Two California lawmakers publicly blew up at each other earlier this month, hitting a nerve on an issue that has long-divided the state’s elected leaders: Whether and how much to offer government-subsidized health benefits to undocumented residents.

In one corner, Corona Assemblymember Bill Essayli declared that he wanted to unravel a new law that offers subsidized health coverage to undocumented immigrants.

In the other, Visalia Assemblymember Devon Mathis stood up for the health care expansion, arguing this helps the state reduce health costs in the long-term and helps working families who are critical to the state’s economy.

That both are Republicans — members of the party that in 1994 pushed to deny any non-emergency health care services to undocumented immigrants through Proposition 187 — underscores how far the state’s political debate has moved to the left over the course of five gubernatorial administrations.

Just 20 years ago, “in the early 2000s, the idea of offering this benefit was considered political suicide for both Democrats and Republicans,” said Arturo Vargas Bustamante, faculty research director at the UCLA Latino Policy and Politics Institute.

The shift unfolded gradually, as a generation of Latino leaders motivated by Prop. 187 rose in power in the Capitol. Former Gov. Jerry Brown in 2015 signed the law that made undocumented children eligible for Medi-Cal.

Then, state budget surpluses and Democratic dominance in the Capitol opened a lane for Gov. Gavin Newsom to sign the law that provided Medi-Cal to income-eligible undocumented residents of any age. That law took effect Jan. 1, making California the largest state to offer government-subsidized health insurance to low-income undocumented residents of all ages.

Citing public health data, Republican Mathis now is making the case that providing Medi-Cal to undocumented residents is the “fiscally conservative” move for the state.

The new law is practically the opposite policy of Prop. 187, the so-called “Save Our State” ballot initiative that denied public services to Californians without legal status. It passed with support from then-Gov. Pete Wilson, a Republican, but did not take effect because of legal challenges.

The topic still carries some political risk for lawmakers of both parties. California is facing a projected $38 billion deficit that could worsen and compel lawmakers to look for budget cuts. Former President Donald Trump has been critical of left-leaning states offering services to immigrants without legal status, and he could return to office.

Polls also show some concern among California voters in how they view immigrants. Four in 10 California voters think that unauthorized immigrants are a “major burden” to the country, according to a poll published by the UC Berkeley Institute of Governmental Studies published earlier this month. Another 30% considered them a “minor burden.”

But for now, Newsom and the lawmakers who advocated for the Medi-Cal expansion insist they won’t go back.

“I’m committed to it,” Newsom said at a press conference earlier this month.

Trump, COVID-19 and money

A potential second Trump administration would seem to jeopardize California’s expansion of health benefits to undocumented groups, but the former president may have actually influenced some of the benefits currently available, Bustamante of UCLA said.

Trump’s rhetoric disparaging immigrants and his unsuccessful attempt to undo Obamacare fired up California Democrats, Bustamante said. For example, when the Trump administration sought to repeal the Affordable Care Act and eliminate the federal subsidies that help millions afford coverage, California filed a lawsuit.

And when the federal administration proposed to punish immigrants for using public benefits, California filed another. In fact the state sued the Trump administration more than 100 times.

The COVID-19 pandemic also played a role in persuading California Democrats to continue expanding health coverage to undocumented immigrants, Bustamante said. It reinforced the importance of medical coverage and highlighted health inequities, especially among Latinos, Blacks and low-income people.

The rollout of these benefits came slowly. During the Brown administration, memories of the Great Recession tempered expectations for pricey government programs. Brown, nonetheless, signed a law by former state Sen. Ricardo Lara that opened Medi-Cal to undocumented children.

By contrast, money wasn’t a problem for Newsom until recently. During the pandemic, the state received increased federal funding for its Medi-Cal program and it took in historic budget surpluses. Newsom backed Medi-Cal expansions for adults that Democratic Sen. María Elena Durazo of Los Angeles and others championed.

Garry South’s career as a Democratic consultant dates to the time when liberals faced serious political risks if they supported services for undocumented immigrants. He managed former Gov. Gray Davis’ campaigns.

