There are 2.6 million undocumented Californians; 1 million of them lack access to preventive health care. Photo by Lynne Shallcross

Maybe you’ve seen it while waiting for the bus at 24th and Mission. At first glance, it’s a poster with people wearing nutritional information labels on their T-shirts. But look a little closer — it’s not about the fat grams in that candy bar you shouldn’t be eating.

Instead, the large posters are an effort to raise awareness about the number of undocumented Californians and their lack of health coverage.

With enrollment for the Affordable Care Act, or “Obamacare,” set to begin on Oct. 1, the posters spark a timely conversation. Daniel Zingale, senior vice president of Healthy California for the California Endowment, the private, statewide health foundation responsible for the posters, praised the federal program but added, “There’s one big problem with Obamacare, and that is its omission of people based on their immigration status.”

Of the 2.6 million undocumented Californians, 1 million of them lack access to basic preventive health care. Another 1.3 million have insurance through a patchwork of employer-based coverage, binational health coverage and private insurance. The remaining 300,000 access regular care through a safety net of public hospitals and community clinics.

Undocumented residents of San Francisco are able to sign up for Healthy San Francisco, but the citywide program can be accessed strictly within San Francisco. It is not a health insurance program like those under the new law, including the expanded Medi-Cal and the Covered California health care marketplace.

Zingale called this a “historic time” but wants more. “What we envision is a state where everyone living and working here has access to basic preventive health care,” he said. “What we envision is a day when immigration status is not a barrier to people’s health or the health of our state or the success of our state.”

Zingale said that undocumented people should have access to preventive health care and he feels the three-month-old bus stop campaign has served as a catalyst for debate on immigration- and health-related topics in Sacramento.

Many times, he said, the politics surrounding immigration policy and a lack of information about undocumented residents get in the way of public health.

Enter the posters. With a quick read while waiting for the bus, anyone can discover that, among other statistics, undocumented Californians paid $2.7 billion in taxes in 2010 and their contribution to the California economy is $302 billion.

“They pay social security tax and Medicare [tax], but they can’t take benefits of either one,” Zingale said. “That’s a surprise to a lot of people when they learn that.”

One recent afternoon at the bus stop on Mission and 24th, Paula Wilson, 27, acknowledged that the information on the poster was indeed new to her. “I actually thought that [undocumented Californians] were going to be included,” Wilson said. She was under the impression that the new law meant everyone in the country got health insurance.

Ted Pech, 34, was also checking out the poster, but the information didn’t surprise him. It is a situation he already sees as unfair. “It sucks to see people work that hard and they get screwed like that,” he said. “But the way our immigration system is so bogged down, of course this is going to happen.”

Also on the posters are facts concerning the value of preventive care. For every $1 spent on prenatal care, $3 is saved. And for every $1 spent on child immunizations, $16 is saved.

There are a variety of possible future pathways to health insurance for undocumented Californians, Zingale said, including policy changes that will offer a pathway to citizenship. Although it is unlikely, the Affordable Care Act could also open to include undocumented residents, he said. Finally, the state, like San Francisco, could create another way for undocumented residents to receive health insurance.

For now, the goal of the advertising campaign is to spread the truth about the contributions of undocumented Californians and give all Californians a sense that they’re “in this together,” Zingale said. “Undocumented people are contributing more to the state than they’re taking. If we offer them some help in staying healthy, it’s good for all of us — it’s the right thing to do and it’s good for the state.”

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Lynne Shallcross was stressed and tired after walking three miles without finding an open community clinic. “Is this what it's like for Mission residents who work full-time?” she wondered. Having walked in their shoes, she feels compelled to write about accessible healthcare in the Mission.

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