In a landmark decision, California is now providing health insurance coverage for immigrants under the Deferred Action for Childhood Arrivals (DACA) program. Covered California’s Executive Director, Jessica Altman, announced this initiative during the “Let’s Talk Health” campaign, which launched in Los Angeles on November 13, 2024.

For the first time since the Affordable Care Act (ACA) came into effect, young undocumented immigrants, commonly referred to as Dreamers, will be able to obtain affordable healthcare coverage via Covered California, the state health insurance exchange.

This is a significant step for California in providing relief to thousands of DACA recipients who have limited health coverage, including freelancers and the self-employed.

An Uncertain Opportunity

Despite this welcoming decision, the initiative faces political uncertainty. Donald Trump’s recent victory in the election has raised concerns among Dreamers and their advocates. During his previous administration, Trump attempted unsuccessfully to repeal both the ACA and DACA. The renewed Republican influence brings questions about the stability of this healthcare expansion, especially as legal challenges mount. In August, 19 Republican attorneys general filed a lawsuit against the Biden administration’s decision to include DACA recipients in the ACA’s insurance marketplaces. According to the lawsuit, this move has burdened states that manage their own exchanges and could incentivize undocumented immigration.

Covered California officials, however, are urging DACA recipients to take advantage of this opportunity as long as it is available. “Coverage is here right now. So if you need to go to the doctor, if you’ve been putting off care that you need, if you’ve never had the opportunity to get your preventive care, you can do that right now,” said Altman.

Expanding Access Amid Legal and Political Challenges

The Biden administration’s rule change earlier this year redefined “lawfully present” for ACA eligibility. This change now allows DACA recipients to buy health insurance through state and federal marketplaces. This update addresses a long-standing gap that prevented many Dreamers from accessing subsidized health care. According to Nicholas Espíritu, deputy legal director at the National Immigration Law Center, reversing this decision would require a lengthy administrative process, offering some temporary stability for now.

Approximately 40,000 people who hold DACA status in California are believed to now qualify for subsidized plans on Covered California. The open enrollment period began on November 1, 2023, and it will close on January 31, 2025. The initial period of coverage will commence on January 1 for enrollees who register before December 31. The younger, typically low-risk DACA beneficiaries are expected to help mitigate the adverse selection problem and, in turn, could enable all participants in the marketplace to enjoy cheaper premiums.

Financial Impact and Federal Uncertainty

This expansion is estimated to cost the federal government approximately $240 million to $300 million per year. However, Dreamers add great value in terms of state and national economies. As reported by the Center for American Progress, DACA participants in California alone contribute about $2.1 billion in federal taxes and $1 billion in state and local taxes annually. California’s AG Rob Bonta has argued in favor of the expansion of the ACA, stating that people who contribute to the system should be able to enjoy its benefits.

However, Trump’s return to the White House introduces risks beyond legal challenges. One potential area of concern involves the “enhanced premium subsidies” introduced under the Inflation Reduction Act, which significantly lowered the cost of coverage for millions. This act is set to expire in 2025. Whether or not these subsidies will be renewed, the Congressional Budget Office estimates that millions could lose their health coverage, a change that would impact not only DACA recipients but all lower-income residents relying on ACA subsidies.

California’s Focus Amid Shifting Administration

California already offers Medi-Cal to low-income residents, irrespective of their documentation, exemplifying inclusive health care coverage. Even with its progressive policies, California’s leaders are preparing for possible federal shifts.

“We’ve made such progress, and it’s been incredible and hard-fought,” said Altman, pointing to California’s record-low uninsured rate. Her focus remains on maintaining these gains and ensuring that vulnerable populations, including Dreamers, continue to have access to necessary health care. As political dynamics change, California is determined to protect its advancements, looking for ways to navigate the headwinds that may arise.

The Path Ahead

The inclusion of DACA recipients in California’s healthcare system represents both a triumph and a challenge. As Dreamers begin to enroll in health plans from which they have long been excluded, the specter of political reversal looms large. Advocates and state officials stress the importance of acting now, even as the nation watches how the courts and Congress will respond.

With open enrollment and the support of California’s health leaders, Dreamers have an opportunity to secure vital coverage. The long-term future remains uncertain due to complex legal battles, administrative decisions, and shifting political scenarios. For now, Covered California is encouraging access to affordable care that is available today, and Dreamers should not let uncertainty stand in their way.