Thread: CA: Health care proposal omits illegal immigrant adults

http://www.sfgate.com/cgi-bin/article.c ... NLHOP1.DTL

Health care proposal omits illegal immigrant adults
Tom Chorneau, Chronicle Sacramento Bureau

Friday, January 19, 2007



(01-19) 04:00 PST Sacramento -- Gov. Arnold Schwarzenegger's health care overhaul might do little or nothing to change how medical care is delivered to an estimated 1 million adults who live in California illegally, despite the Republican governor's characterizations that his plan is universal in scope, critics say.

When the governor released his plan last week, he drew national attention at least in part because he appeared to take on the immigration issue without reservation. "I don't think it is a question or a debate whether they ought to be covered," the governor said in presenting his plan.

While Schwarzenegger's proposal would cover all children, regardless of immigration status, a close reading of the plan shows that it relies on counties to voluntarily set up a new system of care for the illegal immigrant adults that would be separate from other state-sponsored programs.

Some critics question whether counties would have the money -- or the political will -- to establish such programs for illegal immigrants and say he could be trying to sidestep a volatile political issue.

"This is clearly not universal coverage," said Reshma Shamasunder, director of the California Immigrant Policy Center. "In order to have a well-rounded, workable and efficient health system for all Californians, we need to cover all Californians. Any system that leaves out or carves out a specific piece fails to close that loop."

Currently, care of illegal immigrant adults is mostly dispensed at public hospital emergency rooms -- the most expensive service in the system. The governor wants counties to create new networks that would provide regular access to doctors and preventative care, just as Schwarzenegger's plan would provide for the state's other 5 million uninsured residents.

The problem, critics said, is that under the governor's plan, counties might not be left with enough money to fulfill the new responsibility. Moreover, the plan does not mandate county compliance, so some question whether counties in many parts of the state would have the political appetite to take on the new role.

Overall, some observers say the governor deserves credit for putting together a comprehensive plan aimed at universal coverage -- even if undocumented adults are not included.

"The important part of the (governor's ) plan is the change it will make for many of the people here in California in helping create a more productive workforce," said Peter Harbage, a health care consultant who has studied Schwarzenegger's proposal.

"But coverage of the undocumented is very challenging politically, and the governor's plan doesn't offer undocumented adults coverage," he said. "Instead, the governor calls on counties to improve care delivery to the undocumented."

The governor's program would impose a mandate on all but the smallest employers to either provide health insurance to workers or pay into a state fund that would provide coverage. Also, all Californians would be required to have insurance.

Schwarzenegger also would greatly expand the state's two existing health care programs -- Medi-Cal and Healthy Families -- to provide regular medical care for the working poor. He would make state-subsidized coverage available to all children regardless of their residency status.

But when it comes to undocumented adults, Schwarzenegger's plan does not envision the same commitment by the state.

According to the plan, California has about 1 million uninsured adult residents who are not in the state legally. But the governor believes that 40,000 of them will get insurance through the employer mandate and another 160,000 earn enough to buy insurance themselves.

The remaining 750,000 would become the responsibility of the counties and public hospitals.

"We are not requiring counties to buy health insurance for this population, but we are suggesting that there will be enough resources to coordinate their care," said Richard Figueroa, health care adviser to the governor.

Figueroa explained that Schwarzenegger's plan would redirect billions of dollars now spent at public hospitals on uncompensated care to buy coverage for the uninsured. But at least $2 billion would be left over for counties and public hospitals to use to cover the undocumented adults that would still lack insurance.

"The governor wants them to move away from the current model where people are accessing their care at the emergency rooms," Figueroa said. "But this is a conversation we've yet to have with the counties."

Kelly Brooks, a legislative analyst with the California State Association of Counties, said that much of the money the governor wants counties to use for the new system is already spoken for -- both to provide care to the uninsured as well as to support public health programs.

Melissa Stafford Jones, president of the California Association of Public Hospitals, said the group doesn't know enough yet about the governor's plan to say whether there's enough money to provide the new responsibility.

Even if the governor's plan would provide all the money that counties would need, there's no guarantee that county supervisors statewide would agree to implement new coverage programs, mostly because many voters might not support it.

"I'm not convinced that San Diego or Kern County would be as forward-thinking as other boards of supervisors," said Anthony Wright, executive director of Health Access. "The (governor's) plan left it ambiguous about what the expectation or the level of service from counties would be."

Figueroa said the governor wants to work with counties about the shape of the service programs, but the decisions would be left to local officials.

Pray tell, where did he get the number of one million adults in the
state illegally? Is he counting unmatching SS numbers? Did he
do an informal survey on the highway, profiling Hispanics and
then guestimating the percentage of them that are illegal?
By ANY chance, did he count the numbers in the elementary schools
and other schools, for that matter? Or did he just count the
number of food stamp recipients?

Most of the Hispanics I know, drive an hour to the border, walk
across, and get cheap health care (except for birthing), which,
we know, is done, here.

Yes, one million illegals is way low. Of course no one knows how many are illegal but I've heard an estimate of 2 million just in LA. He'd want to lowball it of course.