Despite California’s embrace of federal health care reform, millions of Californians are expected to remain uninsured even five years from now. Undocumented immigrants are likely to be a large share of this uninsured group because they are excluded from coverage under the Affordable Care Act. At the state level, legislation has been introduced (SB 1005) to provide subsidized insurance options for all low-income Californians, regardless of immigration status.
California is home to an estimated 2.5 million undocumented immigrants. This population is distributed unevenly around the state, but undocumented immigrants reside in nearly every county. Los Angeles and other Southern California counties have the largest number of undocumented immigrants—nearly a million are estimated to reside in Los Angeles County alone—and this region is projected to have more than 60 percent of uninsured Californians in 2019.
What do we know about how undocumented immigrants use health care today? The limited body of research on health care use among undocumented immigrants finds lower levels of utilization and spending relative to the native born. Despite their limited access to other health care settings, noncitizens are less likely to have recently visited the emergency room than citizens, even when demographic and health factors are taken into account. In part, this is because undocumented immigrants are relatively young and likely to be working, which suggests that they may be healthier than the general population. However, some of these immigrants—particularly farm workers—face heightened health risks.
Without changes in state or federal law, we can expect that undocumented immigrants will continue to rely on the health care safety net—particularly health clinics and hospital emergency departments. Some counties provide services to undocumented immigrants under their indigent care programs—particularly counties that operate public hospital systems— but the majority do not and are not required to do so. Recent PPIC research suggests that California’s network of clinics is well positioned to serve low-income communities, including those with large numbers of undocumented immigrants. About 75 percent of California’s undocumented immigrants live within two miles of a health clinic, although proximity and access varies across counties.
Comprehensive immigration reform at the federal level could improve insurance coverage and access to care in the long-run, but recent proposals have specifically excluded undocumented immigrants on a path to citizenship from federally subsidized coverage. It’s hard to imagine that changing anytime soon. That leaves it up to the state to grapple with health care access for this sizeable group of residents.