‘Joy turned into shame’: California’s Latino Caucus agonized over slashing immigrant health care

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Moments before an important budget vote last week, state Sen. María Elena Durazo stood on the Senate floor and spoke passionately about the plight of immigrants’ health care in California. She lambasted the Legislature’s choice to freeze Medi-Cal enrollment for immigrants without legal status and charge monthly premiums.

The Senate’s budget negotiations and headlines had long since turned toward a different crisis — housing reform — but Durazo stayed firm. 

Durazo said she was joyful when the state opened Medi-Cal to all low-income residents regardless of immigration status just a year and a half ago. Now “that joy has turned into pain, that joy has turned into shame, and that joy has turned into betrayal,” Durazo told her colleagues on the Senate floor.

The Democrat from Los Angeles issued a clarion call to the public and to her colleagues: “Remember today’s date and what the Senate is doing.”

Durazo’s stand and subsequent vote against the Medi-Cal cuts stood out among a sea of Democratic yes votes. She was joined in opposition by three other members of the state Latino Caucus who voted against or abstained from the measure.

For more than a decade, the 35-member Latino Caucus has championed the expansion of Medi-Cal to immigrants, passing the baton from each new class of lawmakers to another. No one has been more outspoken about the proposed cuts than its members, Democrats who self-identify as Latino or Hispanic, many of whom spent the past month joining rallies on the steps of the Capitol and fiercely debating the impacts.

But the state’s $12 billion deficit put the Latino Caucus in a bind, forcing them and their party to make difficult decisions about walking back health care during a year when the state has too little revenue and too many expenses. 

Many legislators in the caucus say that California is cruelly balancing its budget on the backs of poor immigrants. They’ve argued that California is creating a state-sanctioned, two-tiered health system where some residents are considered “less than.”

Yet, despite some misgivings, the emotional nature of the cuts and the fervor of the rhetoric, nearly all of the caucus — 30 members — voted to approve them within the larger health care budget package.

Under the agreement finalized last week by the Legislature and Gov. Gavin Newsom, in six months, California will freeze new enrollment of adult immigrants who do not have legal status in Medi-Cal, the state’s health insurance program for low-income residents. In one year, non-citizens 19 and older will lose dental benefits, and in two years, most of the adults must pay a $30 monthly premium. Combined, these changes are projected to save California about $1 billion in their initial implementation years, growing to more than $4.3 billion ongoing.

The Latino Caucus, whose members make up 36% of Democratic Assemblymembers and 43% of senators, is one of the most powerful political blocs in California. The caucus historically carried bills to support immigrants without legal status through changes in health care, labor and education.

The decision to cut medical benefits for immigrants was an agonizing one for the Latino legislators as they’ve watched the Trump administration wage an aggressive deportation campaign against immigrants in Southern California and the Central Valley, calling them criminals and reportedly rounding them up at job sites, bus stops and their homes. More than 75% of unauthorized immigrants in California are from Mexico and Central America, according to a 2019 analysis from the Migration Policy Institute.

The lawmakers wrestled with the bleak necessity of Medi-Cal cuts after multiple years of deficits. Some say the programs that they were able to save in the budget, such as home care for immigrants and other Medi-Cal enrollees, are worth defending even if the other cuts are painful.

“There are so many members who share my feelings about needing to maintain health care for all, while also ensuring we’re fighting for everything else on the budget we voted on,” Assemblymember Celeste Rodriguez, a Democrat from Arleta who voted for the Medi-Cal cuts, said in an interview with CalMatters before the final budget was approved.

Sen. Caroline Menjivar, a Democrat from Van Nuys who joined Durazo in voting against the Medi-Cal changes, has consistently opposed cutting benefits for immigrants. “Our actions have consequences and those consequences will cause people to lose health insurance,” she said.

Her outspoken opposition apparently landed her in hot water with some in the party leadership. Last month, her office said Menjivar was removed from a key budget subcommittee because she opposed the Medi-Cal cuts. 

Menjivar said she can’t support policies that single out a specific demographic. “It’s the ‘othering,’ where we’ve created a hierarchy of what human is eligible and what human is ineligible,” that she can’t stomach, she said.

For Durazo, “it’s the specific targeting of immigrants. That’s the problem.”

Health advocates rallied against the cuts for weeks and pressured lawmakers to walk back even deeper cuts proposed by Newsom. A coalition of groups representing health advocates, immigrant rights groups and labor lined the sidewalks on a recent day as lawmakers walked into the building to vote on an earlier version of the budget that mirrors some of the final provisions. Their chant of “health for all” has been a rallying cry for the expansion since 2013.

“We can’t say we believe in universal health care…and say we’re going to make exceptions for this one population,” said Mar Velez, director of policy for the Latino Coalition for a Healthy California.

Caucus chair Sen. Lena Gonzalez, a Long Beach Democrat who abstained from voting on the Medi-Cal cuts, told CalMatters that her “conscience couldn’t bear freezing Medi-Cal benefits for hard working immigrants” especially in the face of immigration enforcement raids throughout Southern California. Assemblymember Sade Elhawary, a Democrat and Latino Caucus member from Los Angeles, also abstained, along with Sen. Lola Smallwood-Cuevas from Los Angeles, who is not a Caucus member.

Gonzalez said the cuts represent a “huge setback” for Californians struggling with affordability, especially when immigrants are “at the core of our economy.”

