California's young immigrants who have been granted reprieves to stay in the country stand to gain little from the federal health reform law that the state Legislature is working to implement.

The Affordable Care Act excludes illegal immigrants from accessing the law's benefits, but some immigrant and health advocates are angry that the young people known as Dreamers have been left out, saying the policy contradicts the law's intent of expanding coverage to more people.

"It really defeats what the goals of the ACA were to begin with," said Sonal Ambegaokar, health policy attorney at the National Immigration Law Center.

The Deferred Action for Childhood Arrivals program, which was announced in June, allows people who were brought into the United States when they were young to stay for two years if they pursue education or military service. The young people eligible for the program are known as Dreamers, in reference to the proposed Dream Act - legislation that would give them a path to citizenship.

More than a quarter of the 1.76 million people who are or will be eligible to apply for DACA - about 460,000 immigrants - live in California, according to an August 2012 Migration Policy Institute report.

After the DACA program was announced, the Obama administration clarified the policy, specifying that people to whom DACA applies will not qualify for Medicaid now or as the health law is implemented. And while many Americans will receive subsidies to buy insurance through their state's exchanges - the insurance marketplaces established by the Affordable Care Act - people granted DACA approval will not be able to purchase coverage through those exchanges even with their own money.

Rule questioned

Critics say the rule does not make sense. They argue that people approved for the program are lawfully present in the country, but when it comes to health care, they are treated as undocumented immigrants and will face a harder time finding coverage.

"It's really unfortunate," said Ronald Coleman, the California Immigrant Policy Center's government affairs manager. "These are individuals that are going to be paying taxes; they are getting work permits."

Providing DACA grantees with Medicaid coverage - known as Medi-Cal in California - or giving them subsidies to buy insurance would increase costs for the state and federal governments, especially as the state expands Medi-Cal coverage. Some conservatives also attack attempts to offer immigrants access to the benefits of health reform - a law they disdain in the first place.

People approved for DACA can still buy private insurance and can acquire health coverage through their employers. And while federal law requires that emergency services be offered to all, states and counties can provide additional benefits for people with different immigration statuses.

California, for example, covers limited breast and cervical cancer treatments and prenatal care for undocumented immigrants, according to the state Department of Health Care Services. And San Francisco provides Healthy San Francisco benefits regardless of immigration status.

Dreamer wonders why

But the Obama administration's policies have upset people like Jirayut "New" Latthivongskorn, a 23-year-old UC Berkeley graduate whose DACA application was approved in January. Latthivongskorn, who was born in Thailand and moved to the Bay Area when he was 9, helped start the group Pre-Health Dreamers as a resource for those pursuing health and science careers or looking for medical care.

Latthivongskorn, who lives in Fremont, said Dreamers were frustrated that they are allowed to stay in the country but will not have access to the exchanges, which are designed to provide affordable coverage for individuals. Advocates point out that many of the undocumented people who would otherwise be eligible to participate in the exchanges are the type of young, healthy patients who help reduce costs for everyone.

"My reaction is: I don't get it," said Latthivongskorn, who hopes to go to medical school.

Support for change

In December, 81 members of Congress wrote to President Obama expressing their concerns about the policy, including Democratic Bay Area Reps. Barbara Lee, Zoe Lofgren, Mike Honda, Anna Eshoo and Mike Thompson, and former Reps. Lynn Woolsey and Pete Stark.

"With up to 1.7 million immigrants potentially benefiting from deferred action under DACA, there are significant costs to leaving immigrants uninsured if they are unable to afford health care on their own, particularly if they turn to hospital emergency rooms and public safety net hospitals for care," they wrote in the letter.

But the federal government does not appear inclined to expand the law. Recent immigration reform proposals from both the Obama administration and a bipartisan group of senators excluded those granted a pathway to citizenship from the health law's benefits.
