Free Healthcare for our Undocumented Neighbors?

What is actually changing — and why it matters for Measure B

California has, for several years, provided full-scope Medi-Cal to undocumented immigrants — the same comprehensive coverage available to citizens and legal residents, with no premiums, no copayments, and no deductibles. This was funded entirely through state-only dollars, since federal Medicaid law does not allow federal matching funds for undocumented immigrants.

Under HR1 and accompanying state budget changes, undocumented immigrants are being transitioned from full-scope Medi-Cal to emergency Medi-Cal — which covers urgent and emergency care, labor and delivery, and certain other acute services, but not routine, preventive, or specialty care.

This transition is part of the revenue loss the county cites as justification for Measure B. In other words, Contra Costa voters are being asked to raise the sales tax in part to continue subsidizing comprehensive, zero-cost health coverage for people who entered or remain in the country without legal authorization.

The cost-sharing comparison

Most Contra Costa residents who have health insurance through an employer or the ACA marketplace pay some combination of premiums, copayments, and deductibles. These are not trivial amounts for working families.

California eliminated all Medi-Cal copayments in 2023. Standard Medi-Cal and full-scope Medi-Cal for undocumented immigrants are therefore identical in their cost-sharing: both charge nothing. The contrast that matters for Measure B is between the zero cost-sharing of Medi-Cal and the real premiums, copayments, and deductibles paid by the working Contra Costa residents being asked to fund it through a higher sales tax.

This is a policy choice that has not been put to voters

The decision to extend full-scope Medi-Cal to undocumented immigrants was made by the California Legislature, not by Contra Costa County voters. The decision to now ask Contra Costa voters to raise the sales tax — in part to continue that coverage — is being made by the Board of Supervisors, again without an explicit public conversation about the tradeoff.

The ballot argument for Measure B frames the issue as protecting “health care” and “the county’s regional hospital.” Those are legitimate concerns. But the argument does not spell out that a portion of the revenue being replaced funds zero-cost, comprehensive coverage for people who are undocumented — while the people being asked to pay the higher sales tax face their own insurance costs every month.

What would a more balanced policy look like?

This page does not argue that undocumented residents should be denied emergency care. Emergency Medi-Cal already provides coverage for urgent conditions, labor and delivery, and acute care — ensuring that no one in Contra Costa is left without a safety net in a genuine emergency.

The question is whether it is appropriate to use a countywide sales tax — paid by every resident and visitor, regardless of their own insurance status or immigration views — to fund comprehensive, zero-cost routine and specialty care for undocumented immigrants. That is a significant policy commitment that deserves a direct public debate, not a line item buried inside a general sales tax measure.

Asking those receiving comprehensive coverage to contribute some share of costs — as most insured Californians do through premiums and cost-sharing in their own plans — would reduce the county’s net expenditures and provide a more equitable distribution of the burden. The county has not publicly explored or proposed this option.