Los Angeles Times (Sunday)

Bill aims to let adults add parents to health plans

Supporters say policy would help uninsured people in California, especially immigrants.

- By Samantha Young

SACRAMENTO — When Laura Chavez’s 74-year-old mom needed eye surgery last month, Chavez paid cash for the procedure.

The cost? $15,000 — and that was for just one eye. She couldn’t afford both.

Her mom, Esperanza Chavez, doesn’t qualify for Medicare because of her immigratio­n status. And she can’t find a private health insurance plan under $1,000 a month.

“We’re constantly having to make decisions based on costs rather than ‘Is this medication really going to help keep you alive and healthy?’ ” said Laura Chavez, 41, a San Franciscan whose mother has diabetes. “It’s just unfair to have to think about it that way.”

Now, a California lawmaker is pushing a bill that would require private health plans regulated by the state to extend coverage to some subscriber­s’ parents. Business groups and others fear the legislatio­n could jack up insurance premiums, but the bill has strong backing from health advocacy and immigrants’ rights organizati­ons, as immigrants make up a sizable portion of California’s uninsured population.

Policyhold­ers can already add children up to age 26 to their health plans — a benefit available nationally under the Affordable Care Act. But California would be the first state to extend the benefit to dependent parents, who are expensive to cover because they are older and sicker than the overall population, health experts say.

“This is groundbrea­king and, quite frankly, a shift in the paradigm about the way we think about people getting health care,” said Assembly member Miguel Santiago (D-Los Angeles), author of AB 570. “The bottom line is we want everybody to get healthcare, and we will fight every angle to ensure that people get adequate healthcare.”

Many states have experiment­ed with how to cover America’s roughly 33.2 million uninsured people, about 400,000 of whom are 65 or older. California’s incomeelig­ible children can receive public health insurance regardless of their immigratio­n status, New Jersey parents can cover a dependent child up to age 31, and Floridians can cover their kids up to age 30 so long as they aren’t married or don’t have dependents of their own.

One group that would benefit from California’s legislatio­n, backers say, would be green-card holders who haven’t met the five-year waiting period to qualify for Medicare and Medicaid, and those here illegally.

While striving to cover parents is a laudable goal, said Sherry Glied, a former assistant secretary at the U.S. Department of Health and Human Services during the Obama administra­tion, employers could face higher insurance premiums.

“This is an expensive population, and it’s also susceptibl­e to real risks,” said Glied, now dean of New York University’s Robert F. Wagner Graduate School of Public Service.

Glied fears some people would abuse the coverage. For instance, she said, someone could bring an ailing parent into the country on a tourist visa, sign them up on their employer’s health plan and arrange for the treatment they need.

California already gives income-eligible unauthoriz­ed immigrants up to age 26 full benefits from Medi-Cal, the state’s version of Medicaid for low-income people.

Lawmakers are considerin­g separate proposals to broaden Medi-Cal eligibilit­y. One bill would apply to immigrants age 65 and up who are in the country illegally, and another would make all California­ns eligible regardless of age or immigratio­n status.

Similar efforts have failed repeatedly over the past several years because of cost concerns, but California now has a $75.7 -billion budget surplus.

Unlike the Medi-Cal measures, which rely on state funding, the bill authored by Santiago, working with California Insurance Commission­er Ricardo Lara, would transfer the cost onto employers and insurance companies. It would allow parents or stepparent­s — regardless of age — whose children claim them as dependents on their taxes to be added to private health plans regulated by the state. They include job-based plans and those purchased on the open market or through Covered California. Employer-sponsored plans regulated by the federal government would not be subject to the bill.

The Assembly Health Committee has approved the bill, which needs to clear the Appropriat­ions Committee before heading to the Assembly for a vote.

It’s hard to pinpoint how many California­ns could benefit from the measure. Nationwide, about 3.4 million people were claimed as dependents on their children’s tax returns in 2019, and an estimated 400,000 of them lived in California, according to an analysis by the California Health Benefits Review Program.

The overwhelmi­ng majority of those parents already have health coverage through Medicare or Medicaid, the analysis concluded, leaving 20,000 to 80,000 California­ns who could benefit.

Despite the relatively small number, California employers say this mandate would raise premiums by $200 million to $800 million a year, depending on how many people signed up.

“Small employers will be forced to reassess how much they can contribute to employees’ dependent premiums,” Preston Young, a policy advocate at the California Chamber of Commerce, told lawmakers at a recent Assembly Health Committee hearing.

Lara, California’s insurance commission­er — whose parents were once immigrants here illegally — said the bill would help the poorest of the Golden State’s families, giving those with no other options “substantia­l peace of mind.”

“When we needed care as children, our parents were always there for us,” Lara said. “As our parents age, a lot of us in turn have become their caretakers.”

Chavez finds herself in the role of caretaker to her children and her mother. She has insurance for herself and her two daughters through her employer, the nonprofit organizati­on Challenge Day.

But she can’t afford to buy a comprehens­ive insurance plan for her mom on the open market. A bare-bones policy, Chavez said, costs more than $1,000 a month because her mom has preexistin­g conditions. She doesn’t qualify for Medicare or Medicaid because she is in the United States illegally.

If Chavez could add her mom to her job-based policy, she wouldn’t have to pay cash for her mom’s needs, and the whole family could share one deductible and one cap for out-of-pocket costs, she said.

“It would bring significan­t financial relief,” Chavez said. “Every month, there are charges we have to budget for and pay for. God forbid she has to go to the emergency room.” This story was produced by Kaiser Health News, one of the three major operating programs at the Kaiser Family Foundation.

 ?? Laura Chavez ?? LAURA CHAVEZ, left, recently paid cash for eye surgery for her mother, Esperanza Chavez, center, because the 74-year-old doesn’t qualify for Medicare.
Laura Chavez LAURA CHAVEZ, left, recently paid cash for eye surgery for her mother, Esperanza Chavez, center, because the 74-year-old doesn’t qualify for Medicare.

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