House Republicans Fight Insurance Expansion For California Immigrants

Earlier this month California became the first state to ask the Obama administration permission to give immigrants here illegally access to a state health care exchange. In California it is called covered California. The request has upset Congressional California Republicans led by Representative. Darrell I sent. They have written a letter asking the administration to deny the request, saying Obama promised never to allow immigrants here illegally that kind of access. That prohibition is clearly in the law. I'm joined by Susan Chernykh, codirector of the Institute for Health Law Studies at California Western School of Law. Susan, thanks for joining us. Thank you so much for having me. Why is California asking for permission to do what exactly? California is asking for permission for illegal people who do not have legal status living in California to have access to purchase health insurance on covered California. Something that was not in the law or that was actually expressly denied to people who are not legal residence of the United States. This would give, presumably give, at least some people some of the population, 2.5 million, people in California who are not here legally the ability to be able to purchase health insurance on covered California. I mentioned there is a letter signed by Darrell ISA and Congressman Duncan Hunter of San Diego that quotes President Obama and quotes the actual affordable care act, both of which make it clear that, these are Obama's words, the ACA explicitly prohibits unlawful residence from purchasing health insurance on a state exchange". The Republicans here am it sounds like you are correct about the law. They are correct about the law. They are correct about the way that the law was passed in the law was enacted. But, the purpose of -- California is attempting to use what are known as innovation waivers, also part of the law of the affordable care act, which is starting in 2017 allow the states to make some changes to the affordable care act. A number of different states have already applied for these innovation waivers to do various things in their states. None of them nearly as large as what California is attempting to do. Yes, the Republican representatives are correct. The original law did not include people who are not here legally. California is attempting to change that using one of these innovation waivers. It sounds like other states have asked for waivers but maybe never anything quite as dramatic. That is correct. They are really asking for waivers to do things that would make their state exchanges work more effectively or efficiently given what the prior law had been. Darrell ISA's letter says -- ISA's letter says taking this step in granting California waiver would race does raise cost to taxpayers that could lead to subsidized coverage for illegal immigrants. What is your take on that? Would it race taxpayer cost? If the administration were to grant this waiver, this California waiver, while the population that is affected would be able to purchase health insurance on covered California, it would not be subsidized insurance. I think that there kind of jumping the gun there. As far as cost. As a matter fact, one of the limitations on what the states need to do in order to get permission to use these waivers is to make sure that they are deficit neutral, federal deficit neutral. Anybody applying and being able to purchase health insurance on the exchange would not be eligible for a premium subsidy. Let me make sure I understand this. If I signed up for Obama care and paper policy, I would get a subsidy. You could get a subsidy. That is not everybody who signs up for Obama care. If your income is between 130% and 400% of poverty level you are entitled to a premium subsidy. For some people out-of-pocket cost subsidies. If I'm a person in the country illegally and apply for Obama care I would not get a subsidy no matter what my income is? That is assuming the waiver goes through. I think the waiver is a request for a waiver is being made on the condition that there would be no premium subsidy available for those folks. This thing we're talking about is separate from the state's efforts to expand Medi-Cal for low income, the low income health program children. It is my understanding here illegally they do have access to Medi-Cal, right? That is correct. That is something very new. Starting in 2016 children who are, do not have legal status, but are eligible for Medi-Cal are entitled to Medi-Cal, fullscope Medi-Cal, all services Medi-Cal provides. This is different. This is a different population altogether. Okay? The population that is eligible for Medi-Cal would not be able to purchase on the exchanges, because the insurance would be unaffordable to them. These are really two completely different populations. One more quick question. This does get a little bit complicated. This month the US Supreme Court ruled that parents of young people who receive deferred immigration enforcement, we call these folk streamers, their parents cannot receive deferred enforcement as well despite an executive order by Barack Obama. Those people remaining in this country illegally, what impact will that ruling have on loan coverage for adults under Obama care? I think the states can do different things. States have done different things. That is, the states can, if they want to, it is a federal programs that the Supreme Court was dealing with, and so, the states have the ability to be able to decide if they want to use state money. State money to fund Medi-Cal benefits for people who are not here legally. It certainly is not helpful for the large number of people who are here illegally and really don't have any access to healthcare except for certain kinds of safety net support services. Susan Channick is codirector of the Institute for Health Law Studies at California Western School of Law. Thank you very much. Thank you very much.