SACRAMENTO — Immigrants who are in California illegally should have access to health insurance through a state version of the
"Immigration status shouldn't bar individuals from health coverage, especially since their taxes contribute to the growth of our economy," Lara said.
The federal law bars those in the country illegally from obtaining coverage through Covered California, the state health insurance exchange.
An estimated 2.6 million immigrants are in California illegally, but many of them are insured through employer plans, so approximately 1 million might be left uninsured if no action is taken, said Ron Coleman, a manager at the California Immigrant Policy Center.
He and other activists are working with Lara on details of a coverage plan.
Alternatives they are examining include a further expansion of Medi-Cal, California's health program for the poor, or the creation of a separate program within or outside of Covered California that might provide subsidies from the state but not the federal government.
"By the end of this year, Covered California will be entirely self-sustaining anyway," said Anthony Wright, executive director of Health Access, an advocacy group working with Lara to fashion a bill. "It will not be federally funded, it will not be state funded. It's funded by a small fee on each policy sold."
Using Covered California could present legal problems, according to Timothy Jost, health law professor at Washington and Lee University's School of Law.
"If California wanted to set up its own completely independent healthcare program for undocumented aliens, it could certainly do that," Jost said. "But in terms of using Covered California, the exchange that is recognized under federal law as the Affordable Care Act exchange for California, I just don't see how they can do that."
Lara is also looking at another alternative, one already being used in 10 California counties, including Los Angeles, Riverside and San Francisco. They provide healthcare services for noncitizens.
In Los Angeles, the program Healthy Way LA Unmatched — named because it does not receive federal matching funds — pays for care for people who aren't covered by Medi-Cal, including those who don't qualify because of immigration status.
Another option would be to expand Medi-Cal to cover people in the country illegally, Wright said.
California has for decades covered legal immigrants not eligible for the federal
"The same logic could apply to other populations" such as noncitizens, Wright said. "There is precedent for California to be a leader. There is precedent for California to piggyback on federal programs but take an extra step to expand to additional folks."
Lara, whose immigrant parents were once in the country illegally, said his proposal is a natural follow-up to last year's legislation allowing such immigrants wide access to driver's licenses and permitting them to practice law in California.
But Lara's idea drew swift criticism from some Republican lawmakers, including Assemblyman
"California cannot afford to create another incentive to attract people to come to our state illegally in pursuit of taxpayer-subsidized benefits," Donnelly said. "It's shameful that … Lara would trade on the plight of those who are ineligible."