Most undocumented immigrants still won't be eligible for federal healthcare coverage if the U.S. Supreme Court upholds President Barack Obama's plan to protect millions from deportation.
But a U.S. Supreme Court decision in favor of the plan could inspire more families with children already eligible for government coverage to enroll. It could also mean expanded coverage for some immigrants in a handful of states, experts say.
The Supreme Court announced Tuesday it would hear a case (PDF) centering on executive actions Obama announced in November 2014 regarding immigration. One initiative would allow parents of U.S. citizens and legal residents to avoid deportation and legally work as long as they have lived in the country since 2010.
Obama also expanded a program created two years earlier meant to protect people who arrived in the U.S. before the age of 16 and who have lived here since 2010.
More than 4 million undocumented immigrants would have been affected. But the actions were put on hold by a federal court after more than 20 states sued over the executive orders. The states allege that the president exceeded his authority by not engaging Congress in the changes.
Now, if the Supreme Court rules for the administration, more healthcare coverage could come for some, but not most, undocumented immigrants.
Undocumented immigrants are ineligible for federal healthcare programs such as CHIP, premium tax credits through the Affordable Care Act's insurance exchanges or federal Medicaid dollars, said Sonya Schwartz, a research fellow at Georgetown University's Center for Children and Families. The executive actions announced in 2014 don't change those restrictions.
But some states allow residents who sign up for the original protections announced in 2012–the ones that shielded from deportation people who arrived in the U.S. before the age of 16–to be covered by state-funded healthcare programs.
California, Washington, the District of Columbia, Massachusetts, Minnesota and New York allow low-income people who sign up for that program to also enroll in state-funded health insurance, according to the Center for American Progress.
California could see another 310,000 to 440,000 undocumented adults become eligible for Medi-Cal if Obama's programs are upheld, said Laurel Lucia, healthcare program manager at the UC Berkley Labor Center.
The number of children eligible for Medi-Cal in California wouldn't change regardless of the Supreme Court's decision because the state recently approved expanding Medi-Cal to all low-income undocumented children. Washington, Illinois, New York, Washington D.C. and Massachusetts also already cover kids, regardless of their immigration status, Schwartz said. Those states may only use state dollars to fund coverage for kids who are undocumented, she said.
But it's possible that if the Supreme Court allows Obama's programs to move forward, families with eligible children will sign them up for that coverage. Some families have previously not signed up their children for fear of deportation.
Alvaro Huerta, a staff attorney with the National Immigration Law Center said, however, some people could still avoid signing up because they're nervous about the future of the programs expanded under President Obama's executive actions, especially with the upcoming presidential election.
“Until we get some kind of permanent reform there will always be some fear, and some people will not come forward to take advantage of the programs,” Huerta said, noting that a permanent solution would be a legal path to citizenship enacted by Congress.
In California, for example, about 38% of those eligible for deportation protection have not yet signed up for the first Obama program from 2012, Lucia said. It's also possible they haven't signed up for the program because of its $465 application fee or difficulty completing the paperwork, she said.
She said the UC Berkley Labor Center hasn't estimated how much it could cost California if the additional immigrants were to enroll in Medi-Cal, but she said it would make sense to let more undocumented people enroll since many are already getting emergency Medicaid coverage, as required under federal law, she said.
“The most expensive healthcare is already being paid for by the state and federal governments,” Lucia said. “Expanding access means they'll get preventive care and more ongoing care. It's a more wise use of existing resources.”