‘He worries … and lives in panic’: Thousands of SJ immigrants in medical limbo

STOCKTON -- "When you go, they always ask about the insurance," a despondent Cristino Abarca said recently from his recovery bed inside a small east Stockton home.

Abarca, 28, a farmworker, was shot seven times by robbers on the afternoon of March 22 after cashing his payroll check at a South California Street corner market. They took his $1,200 and left him to die, firing the final two rounds as he lay bleeding on the ground.

The injuries he sustained mean Abarca will need medical attention for a long time. He may not be able to return to the hard, physical labor expected in farm work, a good job that helped him send needed money back to his struggling parents in Mexico's Guerrero state the past 10 years.

As someone who entered the country illegally, Abarca is in medical limbo. In fact, people living in the U.S. without permission make up the largest group of people who fall outside the health care safety net of resources and providers organized to deliver a significant level of medical care and related services to the uninsured and other poor, vulnerable populations.

After he was shot, Abarca was rushed to the county's only trauma center, San Joaquin General Hospital in French Camp, where he was treated in the emergency department. He was discharged from the public hospital after six days.

His treatment included surgery, implanting a rod inside his broken left leg and attaching a metal brace on the outside. The high cost of those services was covered by restricted scope Medi-Cal -- a form of publicly funded insurance for low-income Californians that covers emergency and pregnancy services regardless of immigration status if all other eligibility requirements are met.

But now that he is out of the hospital, Abarca is on his own. A surgery that had been scheduled to remove his brace was canceled because he had no way to pay for it.

"We're trying to find some type of assistance to cover insurance for surgery, but he doesn't qualify for any programs. It's sad how bad the health process to help people in real need is," said Sofia Candelario, 56, who has volunteered to care for Abarca since he was shot.

"The hospital tried to discharge him less than 72 hours following the shooting. I'm just trying to help as much as I can. He worries about his recovery every day and lives in panic," Candelario said.

Even after the massive effort that has gone into bringing more people under the health insurance umbrella through the Affordable Care Act and the expansion of Medi-Cal to include eligible low-income adults in addition to its traditional population of low-income children, pregnant women and families, thousands of San Joaquin County residents remain uninsured.

The fact is, the county's uninsured rate has dropped from an estimated 29 percent in 2013 to 7.6 percent in 2017, the latest figure from the Small Area Health Insurance Estimates of the American Community Survey. That equates to roughly 57,000 individuals.

The largest demographic within that group are people living in the country illegally, like Abarca. And while not all of that group is uninsured, the total number is estimated at 49,000 by the Public Policy Institute of California. More than 10,000 undocumented individuals in the county do receive Medi-Cal benefits at some point throughout the year, according to the latest figures from the California Department of Health Care Services.

That last figure is small compared with the total number of eligible Medi-Cal beneficiaries in the county, roughly 292,000 people out of a total population estimated by the U.S. Census Bureau at 745,424.

And in information provided exclusively to The Record, the UC Berkeley Labor Center estimates that between 20,000 and 26,000 undocumented adults in San Joaquin County would become eligible for comprehensive Medi-Cal benefits if eligibility were expanded regardless of immigration status.

The vast majority of these adults are likely to currently lack insurance given that 89 percent of all low-income California undocumented adults are uninsured, according to research by UCLA using the California Health Interview Survey.

Like Abarca, 58-year-old Augustin Bravo is a farmworker and an immigrant from Mexico. But when it comes to health care, there is one glaring difference. Bravo is a legal U.S. citizen. And because his family meets low-income eligibility requirements, he has had Medi-Cal insurance for many years.

Despite being covered, Bravo is reluctant to use his benefit. Living with a few aches, pains and discomfort isn't unusual for the experienced vineyard worker, but Bravo isn't well. He is at a higher risk for suffering a heart attack or stroke because of his uncontrolled high blood pressure. He also spoke of "a little trouble" with his prostate.

"Doctor says you need to come in once a year," Bravo said in Spanish and broken English, with translation help from his adult son Fernando. But the last time he visited that doctor was "a long time ago," he said.

While medications are readily available to control Bravo's conditions, he takes no prescribed medicines. Instead, he self-medicates with unspecified herbs.

"It helps a bit, but not enough," Bravo said.

While Bravo opened up about his health condition, the problem in these uncertain times for immigrants who are in the country illegally is that they simply won't speak to anyone they don't know about their lives, their health care or anything having to do with government services. In Bravo's own words:

"Everybody is scared about something bad for their own person."

One of the region's leading advocates for immigrant rights, Jose Rodriguez, said no one will talk publicly because "they have a concern about this issue being used against them as a public charge issue that could be used to deny them some type of citizenship, or they are also concerned about who is getting this information and if it is shared with the federal government. They know there is an anti-immigrant feeling out there."

Last September, the Trump administration announced a proposed rule that would make changes to "public charge" policies. Under longstanding policy, the federal government can deny an individual entry into the U.S. or adjustment to legal permanent resident status -- also known as a green card -- if that person is determined likely to become a public charge.

Prior to this, according to Rodriguez, "health benefits and food programs were off the table when it came to the public charge issue. The government didn't penalize people for using these programs in the past.

"They (immigrants) gave information in good faith in the past, and now there is a concern because of what the president had done and because of his rhetoric that the government knows exactly where they are," he said.

"It's a very touchy issue," Rodriguez said.

This article was produced as a project for the USC Center for Health Journalism's Data Fellowship.

Contact reporter Joe Goldeen at (209) 546-8278 or [email protected]. Follow him on Twitter @JoeGoldeen.

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