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California is stronger when everyone has access to health care.

Increasing access to health care is the right thing to do, and will improve the quality of life for many who call California home.
 Immigrants help take care of California every day. We’ll all benefit when California helps take care of immigrants.
o Millions of California families are of mixed immigration status. One in six of all California children have at least one undocumented parent.
Investing in immigrant families is investing in our state.
Undocumented immigrants are a fundamental part of California.
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It's more cost-effective - and just common sense - to prevent sickness than it is to treat it once it reaches a critical condition. And a little investment will go a long way.
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Undocumented immigrants are a vital part of the fabric of California’s communities – and a major economic engine for California. o Undocumented immigrants are an integral part of our communities and play a major role in
California’s economic life, contributing $130 billion to the state’s Gross Domestic Product. 1
Pass SB 4 this year so that we can move towards a health care system that works for everyone.
SB 4 is an
toward healing the unjust exclusion of undocumented Californians from health care , and builds on the state’s historic decision to expand full-scope Medi-Cal coverage to all eligible children.
SB 4 would:

Set California on a path to expand full-scope Medi-Cal coverage 2 to all low- income adults, regardless of immigration status, depending on future budget allocations. SB 4 establishes a limited enrollment program for Medi-Cal health coverage that will provide services as funding is made available.

Seek to allow adults to purchase health insurance using their own money through the state's Covered
California insurance marketplace. Under the bill, California would request a special waiver from the federal government to make this possible.
No one should suffer or die from an easily treatable condition, no matter where they were born. With
SB 4 we’ll help California families thrive - and set in motion a powerful model for the nation.
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The federal government has failed to create a workable immigration process for the nation, and compounded that injustice by excluding our undocumented neighbors, friends, and family members from health care. California needs to make this right.
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When we invest in equitable access to health for all who are working hard to move the Golden State forward, all Californians will benefit. Together, we can build on the vision and promise of the Affordable
Care Act and begin to empower all communities to improve their quality of life.
1 See note below. Be sure to humanize the issue and always lead with values.
2 This refers to full-scope Medi-Cal with a comprehensive benefit package
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Remember: As the Opportunity Agenda wrote in 2009, “Research shows that people are often most motivated by their values —and if data don’t support their deeply held beliefs, audiences will reject them. So we need to shape conversations with values, and then support our arguments with the best data available.” Weave key statistics in with the experiences of directly impacted people and with valuesbased messages, and use “social math” to help make numbers more relatable. (Eg, “2 cents to the dollar” instead of 2%.)
People without insurance in California:
● Despite the progress the Affordable Care Act has achieved, an estimated 1.5 million Californians will be uninsured and not eligible for coverage due to immigration status. (About 4 out of 10 working-age undocumented
Californians do have health insurance. See the last page of “ Unauthorized and Uninsured ” for the latest statewide data)
Mixed-status families: (Source: USC )
● Immigrants are part of the fabric of our state. “One in six of all CA kids have at least one undocumented parent.”
Immigrant contributions:
Suggestion: When talking about immigrant contributions, be sure to humanize the issue and always lead with values – including the poll-tested finding that expanding health care is the right thing to do.
● Undocumented Californians make up nearly 9% of our state’s workforce and contribute $130 billion to the state’s
GDP – a figure larger than the entire GDP of Nevada.
● Undocumented Californians play a major role in our state’s economic life, contributing $3.2 BILLION dollars in state and local taxes in 2012 alone.
●
Nearly half (49%) of undocumented Californians have lived here more than 10 years
Existing Term or Concept Suggestion
Remaining [undocumented] uninsured
Full Scope Medi-Cal
138% of FPL (Federal Poverty
Level )
“Indigent”
"Subsidies"
“Medical home”
“Broken immigration system”
Replace with a more compelling phrase, eg: "Undocumented people excluded from care"
Explain: “A state health plan that offers a comprehensive range of health benefits .”
Put in context: “A family of three earning under $28,000 a year
($27,724, to be exact.) ”
Explain: “Folks struggling to get by in these challenging times.”
