As part of a $3.1 billion annual investment the state of California will make to broaden accessibility to the state’s Medicaid program, the more than 700,000 undocumented immigrants living in California officially gained access to free healthcare on January 1. The initiative follows from the state’s decision in 2022 to expand Medicaid coverage to all low-income adults regardless of immigration status. 

These efforts at expanding healthcare coverage are part of California Democrats’ broader aims of enacting universal healthcare in California. Indeed, while efforts have been made before to improve coverage, notable limitations remained. For instance, California’s monumental implementation of the Affordable Care Act in 2014 excluded immigrants, and even subsequent expansions of healthcare benefits—such as that which occurred in 2015 for low-income immigrant children and adults over 50–left immigrant adults ages 26 to 49 vulnerable and uninsured. To address this inadequacy, then, California Democrats sought to pass the coverage plan that now gives all undocumented immigrants access to preventative care and other forms of treatment. 

However, the plan hasn’t been without its detractors. Many, chiefly California Republicans, have criticized the costliness of the initiative, especially amid the state’s attempts to navigate a $68 billion budget deficit. This criticism finds expression in the opposition of Republican state senator Roger Niello, vice-chair of California’s Senate Budget and Fiscal Review Committee, who argued, “Regardless of what your position is on [the healthcare expansion plan], it doesn’t make sense for us to be adding to our deficit.”

Others, alternatively, have criticized the effectiveness of the plan altogether, reasoning that immigrants may not even avail themselves of the new opportunity for medical coverage. These critics argue that undocumented immigrants may hesitate to enroll in the program out of fear of legal repercussions. One such repercussion could be a denial of citizenship because of the “public charge” rule, which requires immigrants seeking to become permanent residents or acquire legal status to prove that they won’t be burdensome to the U.S. government. Immigrants may, as a result, be deterred from enrolling out of fear that their newfound coverage under the Medicaid program constitutes a public “burden” and consequently threatens their pathway to citizenship. 

However, these objections don’t entirely have merit. For instance, while the costliness of the healthcare program may seem problematic for California’s budget deficit, keeping undocumented immigrants uncovered is ultimately an incredibly expensive alternative, too. This is because immigrants living in the state illegally tend to delay or completely avoid care because of a lack of eligibility for insurance covering prohibitively expensive healthcare. As a result of this neglect, California incurs an even greater expense because many of these immigrants end up in emergency rooms or otherwise in need of urgent care. 

Additionally, immigrants’ hesitation to make use of Medicaid could be combated through outreach efforts. This could be accomplished by empowering undocumented immigrants to pursue healthcare when they need it. Efforts could also be made to acquaint undocumented immigrants with federal policies concerning immigration, such as the Biden administration’s reversal of the designation of immigrants seeking healthcare coverage as a “financial burden,” to promote confidence in the healthcare system now available to them. If these two measures are taken, California may finally be able to realize its long-held goal of free healthcare for all.