Undocumented immigrants “not only pay nearly $8.5 billion in taxes here in California, they build businesses, and raise the next generation of lawyers, doctors, and elected officials, just like the members of this California Latino Legislative Caucus,” Gonzalez said in a statement. “They too, deserve to be treated with dignity by ensuring their health is prioritized.”

During emotional debates, some legislators who voted in favor of the cuts characterized them as a best-case scenario that prevents anyone from getting kicked off of Medi-Cal, while others said many people will lose coverage as they struggle to make payments and drop off the rolls.

Some of the compromises worked into the budget include provisions to delay the cuts and try to prevent current enrollees from losing coverage. Under the new law, the freeze includes a three-month grace period for re-enrollment should someone fall off of Medi-Cal because of paperwork errors or temporary income increases. Youths who are already enrolled in Medi-Cal will not “age out” once they turn 19. 

The monthly premium and cut to dental benefits apply to non-citizens, including some with legal status like visa or green card holders, but only adults aged 19 to 59 will be required to pay the premium while all adults will lose dental.

Few other options to cut the deficit as Medi-Cal costs surge

The state spends more than $190 billion a year on the entire Medi-Cal program, about 60% of which comes from federal funds. About $12 billion of state-only revenue pays for immigrant health care.

Lawmakers have been grappling with funding the state’s Medi-Cal program, which insures 15 million Californians, for months. Earlier this year, legislators injected billions of emergency dollars into Medi-Cal to keep it solvent.

Rising health care costs and increased senior enrollment fueled a majority of the $6.2 billion shortfall. But finance officials indicated that about $2.7 billion resulted from higher spending on immigrant health care, which the state pays for without federal assistance.

Paired with the deficit Democrats had few options to balance the budget.

Elana Ross, a spokesperson for Newsom, defended the budget as one that preserves the state’s “commitment to immigrant communities.” In a statement, she blamed the increasing cost of health care, more people enrolling and President Donald Trump’s economic policies, including tariffs, for causing the state’s projected revenues to decrease by about $16 billion.

“Because of these outside factors, the state must take difficult but necessary steps to ensure fiscal stability and preserve the long-term viability of Medi-Cal for all Californians,” Ross said.

The move to cut immigrant benefits and bail out Medi-Cal earlier in the year gave political leverage to the state’s Republican lawmakers, most of whom have opposed the expansion for years. Ahead of the budget vote, many Republicans criticized the state for irresponsibly expanding a program that was already stretched thin and is frequently plagued by long wait times, lack of specialists and other access challenges.

All Republican legislators voted against the Medi-Cal bill and every budget bill despite their criticisms of Medi-Cal expansion, citing other fiscal concerns with the Democrats’ budget deal.

The state simply can’t afford the program for immigrants, said Republican Assemblymember Carl DeMaio of San Diego, one of the most outspoken critics of the expansion, last week during the budget vote.

“Let’s be very clear. This is not about whether you support or oppose immigrants. We are a nation of immigrants. We value that,” DeMaio said on the Assembly floor. “But I think a lot of Californians have concerns about prioritizing non-citizens with scarce taxpayer resources, at the same time that we’re cutting services for the neediest citizens in our communities.”

Voting for immigrant cuts with mixed emotions

Rodriguez, who voted yes on the cuts, said she was torn over the budget decisions because she feels responsible for protecting immigrants in her community. When she was younger, Rodriguez said she used Medi-Cal and knows the program is essential for many people in her district.

She grew emotional during budget debates while speaking about the cuts, but told CalMatters her support ultimately hinged on recognizing that she and her colleagues fought successfully to save many safety net programs, including home care and reproductive health services. She said the deal to delay some of the Medi-Cal cuts is a partial win because it gives the Legislature time to contemplate additional revenue streams. 

Assemblymember Joaquin Arambula, a doctor and Democrat from Fresno, voted no on a previous version of the budget that cut immigrant health but voted in favor of the final budget agreement.

Arambula, who worked as an emergency room physician before becoming a lawmaker, said many of his past patients would come in with serious but preventable conditions related to diabetes or heart disease because they could not access primary care.

“I remember their stories. I remember their faces,” Arambula said in an interview before the final budget vote. “I would see these patients in their last minutes of life, and knew that there was so much more that we could be doing in advance.”

Arambula declined to comment on his yes vote.

Looking toward the future of medical care

Velez said the fact that several Latino Caucus lawmakers voted no matters because without their voices, it telegraphs to constituents that everyone believes “It’s OK to do this” when many people oppose it. But in the end, there weren’t enough votes to stop the cuts from happening and she said that will irrevocably damage the trust built over years between advocates, government officials and immigrants.

Some lawmakers have floated the idea of requiring large employers whose employees primarily use Medi-Cal to contribute to the program though no details have emerged. 

“I know I have colleagues who are committed to ensuring health care is truly accessible to all,” Rodriguez said. “We’ll get back to a place where we can fulfill the commitment that was made.” 

Carlos Alarcon, a health policy analyst with the California Immigrant Policy Center, said now that the budget is final, it’s time for the lawmakers who initially said they want to stop the cuts to “put their money where their mouth is” and find solutions.

“We’re at a crossroads where legislators, the governor and the state of California can put us back on the right track to make sure California is seen as a sentinel for protecting immigrants,” Alarcon said.

CalMatters’ politics reporter Alexei Koseff contributed to this report.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

This post was originally authored and published by Kristen Hwang from Cal Matters via RSS Feed. Join today to get your news feed on Nationwide Report®.