All low-income residents in California, regardless of immigration status, would be eligible for the state’s Medicaid coverage under Governor Gavin Newsom’s state budget proposal.
The governor’s proposed $286bn state budget includes $614m to expand Medi-Cal eligibility for all residents, which could make the state the first to expand healthcare coverage for all residents, and the first in the country to attempt universal health coverage for all its residents.
“California is poised to be … the first state in the country to achieve universal access to health coverage,” the governor announced at a press conference on 10 January.
Immigrants ages 26 and younger became eligible for the programme in 2019, and those ages 55 and older became eligible last year. The governor is aiming to close that gap and asking state legislators to cover remaining immigrant populations.
More than 3 million California residents are set to be uninsured in 2022. People who are currently eligible for insurance through the state’s Covered California marketplace account for 28 per cent of the state’s uninsured population, while undocumented immigrants make up 65 per cent.
Roughly 12 million people are enrolled in Medi-Cal.
Expanding access to all eligible people – the result of a years-long “Health4All” campaign among state legislators and immigrant advocacy groups – is expected to cost the state an $2.7bn each year.
The proposal could mean that “hundreds of thousands of currently uninsured Californians would be able to access life-saving, critical healthcare,” according to a statement from the California Immigration Policy Center.
The governor’s proposed budget, covering the nation’s most-populous state, and buoyed by a surplus of more than $45bn, aims to combat “existential threats” to the state, including the Covid-19 pandemic, wildfires, drought, homelessness and public safety.
According to UC Berkeley’s Labor Center, undocumented residents are excluded from Affordable Care Act subsidies and Medicaid eligibility, while noncitizens without a green card are more likely to not have employment-based health coverage – on which roughly half the country relies – than US citizens because of the greater likelihood of their employment in jobs that do not provide health plans.
Governor Newsom has also proposed beefing up the state’s homelessness initiatives with an additional $2bn to expand mental health services, housing and cleaning camps.
The governor’s proposal follows a boost in state revenues after fears that an approaching deficit in the economic fallout from the pandemic would saddle the state in years that followed. Instead, revenues exploded, and income, sales and corporate tax collection spiked by 40 per cent from 2020, and 60 per cent than in 201, according to the Legislative Analyst’s Office.
A group of Democratic legislators have proposed a plan for the state to adopt a single-payer health plan, in which medical expenses for all residents are covered through a government-run fund, rather than a patchwork system of private providers with byzantine plans and federal- and state-subsidized programmes.
The governor told reporters on Monday that he has not read the plan, though he reaffirmed his support for single payer as the “ideal” system but added that “there are many different pathways to achieve the goal.”
“I have long believed it’s inevitable [in the US],” he said. “The question is, what does it look like?”
A commission studying healthcare financing is expected to produce a report later this year, he said.
California Assemblymember Ash Kalra, who authored the proposal for a single-payer funding plan, said in a statement that the legislation allowed Californians to “decide for themselves if they are better off paying for the most expensive healthcare in the world with the worst outcomes of any wealthy nation, or guaranteed healthcare for all with CalCare while reducing overall healthcare costs.”
