Sacramento – Governor Gavin Newsom I did not expect to count with another health care crisis.
In March, when President Trump and the Congress Republicans intensified a national debate on the advisability of reducing health care for poor and disabled Americans, the Democratic Governor had to say to state legislators that California health care had been understood due to the Major initiatives of Medicaid He argued – including the largest expansion of the country of health care funded by taxpayers for immigrants living with illegally in the United States.
Its senior officials of the State Department of Finance discreetly revealed to the California legislators in a letter that the State had borrowed $ 3.4 billion To pay the health insurers, doctors and hospitals who deal with patients registered in the California Medicaid program, known as Medi-Cal. Faced with the increase in health care costs in the midst of a deepen the state budget crisisNewsom must now consider the back cover and benefits.
The governor of the second mandate faces a difficult political decision: informing about his promise to achieve Universal health care And the coverage of bands of millions of immigrants who lack legal status or who are looking for budget cuts elsewhere. With nearly 15 million low-income or disabled residents registered in Medi-Cal, California has More to lose on health care than any other state. Yet even if Newsom condemned Mr. Trump’s approach to price And environmental policies, he was tightened on health policy.
Complicate his political striking rope: Survey The fact that providing health coverage to immigrants without legal status has lukewarm support. And any resulting budgetary problem could harm his political heritage if he presented himself to the presidency in 2028.
“We all know that the cuts arrive definitively,” said Carlos Alarcon, analyst of the benefits of California Immigrant Policy Center, who helped lead a Decadelong campaign in California to extend Medicaid to eligible immigrants without legal status. “The governor should keep his commitment – we will be very disappointed if we see cuts and declines. When times become hard, it is always our marginalized and ill -served communities that lose.”
California allows all low -income adults to register in medi-cali if they win 138% of federal poverty level, or $ 21,597 per year or lessWhatever immigration status. But the costs have been considerably higher than expected.
Democratic Governor Jerry Brown extended Medi-Cal for the first time to people aged 19 and under without legal status, but he expressed Reluctance to go further Due to potential costs. Newsom has signed bills by adding people aged 20 and over. To an estimate 1.6 million immigrants without the legal status being now covered, and the costs have climbed $ 9.5 billion a yearagainst $ 6.4 billion estimated in November. The federal government exceeds approximately $ 1.1 billion in this total for pregnancy and emergency care.
“We can extend from the grace of our hearts to everywhere and everywhere, but when these resources are exhausted, now everyone is losing. We reach this breakdown,” said the member of the California Assembly, David Tangipa (R-Fresno). “Either we become fiscally responsible, or there will be no services for anyone – and that includes the Californian and the undocumented immigrant.”
Democratic leaders responsible for approving the state budget refused interviews. In a press release, the senator from the State María Elena Durazo (D-Los Angeles), who defended the expansion in the Legislative Assembly, said: “Returning this progress would be a harmful and short-sighted decision”.
The legislators plan to freeze registrations for immigrants without legal status, to impose measures to share costs such as COPAYS or drug premiums, or to restrict the advantages, according to people familiar with the problem, who asked not to be identified to protect relations at the State Capitol.
However, it is unlikely that Newsom will reduce funding in its budget review set at the Liberation on May 14. Instead, the cuts would follow whether the republicans of the congress approve a budgetary agreement with major reductions in federal expenses for Medicaid.
“This will be very problematic for the governor. Budget cuts will disrupt the lives of millions of immigrants who have just received health care, but the governor must do something, as this is not sustainable,” said Mark Peterson, expert in health care and national policy at the UCLA. “The prospect of cutting other places to illegally support immigrants living in the country would be a difficult political sale; I do not see that happening.”
If Newsom, as well as the legislature controlled by democrat, are forced to make cuts, he could say that he had no choice. Mr. Trump and the Congress Republicans threatened states like California Last proposal for an American house Reduce the financing of Medicaid by 10 percentage points for states which cover immigrants without legal status. For Newsom, political analysts say Trump could make an easy scapegoat.
“He can blame Trump-there is little money to make,” said Mike Madrid, anti-Trump republican political analyst in California who specializes in Latin American issues. “This makes people look at the health care that they cannot afford and ask:” Why do you deviable do we give it for free to people who are here illegally? “”
The exorbitant cost was a little surprising.
In Newsom’s first budget proposal As governor – in which he called to extend Medi -Cal to young adults without legal status – his administration estimates that it would cost around 2.4 billion dollars per year to extend the advantages to all eligible persons, whatever the status. But the last figure reported to the legislators was almost four times more.
Newsom refused to answer questions from Kff Health News, referring to the previous comments that leave the door open to the reduction of Medi-Cal. The governor noted “sober” discussions with the legislators and said that the Medi-Cal Cup is “an open question” that the president will strongly influence.
“What is Donald Trump’s impact on many of these things? What is the impact of federal vandalism to many of these programs?” Newsom asked rhetorically in Decembersuggesting that it is not clear if it will be able to support the expansion of immigrants without legal status in the years to come.
Newsom expanded Medi-Cal into three phases, starting with immigrants from 19 to 25, who became eligible in 2020, resisting the pressure of health care defenders for a large expensive expansion. He argued that doing it gradually saves money in California.
“It’s the right thing morally and ethically,” Newsom said in 2020. “It is also the financially responsible thing to do.”
The record budget surpluses in recent years have enabled Democrats to continue. Older older 50 to 64 became eligible in 2022, and Newsom committed the difference the following year, approving the coverage from 2024 for the largest group, these ages 26 to 49.
But the costs have increased considerably while the budget image has embarked, according to a KFF analysis of the most recent 2023 files available from the Department of State Health Services, which administers Medi-Cal.
Aside from children, it was more expensive to provide Medicaid coverage to immigrants without legal status than to legal residents. For example, Medi-Cal paid for care, a major health insurer in Los Angeles, an average of $ 495.32 per month to provide care for an adult without children without legal status and $ 266.77 for a legal resident without children.
Not only were immigrants without legal status more expensive, but California made most of the cost. The state has paid around 60% and 70% of health care costs for an adult immigrant without children covered by care, and around 10% for a legal resident without children. These costs do not summarize the total cost of care, which can vary depending on where medical-customs live and increase when filling the prescriptions, going to the dentist or the search for mental health care.
These payments also differ by the insurer, but the trend is due in the state health insurance regimes of the state. Patients of the majority of the state can choose from more than one health plan.
Children without legal status in many cases were cheaper to cover than legal resident children. Generally, children are healthier and require less care.
Mike Genest, who was director of finance for former republican governor Arnold Schwarzenegger, argued that the state should have planned the immense prize.
“The idea that we would be able to allow ourselves in the long term by paying health care for all these undocumented people – that does not exceed,” said Genest.
Although the costs are now raised now, Medi-Cal’s expansion will lead to long-term savings to taxpayers and the health care system, said Anthony Wright, who has previously put pressure on expansion as head of non-profit health access and now combat Medicaid Cuts as Executive Director of the Executive Director USA familiesBased in Washington, DC
“They will present themselves in our health care system anyway,” said Wright. “Leave them without health insurance will simply end in more congested emergency rooms, and this will cost even more.
This article was produced by Kff Health NewsA national editorial hall that produces in -depth journalism on health problems and is one of the main operating programs in Kff – The independent source of research on health policies, survey and journalism. Kff Health News is the publisher of California Healthlinean editorially independent service of California Health Care Foundation.