CA expands health entitlements

MedicineAs California included some unlawful immigrants in Medi-Cal, its version of the Medicaid program, a new study suggested that, nationwide, that population is holding down the costs of health entitlements.

The findings promised to sharpen the debate over immigration reform and its connection to America’s fiscal and economic health. “Researchers from Harvard Medical School, the Institute for Community Health and City University of New York’s School of Public Health at Hunter College found that in one year alone — 2011 — undocumented immigrants generated an average surplus of $316 apiece for Medicare,” California Healthline reported. “Other Americans generated an average deficit of $106 apiece. Undocumented immigrants contributed $3.5 billion more than they received in care in 2011, according to the study.”

The costs of expansion

Medicare eligibility has expanded dramatically under the Affordable Care Act. Many states have jumped at the chance to accept increased federal dollars to grow the program. Although Republicans are divided, some GOP governors in influential states, like Ohio and New Jersey, have approved the expansions as well. And with the Supreme Court declining to rule against the ACA, policymakers of every stripe have begun to consider its broader budgetary consequences.

According to the researchers’ report, “contributions from undocumented immigrants during the first decade of the century prolonged Medicare’s trust fund solvency by one year.” California Healthline added, “The trust fund is predicted to be insolvent in 15 years.”

Straining the system

California Democrats had pushed to expand Medi-Cal to roughly one million immigrants unlawfully present within the state. But over the course of exacting budget negotiations, Gov. Jerry Brown shrank down the ambitious plan to cover only those 18 years of age and under. The reduced population remained sizable, however. “An estimated 170,000 immigrants 18 and younger could qualify,” noted the Los Angeles Times. “The expansion of healthcare coverage to qualifying immigrant children would begin in May 2016, costing $40 million in the new budget and an estimated $132 million annually after that.”

The development has had a cascade effect in areas with relatively fewer unlawful immigrants. The County Medical Services Program recently authorized health coverage for the undocumented in 35 California counties. Although budgetary constraints have historically prevented such measures, “in recent years the expansion of Medi-Cal and the creation of the state’s health exchange under the Affordable Care Act have dramatically reduced the population it serves, leaving it with about $225 million in reserves,” according to the Sacramento Bee.

For their part, California Republicans have warned that the pace of expansion has already added stresses the health care system can’t handle. During the legislative debate on Democrats’ original plan to cover the state’s unlawful immigrants, “Republican lawmakers opposed the additional assistance, saying there aren’t enough doctors available to cover those people,” as Bloomberg recalled.

“‘There are 12.4 million Californians who depend on Medi-Cal right now that have difficulty accessing doctors and services because our reimbursement rates are too low,’ Senate Republican leader Bob Huff said during a budget debate on June 19.”

According to the state Department of Health Care Services, Bloomberg added, fully one third of Californians are currently enrolled in Medi-Cal.

A unified agenda

Although Medicare and Medicaid differ in how their budgetary burdens are distributed between states and the federal government, California officials have suggested that the case for expanding the one strengthens the case for expanding the other. “While these are two different programs with different funding sources, I think there’s no question that this study lends support to the efforts to extend Medi-Cal coverage to undocumented immigrants,” said California Insurance Commissioner Dave Jones. “I think many of the same points in this research — that undocumented immigrants contribute tax money to support government programs — applies to Medicaid and California’s Medicaid program, Medi-Cal.”



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