Bill to Watch: SB1005(Lara), #Health4All

HEALTH ACCESS UPDATE: Wednesday, March 5, 2013


*        The Affordable Care Act dramatically reduces the number of uninsured, but may leave 2-3 million remaining uninsured–SB1005(Lara) would allow all Californians to get the same levels of help to access and afford care, regardless of immigration status.

*        Community advocates and legislators argue that our health system is stronger when all Californians are included; providing coverage is more efficient and effective than episodic and emergency care provided in a patchwork of programs.

        SB1005(Lara) would extend state-only Medi-Cal to *all* under 138% of poverty level, and create a “mirror marketplace” for those above 138% of poverty level to provide health insurance products similar to Covered California.

*          Debate continues at counties: Fresno County loses first round of legal effort to end its medically indigent programs for the remaining uninsured including the undocumented. As our Health Access Report indicated, counties vary widely on their safety-nets.

*          New legislation introduced in the last week on a range of health issues; Health Access bill list forthcoming.

* As CA Leads Nation In Enrollment, Advocacy Still Needed on Successes and Improvements; STORIES NEEDED of California’s Experience With Covered CA & Obamacare

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Now that the deadline in the California Legislature for new bills to be introduced has come and gone, consumer, community, and health organizations are looking through new legislation to weigh support and opposition. (Health Access California will produce a new bill list in the next week.) The health bill that has gotten the most attention and grassroots enthusiasm from health and community groups this year has been SB1005, by Senator Ricardo Lara and many co-authors, to extend coverage for all California’s remaining uninsured, including undocumented immigrants.

#HEALTH4ALL: The Affordable Care Act will dramatically expand coverage, but California will still have 2-3 million remaining uninsured. Health advocates argue that California can and should take steps to include everyone and improve our health system as whole. They state that Californians without insurance generally wait to seek care until they are seriously ill, and in many cases have health problems that could have been avoided with preventive care, or treated early for little cost, become significant, and costly health issues. The impacts of this include lost productivity, increased demand on emergency services, and increased costs in our healthcare system.

While the exact number of remaining uninsured depends on how aggressive California’s enrollment efforts are, the Affordable Care Act (ACA) specifically excluded undocumented immigrants from insurance coverage provided through Medi-Cal and the health care marketplace, Covered California. Around one million Californians will remain uninsured and not eligible for coverage due to immigration status.

SB 1005 will ensure that everyone in our communities has access to quality, affordable healthcare. The #Health4All Act will:
* Extend eligibility for Medi-Cal benefits to low-income undocumented California immigrants who would qualify for the assistance but for their immigration status.
* Create a “mirror marketplace” that offers similar products and benefits to Covered California, run by the same board as California’s Health Benefit Exchange.

FIRST HEARING IN APRIL: A statewide coalition of organizations who agree that immigration status shouldn’t bar individuals from accessing or purchasing quality, affordable health coverage are mobilizing in support of Senator Lara’s bill, seeking additional co-authors and gearing up for a late April hearing in Senate Health Committee.

CONTINUED WORK AT COUNTIES AS WELL: Without a proposal like this, many Californians would need to continue to rely on a patchwork of safety-net systems, including county programs, public hospitals, and community clinics. In November 2014, Health Access California released a report urging a statewide solution to the remaining uninsured, showing that the current county safety-net is wildly uneven. Some counties do, and others do not, cover people based on income or immigration status. For example, in 2009, three counties (Sacramento, Contra Costa, Yolo) stopped funding non-emergency health services for most undocumented adults. The report is available by visiting or directly through the following link:

Since then, Fresno County has been debating whether to cut back or end its Medically Indigent Services Program, including care to the undocumented, despite their central role in Fresno’s community and economy. Last week, a judge handed down a preliminary decision rejecting Fresno’s effort; now advocates are urging the county to withdraw from expensive litigation, and rather than fight it, get to the work of crafting a revised and improved medically indigent care program.

Similarly in the next year, counties across California will be making decisions about the safety-net health services they will be providing to those who remain uninsured. Health advocates will need to be focused on these decisions at county health departments and Boards of Supervisors to better ensure access for all California residents, regardless of income or immigration status.

Ultimately, consumer and health advocates make the case that California is stronger when everyone has access to care and coverage; that it is cheaper to have access to primary, preventive care than to treat illnesses after they develop; and that by ensuring that Californians have that access, counties can make sure that their residents are healthy and contributing economically to their communities.


Health Access wants to know how Californians are experiencing the Affordable Care Act, especially the process of shopping for insurance in Covered California, and what surprises–good or bad–they are encountering. CLICK HERE TO SHARE YOUR STORY, or that of someone you know.