Activists push for health-care services to undocumented immigrants

In 2009, Sacramento County cut health care for Sacramento’s undocumented immigrant population as a way to save money during the budget crisis. The move left the area’s tens of thousands undocumented immigrants without access to health care and with few options to get it: Most are too poor to buy private insurance and aren’t eligible for MediCal or, even, coverage via the Affordable Care Act (see “Caution: No health care for all” SN&R Feature Story, June 19).

Now, five years later, a coalition of local activist groups is pushing local politicians to restore funds and services.

Most large Californian cities already provide some medical coverage for the indigent undocumented. Sacramento used to be in this group. But in 2009 the county’s board of supervisors, responding to the burgeoning economic crisis, rolled back a care program that had at least provided basic health-care services—though virtually no access to specialist care—to the undocumented.

This year, groups such as Sacramento Area Congregations Together and the Sacramento Latino Medical Association started highlighting this issue as one of the defining problems facing Sacramento County. As the election neared, they held a number of area community meetings to push candidates to support reform. The challenge, the groups’ members knew, was to change the composition of the five-person board of supervisors enough to secure a majority in favor of a new program—though how basic or how generous that program would be remained unclear.

At a minimum, the reformers wanted it to cover the low-level, nonspecialist services that the old County Medically Indigent Services Program provided, before the Affordable Care Act expanded MediCal and gave the able-bodied poor access to state and federally funded MediCal services instead. More optimistically, they hoped they could convince the board to fund a network of county clinics.

In last month’s elections, the activists got at least part of the way there. In Sacramento’s District 2, voters elected Patrick Kennedy, who had highlighted the issue in starkly moral language during the campaign.

“I don’t know exactly how it will work,” Kennedy said in regards to pushing new funding through. “But my hope is everyone in Sacramento County will have access to quality health care.”

But it’s no slam-dunk that county-level reform will pass. In Sacramento, as elsewhere in the country, there is no consensus about whether to provide coverage for the undocumented or about how to fund it and how to enroll people.

Kennedy’s fellow board member and incoming chairman Phil Serna is on record as supporting expanded health care access. Fellow board members Susan Peters and Roberta MacGlashan, however, both backed curbing the old program in 2008. Any vote will likely come down to longtime District 5 board member Don Nottoli.

Six years ago, Nottoli voted with the majority to end the indigent care program. Reformers, however, believe that he may now be looking for the middle ground.

“He has a record more sympathetic to the social needs of low-income people, people of color, and so on,” said ACT’s David Ramirez.

Nottoli didn’t respond to an SN&R interview request, but the matter may be resolved soon.

In its last budget hearing the outgoing board of supervisors directed the county executive to organize workshops on the issue for the new board in January. These hearings will, apparently, explore the public health impacts of expanding healthcare for the region’s undocumented, as well as the moral implications of leaving in place the current status quo. There is also talk of a community forum on the topic in April.

“I’m going to listen to the facts, the data,” said Kennedy of these hearings. “And I’m making it clear that I’m concerned with having people who cannot access healthcare in this county.”

Even if Sacramento County doesn’t provide its undocumented residents with affordable health coverage, President Barack Obama’s recent executive action deferring deportation for a large proportion of the country’s undocumented millions will impact access to health care in California. The state already has a policy in place allowing those whose deportation status is now “deferred” to qualify for state-funded medical services. How people will go about accessing these services has not yet been worked out, but at least some of Sacramento’s undocumented population should be eligible in the coming years.

Moreover, ACT and other groups have been pushing state legislators to vote in favor of a bill from State Senator Ricardo Lara (D-Bell Gardens) that would create a “shadow” MediCal system for California’s undocumented population and allow them to participate in the state’s health insurance exchange.

An earlier version of that bill died last year; now, with a newly elected legislature, and with Obama’s executive action on immigration, ACT members are hopeful the needle has shifted. Kennedy is, too.

Post-election, the issue has picked up momentum, he said, and is now something to be pushed for “sooner rather than later.”