Maria Orozco, 27, fought hard to help her husband, Ricardo Reyes, 34, get the medical care he needed to treat his chronic kidney disease. Orozco is a legal U.S. resident; Reyes is undocumented—but he receives the full scope of care available through Medi-Cal as an immigrant Permanently Residing Under Color of Law (PRUCOL), a status that allows undocumented immigrants with certain health risks to receive welfare benefits, including health care.
“I knew my rights for health services and demanded them,” said Orozco, who works at a Richmond-based food delivery company. “It was a long process, but we finally got what he needed, and all his treatment and medication was paid for by the insurance.”
Now, however, those benefits may be threatened, given President-elect Donald Trump’s promises to wholly or partly dismantle the Affordable Care Act, which supports insurance plans such as Medi-Cal that cover low-income individuals and the otherwise uninsured. Local programs that cover undocumented immigrants may also be under threat.
About 5,000 of the estimated 15,000 to 60,000 undocumented adults living in Contra Costa County are eligible for Medi-Cal, which is available only to those who have notified immigration authorities about their presence in the U.S. and are not subject to deportation.
Those who are not Medi-Cal eligible may enroll in a relatively new program, Contra Costa Cares, which was launched last December to provide primary care access for low-income undocumented adults in the county.
The program’s $1 million in funding—from Contra Costa County, Kaiser Permanente, John Muir Health and Sutter Health—is sufficient to provide coverage for its 3,000 enrollees, more than half of whom live in Richmond. Locally, enrollees can seek care at LifeLong Medical Care clinics in Richmond and San Pablo and at Brighter Beginnings Family Health Clinic on Macdonald Avenue.
But with as many as 60,000 Contra Costa adult residents undocumented, the program currently serves only a small fraction of those who qualify, according to the Community Clinic Consortium, the group of nonprofit health centers that launched the program.
“We would enroll all of them if we had more resources,” said consortium Executive Director Alvaro Fuentes.
Contra Costa Cares is not a health insurance plan, but a program that provides primary care, as well as laboratory, radiology and limited pharmacy services.
“Treatment will not be covered by this program, but at least people will know what is wrong with them,” said Edith Pastrano, an organizer with the nonprofit group Alliance of Californians for Community Empowerment, which helps promote Contra Costa Cares.
That alone can be life-saving. Richmond resident Ana Gonzalez said it was during a Contra Costa Cares check-up at LifeLong Medical Care-Brookside clinic in San Pablo that doctors found tumors in her breast.
Subsequent mammogram and biopsy tests, followed by a cyst aspiration, she said, cured her.
Contra Costa Cares partially restored primary health care services to undocumented adults that had previously been provided through a county program that was cut in 2009, during the economic downturn. That program enabled undocumented individuals to enroll in a basic health care plan that covered primary care visits and—unlike Contra Costa Cares—specialty care and hospitalization.
Contra Costa Cares, currently in a pilot phase, is set to expire next summer.
County officials have been working on efforts to keep it intact and even expand it, but now those plans are in question, said Fuentes. That’s because “there is a lot of uncertainty about what the new administration would do as far as repealing and replacing the Affordable Care Act,” he said. And any changes to the Act could affect Contra Costa Cares because the program relies on reimbursements through Medi-Cal.
The possible dismantling of the Affordable Care Act is not the only challenge ahead for those who seek to ensure that undocumented immigrants can obtain the health care they need.
Many undocumented individuals were reluctant to sign up for Contra Costa Cares even before the elections, out of fear of deportation if they released their names and personal information in the enrollment process, said LifeLong Administrative Offices Deputy Director Lucinda Brazile.
When Trump was elected, Fuentes said, that fear worsened.
Contra Costa County District I Supervisor John Gioia said he heard from clinics in the county that residents without legal status were cancelling medical appointments in frustration after the elections.
Under the Affordable Care Act, Contra Costa County has doubled enrollment in Medi-Cal, to 200,000 people total.
If the act is repealed or undone, “we will be impacted, but it is not certain how,” said Fuentes.
To prepare for potential changes, the Clinic Consortium will work with the county, health services and local hospitals to discuss what “the future of the program could look like,” Fuentes said.
At the national level, Gioia said that the California Association of Public Hospitals and Health Systems, an organization that represents the state’s 21 public health care systems, will advocate in Washington, D.C. for maintaining care for lower-income residents.
“I think there will be a lot of pushback by a number of members of Congress, mostly Democrats,” Gioia said. “So we’ll see where this goes.”