DACA recipients get more CA health care

A major rule change under the Biden administration allows certain undocumented immigrants to purchase subsidized health plans through California’s insurance marketplace. But with a Republican-led effort to halt this expansion, and President-elect Donald Trump’s pledge of mass deportations, California health leaders worry that the gains the state achieved in coverage could be undone, writes CalMatters health reporter Ana B. Ibarra.

California is home to about 1.8 million undocumented immigrants. Though legislation to grant them unemployment and home ownership assistance failed this year, the state recently expanded Medi-Cal, its health insurance program for low-income residents, to undocumented immigrants of all ages. 

Since November, people who were brought to the U.S. illegally as children by family and who are also protected from deportation by the Obama-era policy known as Deferred Action for Childhood Arrivals (DACA), can purchase health insurance through Covered California. 

Before this month, DACA recipients were only allowed to get health insurance through their employer. And with the rule change, Covered California estimates about 40,000 more DACA recipients are eligible for marketplace coverage this enrollment season — providing relief for freelancers, self-employed workers or those who have no other means of health coverage.

But 19 Republican attorneys general from states including Alabama, Florida, Kansas and Texas are challenging the new benefit. They argue that it encourages illegal immigration and creates “additional administrative and resource burden” in states that run their own insurance marketplaces. California joined 18 other states filing a brief in defense of the expansion, and the case is still pending.

Meanwhile, Trump has vowed to conduct mass deportations once in office and his administration could potentially roll back other protections for undocumented workers. 

Trump and congressional Republicans could also opt to not renew federal subsidies for the Affordable Care Act, which expire in 2025 and provide assistance for middle-class families. If Congress doesn’t act, an estimated 4 million people in the U.S. would lose their coverage the following year, raising concerns among experts that the number of uninsured Californians will rise. (About 500,000 people in the U.S. have DACA status, and one report found that 20% of those surveyed are uninsured.)

Despite the uncertain future, Covered California officials and immigration attorneys say DACA grantees who are eligible for health insurance should act as soon as possible.

• Jessica Altman, executive director of Covered California: “Coverage is here right now. So if you need to go to the doctor, if you’ve been putting off care that you need, if you’ve never had the opportunity to get your preventive care, you can do that right now. Let’s not let fears about the future prevent what can happen in the here and now and what you can have access to.”

Open enrollment began Nov. 1 and ends Jan. 31. To have coverage by Jan. 1, people must sign up by Dec. 31.

Read more about California DACA recipients’ health coverage in Ana’s story.

While the focus since Election Day has been on statewide ballot measures (two are still undecided) and toss-up congressional races, California Democrats are on the verge of securing as big a supermajority in the Legislature as they already had — and with it the power to pass budgets without any Republican votes and control the flow of legislation. 

In the state Senate, Democrats held 31 of the 40 Senate seats heading into the election, with 20 seats on the ballot. With two races undecided, Democrats will control at least 30 seats, three more than a supermajority.

In the state Assembly, Democrats had 62 of the 80 Assembly seats before the election. With three contests still up in the air, Democrats will win at least 61 seats, seven more than a supermajority. Democrats have enjoyed supermajorities since the 2018 election.

But the people matter as much as the numbers. One new Republican who will be sworn next month is Carl DeMaio, a talk show host, former San Diego city councilmember and full-on Trump supporter whom establishment Republicans failed to defeat. 

• DeMaio, to Politico: “I’m going to be pushing the Republican Party in a whole different direction when it comes to environmental issues, housing issues, social issues. If we want to be a majority in California, which is absolutely possible, we have to transform.”

He is vowing to “shake up our state’s broken political system,” and maybe he’ll be as much of a firebrand in the Assembly as Corona Republican Bill Essayli, who has won reelection. On the last night of the legislative session, Essayli shouted and banged on his desk when Democrats shut him down and accused them of being an “enemy of democracy.”

Trump and congressional Republicans’ pledges to chip away at the Affordable Care Act could not only threaten DACA recipients, but health care coverage for other Californians as well, CalMatters health reporter Kristen Hwang explains.

The federal government spends more than three times what the state spends on California health care programs: $117 billion to support Medi-Cal and the Affordable Care Act, compared to $35 billion from California’s general fund for all state health spending.

Trump and congressional Republicans have signaled that they don’t support renewing federal subsidies for the Affordable Care Act that expire next year. Before the push to lower health care premiums under the Biden administration, Californians paid at least 18% of their income on health insurance. Federal assistance capped that expense to 8.5%.

• Rachel Linn Gish, communications director for Health Access California: “You’re talking about a world where we’re doubling how much people pay.”

Reproductive rights is another health care policy that could be jeopardized. Strengthening abortion protections is often cited by California Democratic officials as one effort in “Trump-proofing” the state, and Assemblymember Mia Bonta, an Oakland Democrat and chairperson of the health committee, said she plans to introduce a number of bills on the first day of the legislative session in January to further protect abortions.

Learn more about how Trump could impact California’s health care policies in Kristen’s story.