsured patients. Theses programs encourage undocumented communities to access care at a more affordable rate, helping address the coverage gap--particularly the one that exists for low-income young adults and undocumented folks.
While California’s lead to expand health care coverage to undocumented young adults and elders is important, it is still not enough. California is only one of 50 states, and even within the state, health care coverage is limited to only a fraction of the adult undocumented population. The My Health LA program and Healthy San Francisco programs illustrate how we can properly invest and create pathways to achieving health coverage through partnership. No one should be denied health coverage due to their legal status, and the coronavirus pandemic emphasizes why everyone must have access to health care coverage. This United States has not, will not, and cannot contain the COVID-19 pandemic if government leaders are not willing to invest in the uninsured and undocumented. Immediate federal and state policy action is necessary to reflect this reality.