California has seen a sharp decline over the past decade in the number of residents who lack health insurance — with one major exception.
The federal Affordable Care Act helped increase coverage rates but excludes undocumented immigrants, who now make up the bulk of the state’s uninsured population.
Consider this: Nearly two-thirds of undocumented immigrants in California who are younger than 65 lack health insurance, compared with less than 10 percent of all Californians in that age range, according to a recent analysis from the Center for Labor Research and Education at the University of California, Berkeley.
It’s a large, lingering disparity, and one that Gov. Gavin Newsom has turned his attention toward in the new year.
In a budget plan unveiled this week, Newsom proposed allowing undocumented immigrants to sign up for Medi-Cal, the state’s health program for low-income Californians. (This is distinct from an ongoing effort to create a single-payer health care system in the state.)
The state already allows undocumented Californians under 26 to join Medi-Cal, and those 50 and over will become eligible in the spring. Opening up Medi-Cal to the remaining undocumented population — approximately 700,000 people — would cost $2.2 billion annually, Newsom said.
“We are positioned with this budget to be able to deliver on what we’ve been promoting: universal health care for all,” Newsom said at a news briefing on Tuesday. “I’m proud to be here — I hope we see this replicated across the country.”
Expanding Medi-Cal to all undocumented Californians has been a goal of health advocates for years. But actually executing that vision seemed somewhat unlikely, until the coronavirus pandemic.
How we got here
The Affordable Care Act, often referred to as Obamacare, brought down California’s uninsured rate to 7 percent from 17 percent after its rollout in 2014.
But federal rules barred California’s 2.2 million undocumented immigrants from signing up for coverage through Medi-Cal or the state’s marketplace, Covered California. The state is home to a fifth of all of the people living illegally in the United States.
“It was always a sort of clear and troublesome exclusion — that we are expanding coverage to everyone, but with one glaring exception,” said Anthony Wright, executive director of the advocacy group Health Access California.
Wright and other advocates immediately began pushing for the state to use its own funds to provide coverage to undocumented immigrants, with some success.
In 2015, legislators voted to allow undocumented children to join Medi-Cal. Four years later, they broadened eligibility to include those younger than 26.
Health and policy experts said it would be difficult to pass coverage expansions beyond those age groups. Compared with adults, children tend to use few health care services, which keeps cost relatively low, and they tend to garner more sympathy from the public.
But then the pandemic hit.
California ended up with a surprisingly large budget surplus that gave the state more flexibility to invest in new programs. And living through a public health crisis revealed to people something that had always been true, Wright said.
“Our health is connected to our neighbors, to our community, including the people who deliver our food, the people who drive the bus, the people who make the society function,” he told me. “I think it changed hearts and minds.”
A poll conducted by the Public Policy Institute of California in March found that 66 percent of Californians supported offering health care coverage to undocumented immigrants. That was up from 54 percent in 2015, the last time the institute asked the question.
In July, state legislators voted to expand Medi-Cal coverage to undocumented immigrants over 50, a change that will take effect in May.
Newsom’s proposal announced this week would cover people between 26 and 49 and, if approved, take effect in January 2024. The governor said on Tuesday that the state’s undocumented immigrants made up 10 percent of our work force and that most had lived in the state for more than a decade.
Though the budget won’t be finalized for months and opponents of the plan have already begun speaking out, many advocates say they are hopeful.
“We are going to be the first in the nation, the United States of America, that is finally going to recognize our immigrants and to give them the kind of health care that they need,” the labor leader Dolores Huerta told reporters.
Where we’re traveling
Today’s travel tip comes from John P. Dinga, who recommends Point Lobos State Natural Reserve:
“I started playing in this park almost every week when I was an eighth grader at the Carmel Mission school. This reserve has many different types of landscape: rugged coastline with lots of trees, bare landscape like the moon, and some beautiful small sandy beach coves.
One could easily spend two or three hours walking around all the parts of the reserve. One can walk or push bike into the reserve for free, which my schoolmates and I used to do. I know the layout of the reserve like the back of my hand, and 65 years later I still visit there whenever I get the chance. The reserve is beautiful, and the deer love it too. But watch out for the poison oak!”
Tell us about your favorite places to visit in California. Email your suggestions to CAtoday@nytimes.com. We’ll be sharing more in upcoming editions of the newsletter.
What we’re reading
A new, ambitious novel that shows our interconnectedness across time, place and cultures.
What’s the best part of winter in California? Email us at CAtoday@nytimes.com with your traditions, recommendations and opinions.
And before you go, some good news
For the first time in at least 15 years, endangered coho salmon are spawning in narrow Marin County creeks, with heavy rains allowing them deeper into their historical habitat.
Though there is a healthy population of coho salmon that regularly returns from the Pacific Ocean to spawn in the region’s coastal creeks, the fish were recently spotted in more inland waters.
“This is the first time in a long time we’ve seen them way, way, way up in these tiny streams,” Preston Brown, the director of conservation at SPAWN, told The San Francisco Chronicle. “They swim, leap, wriggle and jump — they’re pretty acrobatic actually. But they need enough water to carry them through.”
Thanks for reading. I’ll be back tomorrow. — Soumya
P.S. Here’s today’s Mini Crossword, and a clue: There are an estimated five sextillion (10^21) in a drop of water (5 letters).
Jonah Candelario, Steven Moity and Mariel Wamsley contributed to California Today. You can reach the team at CAtoday@nytimes.com.