Although the Affordable Care Act (ACA) significantly improves access to care for many children and young adults not already covered by other means, the law overlooks one significant population: children of immigrants.
“Some of the biggest coverage challenges ahead are for immigrant populations,” stated Shana Alex Lavarreda, the Center’s director of health insurance studies. “Parents who are undocumented and have children who are citizens may have difficulty accessing both the new public and private programs for their kids. This is an issue that must be addressed to ensure that all of California’s children are insured.”
Lavarreda was a recent speaker at the May 8 California Head Start Association’s Healthy and Ready to Learn conference, invited to discuss how the Patient Protection and Affordable Care Act of 2010 (ACA) impacts California’s low-income families with children.
The ACA has already introduced a series of regulatory changes that have benefited many Californians, especially children. Prior to September of 2010, children with preexisting conditions could be denied coverage for to those conditions. Additionally, young adults were dropped from their parent’s plans upon reaching 18 or graduating from college. Now, children with pre-existing conditions cannot be denied health insurance coverage, and parents can keep their children on their health plans up to age 26, regardless of student status.
“There was a time period that I had no health insurance when I was young. At 21 years old, I was dropped from my parents’ coverage because I had graduated college. I couldn’t buy my own insurance because I supposedly had a ‘pre-existing condition’ – back pain. The system worked against me. Thankfully, the Affordable Care Act ensures that my children will be covered,” Lavarreda said.
In 2009, before health care reform took effect, about 9 percent of poor children in California were uninsured for all or part of the year, according to data from the 2009 California Health Interview Survey.
Along with the expansions above, more options for parents will be introduced in 2014. Medi-Cal will expand income eligibility up to 133% of the Federal Poverty Level (FPL), increasing potential coverage for older children and parents. Also, the California Health Benefit Exchange will be operational beginning in January 2014. This federally mandated program will allow individuals to buy coverage with assistance from federal subsidies, up to a household income of 400% FPL.
However, there are major gaps in coverage. According to a recent Center policy brief authored by Lavarreda, up to 30,000 undocumented immigrant children will be barred from participating in the Health Benefit Exchange, a newly established marketplace for health care plans with subsidies for lower-income Californians. Although their parents will be able to purchase private insurance outside of the exchange, they would not benefit from its protections or competitive prices.
In addition, approximately 150,000 uninsured children will be excluded from the ACA-funded Medi-Cal expansion due to their status as either undocumented immigrants or legal immigrants who have lived in the U.S. for fewer than five years. An estimated additional 40,000 children who are legal citizens of the U.S. also may be excluded from the ACA coverage expansions as a result of confusion over their parents’ citizenship status.