President Obama's new immigration overhaul could increase Latino enrollment under his signature health law by reducing the threat of deportation and making more Californians comfortable signing up for coverage they already qualify to get.
Over time, the initiative may also pave the way for more Californians to become eligible for state-funded Medi-Cal coverage. Friday, state officials were noncommittal about that idea, and said they would have to assess the effect of the president's immigration proposal.
In the meantime, California healthcare leaders were optimistic about greater participation.
"The president's decision could be a major boost to enrollment in California," said Howard Kahn, chief executive of L.A. Care Health Plan, which has 1.6 million Medi-Cal members and about 30,000 customers in the state insurance exchange. "It will open up both Covered California and Medi-Cal to people who feared exposure to deportation."
Nationwide, the new immigration program applies to as many as 5 million people, offering them protection from deportation or allowing them to stay in the country longer if they meet certain conditions.
The president's executive action won't make people newly eligible for Obamacare.
The Affordable Care Act bars undocumented residents from getting subsidized health insurance in government-run exchanges or qualifying for Medicaid, a joint federal-state program for low-income people.
Since the health-law rollout last fall, many Latinos who are eligible for Obamacare have been reluctant to apply out of worry that doing so could lead to deportation for family members who aren't citizens.
As a result, the Covered California exchange has launched new TV ads aimed at easing those immigration concerns, and the president's announcement offers more protection against having a family torn apart.
Even as enrollment enters year two, there are roughly 600,000 Latinos in California who remain uninsured despite qualifying for subsidized coverage under the health law. In a recent survey, 37% of those eligible said they were at least somewhat worried that signing up would draw attention to their family members' immigration status.
It's estimated 3.2 million Californians will be uninsured by the end of open enrollment in mid-February, according to UC Berkeley projections. About half of those people, or 1.5 million, are not citizens or legal residents.
Medi-Cal is California's healthcare safety-net program and it has already experienced enormous growth because of the health-law expansion. More than 2 million people have joined the program since January, pushing overall enrollment to 11.3 million.
At this point, it's unclear how many more may ultimately qualify for Medi-Cal under the president's executive order.
Health-policy experts and consumer advocates say California has extended Medi-Cal coverage to similar groups in the past when they have secured legal protection.
For instance, California is among a handful of states that offer Medicaid eligibility to people given legal status under the Deferred Action for Childhood Arrivals program. Obama created that 2012 program for young people who came to the country illegally as children.
About 125,000 of these young California immigrants — sometimes called Dreamers — may qualify for Medi-Cal.
"California has a long history of covering certain immigrant populations excluded from the federal program," said Anthony Wright, executive director of Health Access, a consumer advocacy group. "First, these people have to go through the process the president outlined and then they have to meet the income criteria for Medi-Cal."
Medi-Cal costs are typically split between the state and federal government. But the state would have to pick up the full tab for immigrants covered by this latest overhaul.
Some health-policy experts point out that undocumented residents already qualify for emergency Medi-Cal benefits if they land in the hospital, so the fiscal effect for comprehensive coverage is less than many predict.
"The overall cost difference from emergency Medi-Cal to full-scope coverage is not that large," said Ken Jacobs, chairman of the UC Berkeley Center for Labor Research and Education.
A spokesman for the California Department of Health Care Services, which runs the Medi-Cal program, said the agency "has not received any formal guidance from the Centers for Medicare & Medicaid Services regarding the president's immigration proposal. "Once any formal guidance is received, we will assess its potential impact on the Medi-Cal program."
Obama's announcement came just as the second year of open enrollment got underway, and many people were already trying to sort through their insurance choices.
Sonya Vasquez, healthcare policy director for Community Health Councils, an advocacy group in Los Angeles, said there's bound to be even more confusion now and enrollment counselors will need to have answers for how Obama's move affects people's healthcare options.
The president's executive action could also spur more workers to sign up for health insurance through their jobs.
Dr. J. Mario Molina, chief executive of Molina Healthcare Inc., said immigrants gaining work permits might feel more comfortable taking advantage of those benefits. The Long Beach insurer is a major Medicaid managed-care plan nationwide and sells policies on Covered California.
More than anything, Molina said he worries that the public will misconstrue what's actually happening under the president's overhaul.
"I don't want people to get the impression that 5 million people are suddenly going on Medicaid," he said. "This is not a way for illegal immigrants to get welfare benefits. That is not the case."