Thousands still won’t have coverage after Affordable Care Act
By Natalie Jones
The Camacho family has six children, none of whom have health insurance.
The Sacramento residents emigrated from Mexico about 13 years ago, staying without legal papers. They are among the estimated 2.6 million undocumented California residents who will largely be left out of health-care reform.
“My mom always tells us, ‘You have to take care of yourself, because we can’t afford to go to doctors,’ or, ‘We can’t afford to get sick,’” said Maria Camacho, 19.
On Monday, the open enrollment period for the Affordable Care Act ended (although extensions are available in certain circumstances). California officials are hoping that many previously uninsured residents will now have coverage.
But for California’s sizable population of undocumented immigrants, health-care options are unlikely to change, and may continue to be largely out of reach. Undocumented residents are not eligible to participate in the state’s health-care exchange. Tens of thousands of these uninsured residents are children.
By 2019, California will have an estimated 50,000 undocumented children, according to a 2012 study by UC Berkeley and UCLA researchers. Many of these children will continue to face difficulties accessing health care.
When Vidal Camacho, 18, fell off a trampoline a few years ago and seriously injured his tailbone, his family thought he should go to the doctor. A family friend ended up taking him and helping to pay for the visit.
But recently a cyst formed on Vidal’s tailbone and began oozing blood and pus. His mother has been treating the wound at home with gauze and store-bought supplies. His parents, who work in Sacramento’s agriculture industry, hope he’ll be able to get medical attention soon, but they can’t afford to spend much on a doctor’s visit.
About 95 percent of children in California are covered by health insurance. Of the remaining 5 percent, most are eligible for coverage, but are not signed up for a variety of reasons.
A patchwork of programs, both publicly and privately funded, try to provide health care for the state’s uninsured, but many people slip through the cracks.
Between 3 and 4 million California residents could remain uninsured by 2019, according to the joint UC Berkeley and UCLA study. The researchers estimate that about three quarters of those will be undocumented residents. The rest are likely to be people who aren’t aware they’re eligible for insurance or don’t know how to sign up, and those who still can’t afford coverage.
Vidal has applied simultaneously for Deferred Action for Childhood Arrival status and health insurance under Covered California, the state’s health-insurance exchange. He’s waiting for his Deferred Action application to be processed, which typically takes four to six months, according to the National Immigration Law Center.
The application costs $465, and so far Vidal’s family has only been able to save enough for his, although Maria says they eventually plan to apply on behalf of all of the children.
In California, individuals who qualify for deferred action will be eligible for health insurance under Medi-Cal if they also meet income requirements.
About 150,000 people have applied and been granted deferred-action status in the state so far. The funding for health coverage for them comes from the state. Deferred-action grantees can also enroll for health insurance through an employer, if they have that option.
Many areas also have low-cost or no-cost clinics for undocumented immigrants, but the Camachos have had difficulty finding out about these or accessing them, they said. The family has moved several times during its time in California, making it difficult to maintain relationships and ties to a particular community, Maria said.
Researchers working on a survey for the UCLA Labor Center found that 69 percent of the undocumented youths they talked to did not have health insurance, and about half had experienced health-care delays in the last year due to cost.
The possibility of delayed care concerns Shana Alex Laverrada, a health-insurance researcher at the Labor Center.
“Often with these childhood issues, delays in care can be disastrous,” she said. “You could end up having an episode that puts you in the ER.”
Uninsured children have the highest rates of delayed care of any population, Laverrada said.
California’s counties provide health care to the indigent, but that doesn’t always mean that those without insurance know how to access care or that they receive it promptly. The state plans to cut the amount of funding it gives to counties for indigent care, based on the presumption that more uninsured residents should now be covered under the Affordable Care Act.
“With the expansion and the Affordable Care Act, many of the individuals that were the responsibility of the county now become, in many cases, Medi-Cal enrollees, and that would be a reduction in the financial responsibility for these counties,” said Norman Williams, spokesman for the California Department of Health Care Services.
But this reduction in funding could end up hurting those who still don’t have coverage, such as the Camachos.
Maria said her family’s strategy is to stay as healthy as possible, and use over-the-counter medications and home remedies when necessary.
“We can’t afford to get sick, because we can’t afford to go to the doctor’s and we don’t have insurance to go,” she said.