State Sen. Ricardo Lara (D-Bell Gardens) has long sought to provide health insurance coverage to the multitude of Californians who cannot obtain it because they are in the country illegally. That's a heavy lift, financially and politically, even though the right policy in the long run is to bring as many people as possible under the insurance umbrella. So Lara is trying to attain that goal one step at a time. His current objective is to open the state's insurance exchange, Covered California, to every state resident regardless of immigration status, although only legal residents would be eligible for subsidies. It's a small step that may be more symbolic than substantive, but it's well worth taking.
Analysts estimate that 11 million people are living in the country illegally, about a quarter of them in California. Those with low incomes aren't eligible for state or federal insurance programs, so they typically rely on a hodgepodge of free clinics, basic health services in selected counties and emergency rooms. That's an expensive and inefficient way to provide healthcare, given that the uninsured tend to delay treatment until minor problems become major ones.
Lara has a proposal to extend subsidized insurance to poor Californians here illegally, but that's on hold until next year at least. This month the Legislature is considering a far more modest Lara bill, SB 4, seeking federal permission to let any resident buy unsubsidized health coverage through Covered California. The federal Affordable Care Act closed the state exchanges to anyone in the country illegally, even if they didn't need federal subsidies to afford insurance, because of the vehement opposition in Congress to extending benefits of any kind to those immigrants. But it also allows the government to waive many of its rules for states with innovative ways to meet the act's goals, starting in 2017.
SB 4 would help just a fraction of those without coverage. People living in the country illegally are already able to buy policies from private insurers directly or through agents, and any policy that's offered inside Covered California is available outside it as well. The main beneficiaries of the bill would be the tens of thousands of adult immigrants living in families that are a mix of citizens and noncitizens, who would gain the ability to buy coverage for their entire family — some of it subsidized, some of it not — from one place.
Just as important, though, opening Covered California to all residents would send the message that the exchange has something to offer everyone. Extending insurance to all is part of the effort to control healthcare costs, a task that requires more preventive and efficient care — changes that are hard to bring to the uninsured. That's why the Legislature should pass SB 4.