Explain: “Support to make health plans more affordable.”
Explain: “A reliable doctor or medical care that you can see for non-emergency situations .”
Reframe: “Congress has failed to / we need to … create a common-sense immigration process ”
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Speaking to the press - key interview tips : We do not have to directly answer a reporter’s question; we can respond with our message. Sometimes, we can use phrases like “before we continue, let me emphasize that” to keep the conversation focused on our key messages.
However, we do need to addres s the substance behind questions that touch upon our audiences’ major concerns. But we must do so on our terms, not by repeating anti-immigrant messages - even to debunk them.
Example : Aren’t immigrants overwhelming our scarce resources and hurting our economy already [sic]?
Bad answer: No, immigrants aren’t overwhelming our resources, draining our services, or stealing our jobs. [This could be your entire quote]
Good answer: No. The fact is, immigrants are part of the fabric our communities, and contribute tremendously to California….
Possible questions and suggested answers
Q. So there’s $40 million in this year’s budget – what’s that about?
Through this year's budget process, California expanded guaranteed access to full-scope Medi-Cal for all undocumented children who would otherwise qualify for the program. This provision is already enacted through the budget and is no longer part of SB 4. The expansion for children will go into effect no sooner than May 1,
2016. The 2015-2016 Budget contains an initial appropriation of $40 million for this expansion, and the state estimates that the total cost of providing Medi-Cal to undocumented children moving forward will be $132 million per year. However, the total cost may in fact be less.
Q. So, we already passed an expansion of healthcare for children. How realistic is it to pass SB 4 this year?
Expanding health care is an urgent issue. Adults don't have time to wait - consider the story of Yolanda, who was diagnosed with terminal cancer and given 6 months to a year to live after years of inadequate access to health care. No one should suffer or die from a treatable condition, no matter where they were born. We must pass SB 4 this year so we can lay the groundwork for covering all Californians. The more we wait, the more people suffer.
Q. Last year, the Health for All Act died in appropriations. What’s different this year?
Momentum is stronger than ever to make a framework toward Health for All a reality this year. The state has already expanded MediCal coverage to all eligible children through this year’s budget process, a decision which came on the heels of a historic, bi-partisan vote advancing SB 4 out of the Senate. This underscores the findings of poll released last fall showing that a firm majority of California voters – 54% - support expanding healthcare to undocumented Californians.
The current proposal is a fraction of the cost of earlier proposals. The narrower scope of SB 4
—on adults— significantly reduces the cost, and can be capped to the money available in any given budget year.
Q. What about the Medi-Cal provider rates?
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That's important too - and as Senator Lara has noted, the same people working on SB 4 are the same people working to restore the provider rates. We can walk and chew gum at the same time.
Q. If this passes, are there risks for undocumented immigrants if they sign up?
Health information is confidential and the Federal Government has confirmed it only uses health application information to verify eligibility. Last year, Covered California and several immigrant rights groups issued a special factsheet confirming the privacy and confidentiality of information provided on applications. For Medi-
Cal, many undocumented people already receive short-term "emergency" Medi-Cal, and we have not heard of any issues related to ICE in this context. We will keep working to assure the privacy and confidentiality of this information.
Q.
How is healthcare for California’s immigrants affected by the administrative relief programs President
Obama announced in November?
A.
The Obama administration’s new deportation relief programs (“DAPA” and the expansion of “DACA”) are temporarily on hold due to an unjust, baseless lawsuit filed by anti-immigrant states. Legal experts are confident the lawsuit will ultimately be overturned and these programs will be implemented.
But with SB 4, we have an opportunity to begin to do the right thing, right now . We can expand health care to immigrants who have been excluded this year.
(Technical details: When these programs do go into effect, we expect immigrants who receive deportation relief to be excluded from federal health benefits. But California has a long tradition of providing access to basic health programs such as Medi-Cal to all considered “lawfully present.” That means that immigrants with deferred action who are otherwise eligible for Medi-Cal would be able to receive health coverage. This is already the case with immigrants who have deferred action through the existing DACA program.
