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California’s act to cover healthcare for undocumented people sets up national debate on the politics of immigration and healthcare

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MARC STEINER: Welcome to The Real News Network. I’m Marc Steiner. As usual, it’s great to have you with us.

The war is over health care is heating up between a Democratically-controlled California and Trump’s right-wing Republican power in the executive branch. California’s passing a new law, Assembly Bill Number Four. And it would use state and federal funds so undocumented adults 19-25 would be eligible for Medicaid, giving them access to health care benefits. It also gives families at six times the poverty level–that’s one hundred and fifty thousand bucks a year–a hundred dollars a month to pay for benefits. Opponents say it’s unfair to tax citizens to pay for undocumented people’s benefits. Or as the opponents would say, not undocumented, you’re illegal.

So this new health care thrust in California clearly deepens the divide not only between California and the Trump White House, but on the debates over Obamacare and health care for all, and may have an effect on the 2020 election.

And we’re joined by Michael Lighty, longtime health care activist, and Sanders Institute fellow. Michael, welcome back to The Real News. It’s great to have you with us.

MICHAEL LIGHTY: Thank you, Marc. It’s great to be back.

MARC STEINER: So let’s talk about that. What’s going on, the debate that took place in inside of the House in California? Because I understand that there were other people who wanted a larger bill to cover everybody. There was actually a real debate over this. The governor really was pushing it, as well. So talk a bit about, very quickly, the politics of what was taking place inside.

MICHAEL LIGHTY: Well, this has been an effort, Marc, for a number of years to cover undocumented folks in California, because I think like most advocates, certainly when I worked for the nurses, it was very clear that viruses know no border. That’s even like you see in the vaccine issue of measles, immigration status doesn’t matter. So there has been recognition among progressive policymakers that we really do need to guarantee health care for all.

So there was an effort to cover everybody a number of years ago. It evolved into first covering undocumented kids under 18 and then provided for non-subsidy access to the exchange formed under the Affordable Care Act for adults who were undocumented. And now this latest iteration is to cover undocumented folks under 26. But the real intent was to cover every undocumented person in California who is eligible for MediCal.

MARC STEINER: But that didn’t happen, right?

MICHAEL LIGHTY: That did not happen. There are 2.5 million undocumented folks in California. Half would be eligible if they just followed the regular MediCal criteria. Instead, under 100,000 undocumented folks will be eligible for this program.

MARC STEINER: Part of that had to do with money. I mean, this is costing $98 million, as opposed to covering everyone would be $3.4 billion, which the opponents said was just too much, you can’t do it. Am I right about that?

MICHAEL LIGHTY: You’re right, because politically that’s a very heavy lift. If you’re going to cover every undocumented worker you should cover every Californian, period, regardless of immigration status. That’s our position as Medicare for All supporters. That’s what we did with SB 562. And we always said that yes, you can establish the principle to cover undocumented folks, but if you’re actually going to do it politically and effectively as policy, put everyone in one program and guarantee health care for all.

MARC STEINER: So before we jump into what this might mean a larger national scale, I want to play this clip from Fox News where the kind of conservative pushback against this idea so we can talk about this for a moment. Here it comes.

FOX NEWS CLIP: Well, now; full health care benefits for illegals in California.

It’s about 90,000 low income illegal immigrants will be eligible for this. They’re saying it’s going to cost about $100 million, as you said. I can’t see how–that seems very low in terms of what the costs could potentially be.

But it’s just 90,000 illegals. It’s not all illegals.

That’s what they’re estimating right now. Because it does–there is an income level threshold.

OK. OK. So it’s an income level. But 90,000, they think it’ll cost $100 million a year. Dream on. I don’t see that.

MARC STEINER: And that was Stuart Varney, who benefited from the health care system in England growing up, I’m sure. But anyway, they–that argument, plus the argument that it’s unfair for citizens to pay for non-citizens’ health care, so these are going to be some serious issues in the battle around health care and what California has done in terms of a national struggle.

MICHAEL LIGHTY: But look at that Fox clip, Marc. What was in the background? Was it scenes of the uninsured? Was it scenes of the public health crisis at the border, where kids are being denied health care, among other basic necessities? No, it was a screenshot of the stock price of key health care industry corporations, insurance companies and others. That’s the lens through which the health care system is viewed by Fox and so many people in this country. It’s an industry. What we’re saying on principle is it’s a caregiving profession, and that we need to guarantee health care for all with no barriers to care and no borders.

So politically we are in this fight, and we have an alternative vision. The question of paying for it is real. It’s much more cost effective to pay for universal health care for all through single payer than it is to do this. And the issue I think politically is if you’re going to tax individuals and then not really guarantee health care to them, you’re going to create a political fallout, whether it’s immigrants or any other issue. It has to be universal. It has to be guaranteed for it to actually work politically.

But on the other hand as Larry Levitt from the Kaiser Family Foundation said, this is hugely important symbolically. It’s a hugely important affirmative fight taking on the administrator’s assumption that somehow if we deny folks who work in our restaurants, who clean our buildings, if we deny them health care, we’re going to be healthier. It’s an absurd position. We rely upon these people all the time. When we go to restaurants we pay for them. They’re just not getting health care. They pay into Social Security. We’ve seen studies in California; nearly 80 percent of the undocumented folks are working. They’re paying taxes. They’re not getting health care. And they’re discriminated against by employers who are taking advantage of their immigration status.

