Health coverage for the illegal will be a tough sell

Gov. Arnold Schwarzenegger has a bigger problem than Republican legislative resistance in trying to sell a core element of his healthcare overhaul. That problem is the public.

The governor wants to require everybody in California to carry health insurance. That means illegal immigrants too. People who can’t afford coverage would get state subsidies.

“If you can’t afford it, the state will help you buy it, but you must be insured,” Schwarzenegger declared Monday in announcing his plan.

No way, say most Californians. Not for people who sneaked into the state illegally.

A new poll being released today by the Survey and Policy Research Institute at San Jose State University shows that when Republican legislative leaders flat-out call the concept of insuring illegal immigrants “a nonstarter,” they’re reflecting the California mainstream.

Conservatives are in the center on this one. Schwarzenegger is over on the left.

The statewide poll of 985 Californians was conducted just before Schwarzenegger unveiled his plan, and the questions are generic. When interviewers didn’t mention illegal immigrants, a majority (52%) of those surveyed thought the state should “guarantee” health insurance for everyone. Even more people (59%) felt all children should be insured.

But the replies to another question showed that the governor has a lot of convincing to do before the public accepts all of his ambitious “reform.”

Asked whether the state should guarantee health insurance for illegal immigrants, 37% answered yes, 52% no. The negative reaction was even stronger among registered voters: 32% yes, 58% no.

Democrats are about evenly split on the question. But nearly three-fourths of Republicans and independents oppose guaranteeing health insurance for illegal immigrants.

Two-thirds of Latino voters favor it. But only roughly a quarter of white voters do.

There’s an intriguing L.A. finding. Attitudes in Los Angeles County differ sharply from all other major regions of the state. In L.A., 52% of voters favor insuring illegal immigrants and only 42% oppose it. And that’s not just because there are a lot of Latino immigrants in L.A. County.

L.A. Latinos do overwhelmingly favor the notion -- even more so than Latinos statewide -- but a small plurality of whites also support it.

By contrast, 56% of voters in the liberal San Francisco Bay Area oppose insuring illegal immigrants; only 32% favor it.

L.A. residents seem to have bought Schwarzenegger’s argument even before he started making it: that illegal immigrants are entitled, by a federal court ruling, to costly care at overcrowded emergency rooms even if they’re not insured. And everyone else -- taxpayers, policy holders, medical providers -- gets stuck with the stiff tab.

The governor’s pitch hasn’t sunk in anywhere but in L.A., “where people have real-world experience,” says San Jose State polling director Phil Trounstine.

Schwarzenegger argued it this way Monday:

“Let me be clear about this one issue ... the debate over covering undocumented or illegal immigrants. I don’t think it is a question or a debate if they ought to be covered.... A federal law requires us to treat everyone who shows up at an emergency room and needs care....

“Therefore, the decision that [we] made was not should we treat them.... The question really is, how can we treat them in the most cost-effective way? Because right now they go into an emergency room, and that means sometimes thousands of dollars are being rung up with all kinds of ... CAT scans and X-rays and this and that for a simple nosebleed.

“But in the meantime, we can do it cheaper by sending them just to a doctor.... We are trying to be realistic here and not live in denial.”

Schwarzenegger says that during the last decade, 65 emergency rooms have closed in California “because they’re fed up with it. They don’t want to keep treating people without insurance.” In L.A. County alone, he says, one-fifth of the emergency rooms have closed.

In his annual State of the State Address on Tuesday night, the governor told legislators about recently visiting California Hospital Medical Center in downtown L.A. Last year there, he said, uninsured patients “left behind $60 million in unpaid bills. That’s one hospital.

“Multiply that by the number of hospitals in California and the amount runs into the billions. Guess who’s paying for all this? You and you and you and me and all of us who are lucky enough to have coverage. That’s who pays.”

We pay for it with the “hidden tax” of higher insurance costs, he says.

But Republican legislators aren’t buying. Anything that smacks of rewarding illegal immigration is anathema to them and to their voters. Never mind that their constituent farmers, restaurateurs and garment makers draw the workers to California with jobs.

Insuring illegal immigrants, says Assembly GOP Leader Michael Villines of Clovis, would “create a worldwide incentive to come to California for healthcare. The magnet would be enormous.”

Senate Republican Leader Dick Ackerman of Irvine says his colleagues would even oppose insuring just illegal immigrant children and excluding the estimated 1 million undocumented, uninsured adults. “It’s the nose under the tent argument,” he says. “We’re already spending $4 billion to $6 billion on various benefits for illegals.”

It’s not clear whether Schwarzenegger’s complex plan would require a two-thirds supermajority vote in each house -- therefore needing some Republican support -- or if Democrats could pass it themselves with a simple majority.

Regardless, no legislation this colossal and contentious can be passed and sustained without broad public support. Schwarzenegger knows this. After all, he originally ran for election railing against an unpopular act granting driver’s licenses to illegal immigrants -- and forced its repeal immediately after taking office.

George Skelton writes Monday and Thursday. Reach him at george.skelton@latimes.com.