Making immigrants sick: Trump’s Obamacare assault could trickle down to Sacramento’s undocumented

For Sacramento County’s undocumented residents, life is increasingly uncertain. With an incoming federal administration headed by President-elect Donald Trump, who has vowed to defund so-called “sanctuary cities” and jump-start mass deportation, one threat that has so far flown under the radar is what might happen to Sacramento County’s recently revived health care program for undocumented immigrants.

The county decided to defund services for undocumented immigrants during the height of the recession in 2009, dropping coverage provided by the County Medically Indigent Services Program to save $2.8 million. Those savings were lost to increased emergency room visits and other costs associated with the dropped health coverage, advocates say.

In June 2015, the Sacramento County Board of Supervisors voted to reinstate health coverage after feedback from community health care providers and advocates, according to Samantha Mott, a spokeswoman for the Department of Health and Human Services. Healthy Partners was launched by unanimous vote in January 2016, with vocal advocacy from District 1 Supervisor Phil Serna. The program is funded with $6.4 million of taxpayer money from the county general fund, Mott said, and provides primary and prevention care to enrollees age 19-64.

According to the program’s supporters, the cost is covered by savings realized under the Affordable Care Act, also known as Obamacare—meaning Obamacare is indirectly funding the county’s immigrant health care program. Should Obamacare be repealed, as House Republicans and Trump promise to do as a first act in power, Sacramento’s undocumented residents could suffer the consequences.

The impacts would be notable. The program was already filled to capacity in August 2016, with 3,000 covered and more on a waiting list.

Gabby Trejo, associate director of Sacramento Area Congregations Together, a community organizing group that works in part with undocumented immigrants, said the program has been integral for that community. Trejo said supervisors will vote in the spring on whether or not to continue funding Healthy Partners, when the board reviews its budget for such programs. But the long-term future of Healthy Partners—and the fate of the people waiting on its rolls—remains uncertain.

“We don’t know the exact impact until the new administration is sworn in and we see what the Affordable Care Act will look like, or not look like, in the future,” Trejo said. “But covering 3,000 undocumented adults has allowed us to save money in terms of how many people we’re seeing in the emergency room, because we’re able to provide them with primary care.”

Though not formally a source of funding for Healthy Partners, Obamacare allows the county to reallocate money saved through reduced emergency room costs to keep the program thriving. (The program doesn’t cover seniors because their insurance costs were deemed too expensive. Undocumented children had been getting patchwork care though other programs; in May, state lawmakers made them eligible for Medi-Cal services through the state’s insurance exchange, Covered California.) UC Davis law professor Kevin Johnson, dean of Chicana/o studies at the university, explained that such funding could face a dire threat from Trump.

“It’s possible that the Trump administration could go to Congress and act to tighten the use of federal funds and to limit the ability of states to obtain the use of federal funds for undocumented immigrant benefits,” Johnson said. “The issue now … is … President-elect Trump has emphasized that he’s going to focus more on deporting undocumented immigrants than the past administration. Some would say, ’If we’re going to focus on deporting them, why should we be providing any benefits to undocumented immigrants?’ And others would say … ’We should protect them like we protect all residents of the community.’”

Two advocates who work directly with undocumented immigrants agreed it was impossible to predict the aftershocks of an Obamacare repeal, saying much was contingent on how the promised federal action is carried out. But the advocates cited strong concerns over the congressional threat and its implications for Sacramento County’s undocumented adults. (The program doesn’t cover seniors because their insurance costs were deemed too expensive. Undocumented children had been getting patchwork care though other programs; in May, state lawmakers made them eligible for Medi-Cal services through the state’s insurance exchange, Covered California.)

California Rural Legal Assistance Foundation Executive Director Amagda Perez said the uncertainty has already made some in the undocumented community apprehensive about signing up for a program that someone like Trump could bait-and-switch into a domestic surveillance program.

“It’s always a concern because they just don’t know if it’s going to flag someone for deportation,” Perez said. “Even though in the legal realm applying for health benefits would not put a person in legal proceedings, the fact that they’re undocumented just brings additional concerns. Anything that might bring them to the attention of a government agency that has the power to remove them is always going to be a concern.”

Repealing Obamacare could squeeze Sacramento County and other jurisdictions to keep their undocumented health care programs going, noted Ronald Coleman, government affairs manager at the California Immigrant Policy Center.

“It could put a number of cost pressures onto state and local budgets, but we think that California and Sacramento would still be in a position to provide health care for the undocumented population,” Coleman told SN&R.

That’s because Coleman thinks local and state governments could still afford these programs even without Obamacare. But being able to afford them and actually paying for them are two different things, and Coleman acknowledged Trump’s sniper eye on Obamacare is the biggest trickle-down threat to Healthy Partners.

“The biggest threat right now is the repeal of the ACA and how it could potentially put cost pressures on … local government budgeting,” Coleman observed. “With that said, Sacramento County has newly invested in this population, and it’s not an investment that would break the budget.”