Expanding California’s Medicaid program to include all immigrants seemed a good idea to lawmakers two years ago, when the state budget was running a surplus and immigration was a back-burner issue.
But the law finally took effect this month with the state $38 billion in the red and with unfathomable numbers of immigrants pouring into the country illegally.
It doesn’t help that one of the things Medi-Cal, the state program, offers coverage for is sex-change surgeries, prompting critics to complain that California is now paying for transgender treatment for immigrants without documentation.
The policy is now taking intense fire from Republicans, including former President Donald Trump who mocked the idea on social media, and Florida Gov. Ron DeSantis, who during a presidential primary debate this week said he’d try to shut the program down.
“You’re here illegally, and they’re doing that? We should not let states provide these benefits,” he said.
Opponents say the full coverage will cost $4 billion a year — a price the state can’t afford to pay for people who, under the law, aren’t supposed to be in the U.S. anyway.
“We’re going to have to cut from somewhere and this should be part of the conversation,” state Assemblyman Bill Essayli, a Republican, told The Washington Times.
He filed legislation last week to repeal the coverage for immigrants who are in the country illegally.
The complaints come as the migrant surge rages at the border and communities across the country are cutting services to residents to free up resources for the newcomers.
In New York City, officials have trimmed preschool enrollment and there simply aren’t enough credentialed English-language learner teachers to accommodate all the new students, Danyela Souza Egorov, vice president of the Community Education Council for New York City School District 2, told Congress on Thursday.
She also said the migrant surge has forced the city to cut back on school safety officers, and the system has been forced to try to recruit parent volunteers to patrol their schools instead.
In Eagle Pass, Texas, which last year became ground zero for the border chaos, the fire chief said of the 45 ambulance call-outs each day, two-thirds of them are related to illegal immigration, costing the city as much as $18,000 a day.
That’s money the feds don’t reimburse.
But residents sure feel it, he testified to Congress. The 18-bed emergency room at the community’s one hospital gets so overloaded that residents have had to wait in the ambulance for two hours before space could be made for them. And they are still the lucky ones.
“Sometimes our residents are left without an ambulance service,” Chief Manuel Mello III told the House Judiciary Committee in a hearing to examine the growing price tag of the border chaos and the millions of migrants who’ve been caught entering the country illegally and released into American communities.
Analysts say there are several facets of the debate. The border needs for communities like Eagle Pass are one matter. The immediate demand for services by newly arrived migrants once they reach their destinations in the interior is another facet.
And then there’s California and other communities that are seeking to expand eligibility for regular benefits and services to include those here illegally.
Gov. Gavin Newsom, a Democrat, championed the Medi-Cal expansion two years ago and has defended it this year amid new complaints.
“In California, we believe everyone deserves access to quality, affordable health care coverage — regardless of income or immigration status,” he said. “Through this expansion, we’re making sure families and communities across California are healthier, stronger, and able to get the care they need when they need it.”
The governor’s office said offering insurance-style care can end up saving money by allowing immigrants who are in the country illegally to obtain preventive care for chronic conditions, lowering demand for emergency room visits and more expensive treatments later in the progression of a condition.
Hospitals are required to provide emergency care to all, regardless of legal status.
California isn’t the first state to cover all immigrants. Oregon’s plan went into effect last year.
But as the largest state with the largest Medicaid program, and with the largest number of undocumented immigrant residents, its experiment will be the most watched.
Its coverage of undocumented immigrants was progressive, starting nearly a decade ago when the state extended its Medicaid program to include juveniles. It then added young adults, then older undocumented immigrants, and now it is closing the last gap and covering all without regard to age or legal status.
The fact that transgender care is covered particularly incensed some critics.
“It sort of shows how ridiculous it is. It shows what Californians are going to be paying for. This isn’t medical necessities,” Mr. Essayli said.
Still, he said that’s a sideshow to the bigger questions.
“This is really more about fiscal responsibility and asking California’s taxpayers to pay for illegal immigrants, citizens of foreign nations, when our own people don’t even have affordable health care here in California,” he said.
Then there’s the aspect of how immigrants themselves will react.
“When you announce a program like this, when you put it out, it’s going to attract more illegal migrants to come to California,” he said.
• Stephen Dinan can be reached at sdinan@washingtontimes.com.
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