Fifth Circuit Appeals Court Ruling on President Obama’s Executive Order on Immigration: What It Means for #Health4All in California

Last Monday the U.S. Fifth Circuit Court of Appeals voted 2-1 to block President Obama’s 2014 executive order on immigration, dealing a major setback to efforts to shield an estimated five million immigrants living in the U.S. from deportation (learn more here). Issued in November 2014, the President’s executive order would have allowed millions of immigrants to apply for work authorization and protection from deportation. From the immigration enforcement perspective, it would have allowed the Administration to prioritize enforcement of current law—such as it is. Ironically, the Obama administration has processed more deportations, about 400,000 per year, than any other president in history (learn more here). In February of 2015 a Texas district court issued a preliminary injunction, bringing implementation of the executive order to a halt.

The health coverage intersection in California came the following June, in the final state budget where the Brown Administration reaffirmed California’s policy of including income-eligible California adults with “deferred action” immigration, such as those who may benefit under President Obama’s administrative relief, in state-funded full-scope Medi-Cal. The state budget also includes coverage of kids regardless of immigration status—with additional implementation direction passed in SB4.

Gov. Brown’s budget clarification also provides a case in point for the Fifth Circuit Court’s dissenting argument by Justice Carolyn King: The President’s DAPA Memo provides only guidelines—it does not confer any actual benefits to the immigrants, as justices on the prevailing side have claimed. King is right, and this is why states like California that recognize the value of extending health services to the entire community, have had to make special policy provisions and allocate separate state-only funding to extend affordable coverage to immigrants. This is our choice—that only a few states have made, and the President’s Executive Order, even if it withstands the court challenges, does not change this.

Looking for the Silver Lining While Continuing the Momentum on Health4All

As noted by Marielena Hincapié of the National Immigration Law Center, If there is any silver lining to Monday’s appeals court decision it is simply that this issue will very likely go to the Supreme Court in the current October-June cycle—all it takes is four justices to put the case on the docket.

If the Supreme Court rules in the Administration’s favor, the Administration would have only a few months to implement the executive order.  California, however, should be ready to move ahead with state-funded Medi-Cal eligibility for the DAPA adults.

That, in turn, would get us closer to the statewide goal of #Health4All. It would make expansion–and the expense–of a full Medi-Cal expansion to all who are income-eligible relatively smaller. Next year’s SB 10 (Lara) would seek that, as well as a Section 1332 waiver from the federal government to allow immigrants from households above the Medi-Cal eligibility threshold to purchase coverage through Covered CA.

All of these things will take time—longer than any human being should have to wait for decent health care.  This is where the counties come back into the picture and where their role should be expanded. Earlier this year, Sacramento, Contra Costa, and Monterey counties, along with the County Medical Services Program serving 35 small and rural counties, all started new pilot programs extending primary and other levels of care to their undocumented residents, while Los Angeles and Santa Clara and other augmented what they offered. From these counties we hope to glean important lessons for the broader campaign for #Health4All.

This is to say, and if we may echo Hincapié: “the power of our movement [for #Health4All and more] is greater than the sum of any anti-immigrant decision.”

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