“Not too long ago, California was pretty politically competitive, but it isn’t now,” South said. “Yes there are some districts in which Republicans win Congressional seats, Senate seats, Assembly seats, but they’re marginalized to the point of being irrelevant, and so most Democrats running in most places in California don’t have to worry about being beat by a Republican. They’re more concerned about being in a run-off with another Democrat.”

He likened expanding Medi-Cal to undocumented immigrants to when the state allowed them to obtain driver’s licenses. It took years and various failed attempts, but legislators and most Californians ultimately determined that it was safer for everyone to get these drivers licensed and insured, he said.

Central Valley Republicans supported Medi-Cal expansion

Aside from Essayli, most elected California Republicans have been fairly quiet on the state’s new benefits for undocumented residents. Tim Rosales, a Republican political consultant, said supporting the expansion would not necessarily damage a GOP candidate’s chances in a future election, but the lawmaker would have to defend their reasoning to right-leaning voters.

He said many Californians have come to accept the role that undocumented people play in the state’s workforce and economy.

“In the Central Valley and other parts of the state that are heavily agricultural, people who live, work and exist in that economy…have understood that the undocumented population is such a huge part of the California fabric,” Rosales said. “People feel like they can talk about it more, and politically, reality is setting in, and that goes for both Democrats and Republicans.”

Mathis, who will be leaving office after this legislative year to do consulting work in the southern San Joaquin Valley, said his community was part of why he wrote in The Sacramento Bee explaining his support for the Medi-Cal expansion.

“I grew up in one of the poorest areas of the state, in a highly Latino area; these are common things that we see and that we know,” he said.

“I did the Op-Ed because I’m sick and tired of one, people on the hard right trying to make everyone sound like them,” Mathis said, “And two, to just say stop the rhetoric for five minutes and look at the actual issue.”

Mathis’ declaration echoes votes by two former San Joaquin Valley Republicans who supported the law Brown signed providing Medi-Cal to undocumented children. They were former Sens. Anthony Cannella of Ceres and Andy Vidak of Hanford.

What’s next for undocumented health care?

Earlier this month, Essayli introduced Assembly Bill 1783, which proposes to pull funding from health coverage expansions for undocumented residents. Although that may be a long shot given the Legislature’s Democratic majority.

“As the son of immigrant parents who came to this country by legal means, I was outraged our state government would earmark billions in funding for the healthcare of foreign nationals when our own citizens cannot afford their healthcare,” Essayli wrote in the Orange County Register.

The Medi-Cal expansions allow Newsom to get closer to his goal of providing universal health coverage, where everyone in the state would have access to medical insurance. Because California is home to the nation’s largest population of unauthorized immigrants — about 2 million people — it would be impossible to achieve universal coverage without covering this population, experts say.

The Affordable Care Act provided health coverage to millions of Americans and expanded the public’s understanding on the need for coverage, but barred anyone without legal status from accessing federally subsidized insurance. That means immigrants who don’t qualify for Medi-Cal have no option but to buy insurance on the private market at full-price.

Researchers at the UC Berkeley’s Labor Center have estimated that more than 1 million undocumented people will gain coverage because of the sweeping Medi-Cal expansion, but another half million will still be without because they earn too much to qualify for Medi-Cal but can’t afford coverage on their own.

Democratic Assemblymember Joaquin Arambula of Fresno is carrying Assembly Bill 4 that aims to allow undocumented people who don’t qualify for the Medi-Cal program to buy subsidized coverage. Arambula said the goal is to establish a program specifically for undocumented immigrants that mirrors the insurance options offered on Covered California, the state’s insurance marketplace. Setting up the program will take some time. Asking the state for funding to provide subsidies will come later, he said.

Arambula pointed to Colorado, which is experimenting with OmniSalud, a program that offers undocumented people the similar insurance options offered in its marketplace and at a subsidized price.

Originally, Arambula wanted to ask the federal government for permission to allow undocumented people into the existing marketplace, but Arambula said this alternative model means California’s program won’t hinge on the feds’ approval.

“We want to insulate ourselves from whomever will be in the federal government at the end of the year,” Arambula said.

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Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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