On Friday, Governor Jerry Brown signed SB 10, which authorizes California to submit a federal waiver to allow undocumented Californians to purchase insurance on Covered California, the state’s health insurance marketplace created under the Affordable Care Act (ACA). This underscores our state’s commitment to covering all Californians. However, under federal law, undocumented consumers will be barred from receiving federal subsidies. So what would premiums cost this population?
This ACA 411 map shows one example of what unsubsidized coverage on Covered California cost in 2016. The average monthly premium for a 40 year old purchasing the second-lowest silver plan, without subsidies, ranged from $245 to $421 depending on the region. (In reality premiums also vary by age and type of plan.)
When consumers use their insurance, they incur additional out-of-pocket costs in the form of copays and deductibles. These amounts depend on the type of plan. Silver plans in 2016 have an annual deductible of $2,250 for medical services and $250 for drugs.
The role of federal subsidies in bringing down the cost of plans on Covered California can’t be overstated. In 2015 almost 90% of Covered California consumers received subsidies to help pay their premiums. Those subsidies were worth, on average, $441 per month in 2014, the latest year for which data have been released.
That’s financial help undocumented consumers won’t get, but will likely need. The Public Policy Institute of California estimates that 87% of undocumented immigrants earn below 250% of the federal poverty level (or $29,425 per year).
The waiver, if approved by the federal government, will mark an important step forward in the state’s ongoing efforts to provide access to health coverage for all Californians. However, it remains to be seen how many undocumented Californians can actually afford to purchase the insurance made available to them. This highlights the need to continue to improve insurance affordability — in terms of premiums and out-of-pocket costs — for the benefit of all California consumers.
Amy Adams is a senior program officer for CHCF’s Improving Access team, which works to improve access to coverage and care for low-income Californians.
Prior to joining the foundation, Amy worked for the Service Employees International Union (SEIU), leading a range of state and federal health care policy and research efforts. Her most recent work there focused on the Affordable Care Act (ACA), analyzing regulations and developing policy positions. Prior to that, she led a team working on Medicaid policy issues in California and other states, including public hospital and long-term care financing issues. Amy also brings program evaluation and assessment experience through her previous work as deputy director of a nonprofit research and policy organization and a private consultant to foundations, government agencies, and nonprofits. She received a bachelor’s degree in American Studies from Yale College and a master’s degree in social welfare from the University of California, Berkeley.