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Henry A. Barrios / The Californian

Eduardo Garcia, 34, and his family Erika Soto, 33, left, and daughter Maria Soto, 12, standing next to him and son, Alfredo Jesus Garcia, 5, not pictured, attend a soccer game at Sam Lynn Ball Park. Like many immigrants they are not aware of how the Affordable Care Act will affect them. Only Alfredo Jesus Garcia was born in the United States.

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Henry A. Barrios / The Californian

Out of the four members of their family, only Alfredo Jesus Garcia, 5, who was born in the United States, has health insurance. The other family members, from left, Erika Soto, 33, Maria Soto, 12, and Eduardo Garcia, 34, were born in Mexico and do not have health insurance.

Understanding the intricacies of the Affordable Care Act can be tricky for anyone, but it can be even thornier for immigrants.

Legal immigrants may have the same opportunities to buy insurance as citizens under so-called Obamacare -- such as enrolling in health insurance plans offered on the state's health benefits exchange.

The law won't open any new avenues to coverage for illegal immigrants.

With the rules varying widely depending on their status, local immigrants will get help understanding what the Affordable Care Act means to them this fall.

The UFW Foundation will offer information sessions and is preparing its own certified enrollment counselors to help people sign up for health care coverage. Later this month, the Dolores Huerta Foundation will kick off a three-week campaign to spread information about the Affordable Care Act through phone calls and door-to-door visits in east Bakersfield, south Bakersfield and other parts of Kern County.

"Last year, November 2012, we were successful in reaching 15,000 voters, so we are confident that in this three-week period we can reach the same amount of voters to really inform them," said Camila Chavez, executive director of the Dolores Huerta Foundation.

Getting accurate information about Obamacare to Kern's immigrant population is a challenge.

Ambar Tovar, programs director for the UFW Foundation, said the most trusted source of information is often Spanish-language television. But immigrants might not be getting the full story on Obamacare from a public service announcement or news segment, she said.

"We really need to do a concerted effort because there's so much misinformation," Chavez said.


About 117,000 Kern County residents are not American citizens, according to U.S. Census Bureau estimates. The county is home to an estimated 68,000 undocumented immigrants, according to the Center for the Study of Immigrant Integration, University of Southern California.

Though illegal immigrants don't have new choices under Obamacare, Carmen Burgos, project manager for the Kern Consumer Health Center at Greater Bakersfield Legal Assistance, said other immigrants should not assume they don't have options. Instead, they should consult trusted local resources to find out what they could qualify for.

"Don't exclude yourself automatically," she said.

Under federal Medicaid rules, lawfully present residents generally must wait five years before they are eligible for Medicaid, called Medi-Cal in California. But in California, those residents, such as green card holders, can apply for and receive state-only funded Medi-Cal sooner as long as they meet the other requirements to receive the benefit, according to the California Department of Health Care Services.

Unlike illegal immigrants, immigrants who came to the United States as children and are under the Deferred Action for Childhood Arrivals program, sometimes called "Dreamers," may be eligible to receive Medi-Cal if they meet criteria like income and residency requirements. But these immigrants also are not able to buy insurance through the exchange.

Lawfully present residents and lawful temporary residents -- including green card holders, people with student or work visas -- can apply for insurance on the exchange and may qualify for subsidies, Larry Hicks, Covered California information officer, wrote in an email.

In families with mixed immigration status, legal family members can look for a health plan through the exchange. But that route gets more complex when it comes to calculating how much these families pay for health plans and receive in subsidies because illegal family members cannot be counted toward the family's total household size.

For example, Hicks wrote, if one person in a family of four is an illegal immigrant, the family's income-eligibility will be based on "the established income threshold for a family of three."

"The family's total reported household income will then be adjusted (reduced) by a fixed amount to account for the excluded undocumented" person, he wrote.


Elvira Medina said she didn't know exactly what the Affordable Care Act was all about when she stopped by a free health screening in southeast Bakersfield in August.

After living in the United States for 23 years, mostly in Bakersfield, the 43-year-old diabetic said she doesn't have insurance because of her immigration status and lack of identification from Mexico. She had heard that people will face penalties for failing to have health insurance.

"For undocumented people, how are we suppose to meet the mandate?" she asked. "What are we suppose to do?"

She isn't alone in her confusion. As they headed to a soccer game at Sam Lynn Ballpark this week, undocumented and uninsured Mexican immigrants Erika Soto and Eduardo Garcia said they are also puzzled by the law.

Living without health insurance can be costly for the family. Garcia, who works part-time at a local market, said he wound up paying $185 for four pills after he visited Bakersfield Memorial Hospital for an infection and fever about a month ago.

Dressed in bright yellow Club America jerseys, Soto and Garcia said their 12-year-old daughter, who was born in Mexico, also doesn't have insurance but their 5-year-old son, who was born in California, is covered by Medi-Cal.

"We have heard that we have to apply for the Obamacare," Soto said. "We heard about it on TV news but we have not gone to apply."

But the so-called individual mandate will not apply to Medina, Soto and Garcia or other illegal immigrants. Unlike most citizens and lawfully present immigrants, they won't have to pay a penalty if they don't have health insurance next year.

But illegal immigrants also will not be eligible to buy insurance on California's state-run health insurance exchange, Covered California. And they cannot receive Medi-Cal -- except in certain situations such as for emergency and pregnancy care.

"They could purchase their coverage in the private market but I don't think that that's affordable," said Burgos, the project manager for the Kern Consumer Health Center.

Administrators at local safety net providers -- county hospital Kern Medical Center and federal qualified health center Clinica Sierra Vista -- said they don't know how many illegal immigrants they treat. But they said it's a group of patients that won't shrink with the launching of the Affordable Care Act.

"I think that come Jan. 1, there are still going to be a large number of individuals who rely on the safety net for medical care and undocumented individuals will be one of them," said Jacey Cooper, executive director of managed care at KMC.

"It's going to be a huge number of people that are going to be kind of left along the side of the road here," said Steve Schilling, Clinica Sierra Vista's CEO.

Alvaro Huerta, staff attorney for National Immigration Law Center in Los Angeles, said the consequences of leaving illegal immigrants out of health care reform are "profound." Including them would bring a younger, healthier population into the insurance mix, in turn driving down everyone's costs and premiums, he said.

"It's shortsighted not to include undocumented people in the population who will be both required and allowed to have health insurance," Huerta said.