We need health insurance that covers our health care needs. Without health coverage that protects us from unexpected, high medical bills, we can’t enjoy a productive, secure and healthy life. In fact, people who don’t have health coverage often do not obtain preventive health services or receive ongoing care for chronic conditions that improve health outcomes and save lives. And for those of us who work in the food system or other essential industries, yet are undocumented, health coverage has been missing despite being sorely needed, especially during the COVID-19 pandemic.
In late June, California took another step to making health care accessible to all. California is the first in the nation to enact a state budget that provides health coverage to all income-eligible residents regardless of immigration status. In reflecting on this milestone, I marveled at the progress California has made since the anti-immigrant days of the early 1990s with the passage of Proposition 187. That ugly ballot measure tried to prohibit undocumented, taxpaying residents of California from accessing public safety net programs and even public schools. Thankfully, the measure was thrown out by the courts for blatant unconstitutionality and never implemented.
How We Got Here
Manuel Pastor’s 2018 book State of Resistance chronicles the remarkable rise of California progressive movements beginning in the 1990s to the present day. Including all residents in the Medi-Cal program – no matter their immigration status — stands as one of the crowning achievements of the movements for immigrant justice and health care rights. I give my congratulations to all of the grassroots and advocacy organizations from across the state that joined together in the Health4All Campaign (co-led by California Immigrant Policy Center and Health Access) and worked so hard for so many years to win this victory!
California health foundations like The California Endowment, California Health Care Foundation, Blue Shield of California Foundation, and Cal Wellness contributed to this success through long-term support of the health and immigrant justice movements. There are many lessons learned for philanthropy in this story, chief among them the importance of steady, patient support for advocacy and community organizing.
Cal Wellness has funded some of the organizations instrumental to this campaign for two decades or more. Big public policy wins often take a long time, and philanthropy must be in it for the long haul. California health funders provided a variety of grants to advance health coverage for all – including core support to provide a baseline of reliable, unrestricted, long-term support for grantees. In addition, foundations provided funding for specific activities such as communications and narrative change, polling, the launching of the Health4All campaign, and grantee convenings and retreats to build stronger relationships between organizations.
There's one final lesson for all of us, including philanthropy, to remember – we need to go beyond just celebrating a victory to make sure we finish the job by seeing things through to the end: equitable implementation of the Medi-Cal expansions, including encouraging more people to enroll. And even further beyond that, we need to make sure that individuals signing up for coverage actually get the care they need when and where they need it.
While there is much to celebrate, there is still more work to do. But now we're in a much better place to do that work than we were in 1994 when California voted to take public benefits and public education away from undocumented residents – a notion simply unthinkable today. Cal Wellness will continue our work to ensure equitable health care coverage for all.