But, even when the new deportation relief programs are in effect, California’s undocumented community members will be left out of the programs.)
Q: Shouldn’t we wait until we see the results of the court case against the President’s executive immigration order?
E ven when the new deportation relief programs are in effect, half of California’s undocumented community members will be left out of the programs. That’s why SB 4 is so important. It gives us the opportunity to expand access to affordable health insurance this year, regardless of immigration status. With SB 4 we have an opportunity to start doing the right thing, right now.
Q: Why should California cover undocumented immigrants?
It’s better for everyone when we treat preventable conditions early, rather than resort to emergency rooms. We also must consider the health, fiscal and social costs of inaction. It doesn’t reflect our values, and it simply doesn’t make sense, to lock a whole population of Californians out of access to care. That will only exacerbate health disparities in the future. We have nothing to gain from letting people go bankrupt trying to pay their health bills, or letting people die from an easily treatable condition, just because of where they were born.
Q: Why now? Why does this priority deserve higher budget priority than the other worthy projects?
We stand in support of several key measures this year. SB 4 deserves to be part of that top tier of priorities because it continues the momentum of both the efforts on health reform and immigrant rights, both movements
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Californians are included.
We also recognize that for each year we fail to act, there will be more California families living sicker, dying younger, being one emergency from financial ruin. California’s action would have national importance to the efforts on both protecting Obamacare and pushing for immigration reform.
Q: Don’t immigrants already use up a lot of public benefits?
The fact is, undocumented immigrants are unfairly excluded from the vast majority of vital health programs.
Our nation has failed to create a commonsense immigration process, and it’s time for California to enact a sensible approach to healthcare that includes all of our co-workers, neighbors, friends, and family members.
Q. Covered California has had trouble signing up Latinos. Why would this new exchange be any different?
While Covered California has improved in signing up Latinos and needs to continue to ramp up its outreach, the fact is that the exclusion of undocumented immigrants from the ACA splits “mixed status” families right down the middle. And for millions of Californians in these families, there is an understandable mistrust of sharing private information given the Obama administration’s aggressive deportation policies. By passing SB 4 and building on California’s other pro-immigrant laws, we can help empower all members of mixed-status families to sign up for care.
Q: Why allow access to Covered California or a mirror marketplace without subsidies? What’s the point?
First of all, California should remove the exclusion of undocumented immigrants from its health insurance marketplace, on principle. It’s doesn’t reflect California values or good policy to restrict people from buying coverage, especially if they are using their own money and trying to do the right thing and buy coverage for themselves and their family.
California has hundreds of thousands of mixed-status families that could be better helped if Covered California could serve the entire family —even if some members are eligible for subsidies and some are not. Covered
California could better walk through the coverage options for the entire family, and with more welcoming and inclusive policies, it is more likely Covered California sign up the eligible but un-enrolled people that have undocumented family members.
As California continues to recover from the recession, it will be important to address financial support to make purchasing insurance through the exchange affordable. Creating the mechanism for undocumented
Californians to sign up for coverage through an Exchange is an important first step.
Q: Don’t the uninsured already get care today through emergency rooms, public hospitals, and county indigent care programs?
The current law is that emergency rooms must stabilize a patient that walks through their door —but there is no prohibition on sending a bill of thousands of dollars afterwards. Also, hospitals are not required to provide anything other than emergency care —so there’s no requirement to provide primary or preventive care, or any disease management or non-urgent help for cancer, AIDS, asthma, diabetes, or any other issue.
Counties have an obligation to provide indigent care, but they vary widely about how they meet that obligation, what they offer, and who they serve. Only ten of 58 counties provide non-emergency services to the undocumented. Governor Brown and the Legislature reallocated most of the money ($900 million) that went to the county safety-net to serve the remaining uninsured, which limits the ability of counties that want to from providing such care and coverage.
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