Sacramento, California – Governor Gavin Newsom did not expect to experience a new health crisis.
In March, while President Donald Trump and the Republicans of the Congress were the national debate intensifying about the possibility of reducing medical care for poor Americans and with a disability, the Democratic Governor had to inform the state legislators that the costs of health care had been out of hand in California.
This is due to the large Medicaid initiatives that newsom supported, including the greatest expansion of the country of medical care that is financed with public funds for immigrants who live in the United States without papers.
His senior officials of the State Finance Department revealed discretion to the Californian legislators in a letter that the State had asked a loan of $ 3.4 billion to pay insurers, doctors and hospitals who attended the patients registered in the state program of the Medicaid, known as Medi-Cal.
Before the rise in healthcare costs in the midst of A budgetary crisis Returning, Newsom must now take into account the possibility of reducing coverage and benefits.
In his second term, the governor is confronted with a difficult political decision: not to fulfill his promise to achieve universal medical assistance and to remove the coverage of millions of immigrants without legal status, or seek budget reductions in other places.
With nearly 15 million inhabitants registered in Medi-Cal, California has more to lose in terms of medical care than any other state. Although Newsom has convicted Trump’s strategy on rates and environmental policy, he has remained an airtight health policy.
To complicate your political situation, Surveys They show that providing medical coverage to immigrants without papers has little support. And any resulting budget problem can harm its political legacy if you request the presidency in 2028.
“We all know that the cutbacks will certainly be,” says Carlos Alarcón, health analyst and public benefits of the California Immigrant Policy Center, who helped to stimulate a campaign of a decade in the state to expand Medicaid to immigrants without eligible documents.
“The governor must fulfill his dedication; we will see a lot of disappointment when we see cuts and reductions. In difficult times it is always our marginalized and unhonished communities that lose,” he added.
California allows every adult with a low income to register with Medi-Cal as 138% of the federal poverty area, or $ 21,597 per year or less, regardless of their immigration status. However, the costs are much higher than expected.
Democratic governor Jerry Brown expanded Medi-Cal to people of 19 years or less without papers, but expressed his restraint to expanding it Outside that group due to possible costs.
Newsom has announced laws that include people aged 20 or older. It is estimated that 1.6 million immigrants are now covered without legal status and the costs have been shot at $ 9,500 million a year, compared to the $ 6,400 million estimated in November. The federal government bears around $ 1.1 billion of that total for medical care for pregnancy and emergency situations.
“We can expand anywhere due to pure generosity, but as soon as these means are exhausted, we all lose. We reach a critical point,” said California Assembly David Tangipa (Fresno Republican). “Either we assume tax responsibility, or there will be no services, including the Californians and immigrants without papers.”
Democratic leaders who are responsible for approved the state budget did not accept interviews. In a declaration, state senator María Elena Durazo (Democrat van Los Angeles), who defended the expansion in the legislative power,: “Turning this progress would be a harmful and blunt decision.”
The laws are considering the registration of immigrants without freezing papers, to impose shared cost measures, such as copagos or premiums for medicines, or limit the benefits, according to people who are familiar with the issue that asked not to be identified to protect their relationships in the state hairstyle.
However, it is unlikely that Newsom drastically reduces the funds in his budget investigation, published on 14 May. On the other hand, the cutbacks would take place if the Republicans of the Congress approve a budget agreement with important reductions of federal expenditures in Medicaid.
“This will be very problematic for the governor. Budget reductions have an influence on the lives of millions of immigrants who are just starting to have medical help, but the governor has to do something because this is not sustainable,” says Mark Peterson, an expert in national medical and political care for the UCLA.
“The possibility of reducing other costs to support immigrants who live in the country without permission would be a difficult political strategy; I don’t think that happens,” he said.
If Newsom, together with the legislative power that was controlled by the Democrats, would be forced to make cuts, could claim that he had no choice. Trump and the Republicans of the Congress have threatened states such as California with the Last proposal From the American House of Representatives of reducing the financing of Medicaid in 10 percentage points for states that offer coverage to papers without papers.
For Newsom, Trump can be an easy scapegoat, they say analysts.
“You can blame Trump; the available money is limited,” says Mike Madrid, an anti-Trump Republican political analyst in California, specializing in Latin issues. “This ensures that people see the medical help they cannot pay and ask themselves:” Why do we give it to those who are here without documents? “
The exorbitant costs were a surprise.
In the First budget proposal Newsom as a Governor, in which he suggested expanding Medi-Cal to young adults without documents, estimated his administration that expanding the benefits for all eligible persons, regardless of their status, would cost around $ 2.4 billion annually. But the last digit reported to legislators was almost four times higher.
Newsom refused to answer questions from KFF Health News and, instead, referred to earlier comments that leave the door open for the possibility of reducing medi-cal. The governor emphasized the “serious” conversations with the legislators and said that cutting the program is an “open question” in which the president will enormously influence.
“What is Donald Trump’s impact on many of these issues? What is the impact of federal vandalism on many of these programs?” Asked newsom Rhetorical in December, which suggests that it is not clear whether you can retain expansion for immigrants without papers in the coming years.
Newsom expanded Medi-Cal in three phases, starting with immigrants aged 19 to 25, who were eligible in 2020, against the pressure of medical care defenders for a large and expensive expansion. He argued that it was gradual, ultimately, California would save money.
“It’s the right and ethical”, ” Said Newsom in 2020. “It is also financially responsible.”
Due to the record surpluses in recent years, the Democrats were able to continue. Older adults of 50 to 64 years old They started to be eligible in 2022, and Newsom closed the gap the following year and approved the coverage for the most numerous group, 26 to 49 years oldFrom 2024.
However, the costs have risen a lot, while the budgetary scenario has deteriorated, according to a KFF analysis of the most recent records of 2023 that are available at the State Medical Care Services department, which manages Medi-Cal.
In addition to the children, it was more expensive to offer medical coverage to immigrants without legal status than to legal residents. Medi-Cal, for example, paid healthcare, a large health insurer in Los Angeles, an average of $ 495.32 per month for attention to an adult without children without papers, and $ 266.77 for a legal resident without children.
He was not only more expensive for immigrants without legal status, but California absorbed the most costs.
The state paid around 60% and 70% of the medical healthcare costs for an adult immigrant without children covered by care, and about 10% for a legal resident without children. These costs do not cover the total healthcare costs that can vary, depending on where medi-kal patients live and rise when recipes, go to the dentist or seek mental health care.
These payments also vary according to the insurer, but the trend is maintained in all Medi-Cal plans. In most of the state, patients can choose from more than one health plan.
In many cases, the coverage for children without legal status was cheaper than that of children with a legal stay. In general, children are healthier and need less attention.
Mike Genest, who served as director of Finance during the government of the former Republican Governor Arnold Schwarzenegger, argued that the State should have planned the enormous costs.
“The idea that we can pay medical attention for all these people without papers in the long term is untenable,” said Genest.
Although the costs are now high, the expansion of Medi-Cal will generate long-term savings for taxpayers and the health system, said Anthony Wright, who previously became health access for expansion as director of the non-profit organization and is now fighting the cuts to Medicaid as executive director of Families USACon Sede and Washington, DC
“Anyway, they will stay to our health system,” said Wright. “Leaving them without medical insurance will only lead to more busy first aid and will cost even more. It is not economically useful that they do not take a crucial income for clinics and hospitals, which only causes more problems.”
This story is produced by KFF Health Newsthat publishes California Healthlinean editorial independent service of the California Health Care Foundation.
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