So combine that whole set of social issues you see fundamentally that if we believe health care is a right it is not and cannot be based on immigration status. And that’s a political fight we’re going to have to win federally if we’re ever going to establish guaranteed healthcare because otherwise the right would use that as a reason to deny it to everybody.

MARC STEINER: Well, let’s talk about that fight that that could be, will be brewing because of this, and the long term in the 2020 election around the question of immigration and health care. And we talked earlier before we went on camera about abortion health care is another one. We won’t dive into that one too deeply today.

But let me show you this map. This is a map that our visual producer Andrew Corkery found that I want to share with you and with our viewers, that shows states that actually cover health care for immigrants. And you can look at this map and see that you’ve got, you know, some states like California, Oregon, Washington, New York, Illinois cover adults and children, and some states pregnant women only, like Texas, Oklahoma, Arkansas, southern states; Minnesota, Nebraska. And then you have children only in a couple of states. But the vast majority of states, no matter whether they are blue or red states, don’t cover immigrants at all. Undocumented immigrants at all.

So this is–this is a very tense, touchy battle that really draws lines. It doesn’t even often go into what’s fact. It has to do more with emotions about who people are coming across the border, what they should get, and what we should be paying for as citizens, right? So talk about your analysis here about what this map says about what this struggle might mean coming up in the next year for this presidential election.

MICHAEL LIGHTY: It is definitely an issue that varies by state. I think it’s ironic, of course, that there might be some states controlled by the GOP where immigration is not the decisive issue in health care; for example, Texas. And then there are, of course, other states like California, I think, where it is not a barrier to majority support for universal health care.

Where it is a barrier to support for universal health care we have two options. We are going to have to either win the fight over comprehensive immigration reform, or we’re going to have to make the argument that through health care we change people’s attitudes toward what it means to including undocumented workers who are already part of our society in the social programs that define it. So that really is, I think, the political question that we have to face. As a matter of principle, if you believe health care is a human right and you believe we need to guarantee health care for all, you’re not going to condition that right on status, whether it’s gender, sexual orientation, gender identity, race, and so forth. And immigration status is one of those.

Ultimately I believe politically we have to win on the issue of converting the health care industry to a caregiving profession that guarantees health care with no barriers to care. If we don’t include undocumented folks, we don’t include every resident, we don’t achieve it. And then we have leakage in the system. You have ill individuals who are not getting the treatment they need. And that’s going to affect everyone.

I think, really–when I talk about this issue, Marc, with advocates, I often cite Dr. Martin Luther King, who said that we are all tied in a single garment of destiny. What affects one directly affects all indirectly. And that couldn’t be more true in health care, it couldn’t be more true in this issue. And if we’re not prepared to actually address the public health crisis that asylum seekers face at the border, that folks in our own communities face regardless of status, then we’re not going to achieve what all of us need. And that’s the fundamental point. All of us have a stake in everyone around us being healthy.

MARC STEINER: So just to round this out, I mean, there are two quick issues–not quick, because you could go on for days with this. But but A is that this California bill does set up a huge debate. There’s no way California by itself could create Medicare for All. The state can’t do it alone, given the nature of health care in this country. And B, when you look at what happened just now between Mexico and the United States, and Trump pushing the tariff, and all the other things that just happened, and the complexity of that when Mexico is actually doing things before Trump did anything, the real issue is here this becomes a real–as I said earlier, an emotional issue. So the question is how you tie them together or separate them when you’re trying to create a political movement on the progressive end of the spectrum.

MICHAEL LIGHTY: Well, it is significant that Representative Jayapal comes out of the immigration rights movement and is the leading advocate for Medicare for All in the House as the primary co-sponsor of the bill. So there is fundamentally a kind of understanding that these issues are linked. I tend to think when you go to places like Iowa, and all of a sudden you realize that the hog farms are staffed overwhelmingly by immigrants from Mexico and Central America; when you go to Georgia and you see the expansion of Latinx communities there; obviously in Florida; these states are are important swing states, pivotal states. Minnesota, obviously, has a large Somali population. So you really can’t escape anywhere you go in the country. The issue of undocumented folks being an integral part of the American workforce. And so we are in a fight, ultimately, over xenophobia, over structural racism, over injustice that is rooted both in race and immigration status. And they directly impact healthcare.

If we take the principle guaranteed health care with no barriers to care, everybody in, nobody out, then I believe the politics of resentment which drive the dynamic you’re talking about, they’re getting it but I’m not–and that’s true for white working class folks and it’s true for a lot of other folks as well–that resentment dynamic, right, goes away if everybody’s situation improves. If everybody has guaranteed health care why are you going to resent someone else having it?

MARC STEINER: Michael Lighty, we’re just touching the surface here. We’ve got a little bit more than the surface, but we have so much more to talk about with this. And I appreciate the work you do and you joining us here on The Real News. And thank you so much for your time today. We’ll look at this some more.

MICHAEL LIGHTY: All right. Thanks a lot, Marc.

MARC STEINER: Always good to talk to you. And I’m Marc Steiner here for The Real News Network. Thank you all for joining us. Take care.

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Michael Lighty

Michael Lighty is a founding Fellow of the Sanders Institute, and currently serves on the Lancet Commission on Public Policy and Health in the Trump Era. Lighty has advocated, organized and developed policy for healthcare reform nationally and in California for nearly 30 years.