Last week’s court decision on medical care for undocumented individuals has both health advocates and legal experts across the state buzzing. And as FM89’s Diana Aguilera reports, the issue could have an impact beyond those in the program.
The ruling by Fresno County Superior Court Judge Donald Black lifted part of a 30-year-old court order involving specialty medical care for the indigent.
The county had been barred from using a person’s immigration status to turn away people from the program.
But Judge Black overturned that provision, saying the Affordable Care Act and a change in the way counties receive health funding from the state should allow the county to turn away the undocumented.
That’s left community health advocates concerned about what the ruling could mean for the health of all county residents.
John Capitman is the director of the Central Valley Health Policy Institute.
"This is not just a concern from a small share of undocumented people who will be at strong risk for negative health outcomes."
He says the people served by the program are often chronically ill and need access to specialty care.
"There’s no other way to say it. They represent potential risk to the rest of the community, particularly folks who get infectious diseases. If they can’t get appropriate care that puts all of us at risk."
Black's decision stopped short of dissolving the county’s entire indigent health care program. That’s something advocates like Capitman applaud.
County officials blame the situation on a projected $14 million budget cut in health funding from the state. While many indigent residents have transitioned from the county program to expanded Medi-Cal, undocumented individuals are specifically excluded from the new federal health care law.
Fresno County's chief administrative officer John Navarrette says the planned cut puts the county in a financial pickle.
"We’re pitted in a situation that we're not able to fund it unless we reduce other programs, other health programs. What ends up at the end of the day is you’re pinning one health program against another program to provide the coverage for undocumented folks in our community."
Navarrette says undocumented individuals will continue to receive primary care from federally qualified health centers including Clinica Sierra Vista, which was the plaintiff in the case.
But Stephen Schilling, Clinica’s CEO says there’s only so much health clinics can offer.
"If the decision is allowed to remain then we’re going to have a huge public health problem because federally qualified health centers do not provide the full range of specialty care such as orthopedic surgery, dermatology, neurology."
Schilling says the injunction was about specialty care, not primary care.
"When I need to send a patient in for orthopedic consult or an orthopedic surgery where are they going to go? Or they have a communicable disease and we need to isolate them to determine their status, where are we going to send those patients?"
The issue has become a rallying cry for advocacy groups from across the state.
Sandra Celedon-Castro, from the group Building Healthy Communities, says county officials should take into consideration how much undocumented individuals contribute to the local economy.
She says undocumented workers are “the backbone of our county’s economy.”
"If we value our farm workers and we value our farming industry then we need to show that, and we need to show that by providing care and continuing to provide care for everyone."
While last week's ruling was a major milestone in the decades old case, it likely won’t be the last.
Jessica Smith Bobadilla is the director of the New American Legal Clinic at San Joaquin College of Law.
“I think it is exactly the type of case that could be ripe of appeal. One thing is there’s different interactions of new legislation that’s impacting kind of a long standing standard. There’s a large group of affected people in this area potentially by a decision like this.”
Schilling says his legal team is considering an appeal.
Black stayed the order for 60 days, so for now, those in the program will continue to receive care. If it stands, the Board of Supervisors would still need to vote to change the program to exclude undocumented residents.
While the legal battle may continue, there could be a resolution at the state level.
The Senate Health committee will hear a bill Wednesday that would expand health care to all Californians, regardless of their immigration status.