‘I accepted I was going to die.’ Uninsured Californians make tough health care decisions
Honduran immigrant Sergio Tulio Arévalo Soliz suffered chest pains, heart palpitations and shortness of breath for four days before arriving at Adventist Health Hospital in Hanford on Jan. 6.
Doctors told the 42-year-old Soliz he needed emergency heart surgery but the undocumented Fresno County farmworker is uninsured and doesn’t qualify for full-scope Medi-Cal. He couldn’t afford to pay for the surgery, so he told the doctor to discharge him.
“I told them to send me home so I could spend my last moments with my family,” he said in Spanish, as tears welled up in his eyes. “I had no money for the surgery. I felt I didn’t have another option so I accepted that I was going to die. I was very, very afraid.”
Doctors at the hospital didn’t let that happen and they went through with the procedure. But the surgery wasn’t covered by insurance, Soliz said, and he is nervously awaiting the medical bills.
Soliz would qualify for Medi-Cal based on his low income, yet he is ineligible for full benefits because he is undocumented. But hundreds of thousands of undocumented residents living in the Central Valley like Soliz could soon gain acess to the state’s health insurance program for low-income people.
As part of the 2022-23 budget, Gov. Gavin Newsom earlier this month proposed expanding health insurance to all low-income people, regardless of their immigration status. The Medi-Cal expansion would fill a gap in health care coverage for undocumented Californians between the ages of 26 and 50, providing universal, comprehensive benefits to an estimated 700,000 undocumented people.
But even with coverage, many advocates say more reform is needed to address long-standing racial and health disparities that prevent immigrants from receiving high-quality care. This includes removing barriers to language access and interpretation services, while ensuring cultural competence among healthcare professionals.
The governor’s proposal would guarantee “full, comprehensive health coverage with no monthly premium, no co-pay, no deductible– it’s completely free to the patient. It’s life-changing,” said Sarah Dar, the director of health and public benefits policy at the California Immigrant Policy Center, an immigrant rights organization.
But, she added, “it’s just one part of what I think can be a solution to addressing these gaps. Our health care system is just extremely, unnecessarily complex. There’s a lot to be tackled.”
California is home to an estimated 2 million undocumented immigrants, making it the state with the largest number of undocumented people in the U.S., according to the nonpartisan Public Policy Institute of California.
Fresno-area farmworkers struggle to get health care
The state currently offers Medi-Cal coverage to undocumented people under 26 years old and those ages 50 and older. The new proposal, which would cost the state an annual $2.7 billion, would make California the first state in the U.S. to provide universal medical coverage to income-eligible undocumented people. If approved, the law would take effect in January 2024.
The state already offers some Medi-Cal coverage to undocumented individuals of all ages for emergency medical services and prenatal and maternity care. But that care can be inconsistent and inefficient because it often covers procedures that stabilize a patient but does not address the underlying condition, said Dar of the California Immigrant Policy Center.
“If it’s a life-threatening emergency and if you are at risk of dying or losing a limb, for example, they will stabilize you and emergency Medi-Cal will cover that,” she said. “It won’t necessarily cover a lot of that follow-up care. It’s not health coverage and it’s very inhumane.”
Expanding full-scope Medi-Cal would mean all low-income Californians could have access to primary care doctors. That’s critical, especially for those with a condition that could get significantly worse over time if it is not monitored or treated, said Jose Torres Casillas, who is a policy and legislative advocate at Health Access California, a statewide coalition that has long advocated for expanded health care access for immigrants.
“Having access to a regular doctor and having these regular checkups will go so far,” Casillas said. “With that access to the full-scope benefits of Medi-Cal, people would be able to receive a more consistent level of care.”
Expanding Medi-Cal could also ensure that undocumented immigrants seek care before their condition becomes life-threatening, with no fears about a lack of insurace or out-of-pocket costs. Many immigrants also forgo care to continue working and making ends meet.
That was the case for Soliz, who waited to seek medical care for his heart condition until he could no longer handle the pain. It’s a common response for farmworkers, who are considered one of the region’s most vulnerable groups, Casillas said.
“They might be one of the breadwinners, they might just decide to delay their care or they might decide to not even seek care,” he added. “They tend to have a feeling they need to sacrifice their health in order to keep working.”
Low-income Californians could get access to Medi-Cal
Soliz woke up from his surgery with a piercing pain in his chest and the inability to see.
A few days later, Soliz returned to his modest, two-bedroom home in Riverdale, a rural community located 23 miles south of Fresno, where he lives with his wife, 45-year-old María Guadalupe Toledo Mejia, as well as their three children and infant grandchildren. Mejia heard her husband coughing uncontrollably in the middle of the night and saw that his wound was bleeding. He doubled over in pain before falling back onto the bed. His eyes glazed over as he laid there expressionless, she said.
Mejía felt helpless watching her husband struggle during the recovery process. At follow-up appointments, doctors kept telling her that Soliz’s symptoms were common after an open-heart procedure. But that’s about all she understood from the English-speaking doctors. She tried to bridge the communication gap by using a translation app.
“Every time he would cough, his wound would bleed and bleed,” she said in Spanish. “Doctors kept telling us this was normal. In the hospital they only really spoke to us in English and it was hard to understand. We are very worried. We don’t know what’s going to happen. We are leaving it up to fate and praying to God that he’ll recover.”
Dr. Efrain Talamantes, who is a primary care physician, regularly treats undocumented patients at his clinic in East Los Angeles. He said patients’ conditions are often “further exacerbated because of a lack of access” to vital resources such as translation services, financial security and culturally competent doctors who understand the needs and attitudes of the immigrants they serve.
“If our patients don’t have access to those resources that are often covered by health insurance, then the recovery period can be extended,” he said. In many situations, “the economic realities of people’s circumstances are always going to prevail.”
With access to health insurance, he said, patients like Soliz have a better chance of recovering and remaining healthy in the future.
“If we don’t have a head start on understanding who these patients are, and what they need to go through, then it’s not possible to plan,” he said. “Beyond recovery, having access is an opportunity to ensure that we don’t let patients fall back to doing something that’s going to harm them that then will result in another catastrophe.”
For Soliz, the past few weeks in recovery at his home have left him exhausted, unable to get out of bed without the help of Mejia or one of his children. Doctors have told him it’ll be at least three to four months before he can return to working in the fields, where he mainly picks grapes during the harvest. In the meantime, he’s worried about finances. He said he’d rather go back to work than not provide for his family.
“It’s a painful decision, but if I have to go to the fields then that’s what I’ll do,” he said. “I’d rather risk my health than watch my family go hungry.”
He hopes that the Medi-Cal proposal passes and that it can help others like him who are struggling due to a lack of health insurance.
“Unfortunately, I wasn’t able to benefit from the law, but I would like others to have that opportunity, because the truth is that it would be very helpful,” he said. “Believe me. I don’t want others to go through what I’m going through.”
