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Fact check: Which Democratic Party lawmakers have introduced bills to provide healthcare to undocumented immigrants in 2024?
Executive Summary
Two Democratic lawmakers in Maryland — House Delegate Bonnie Cullison and Baltimore City State Senator Antonio Hayes — sponsored the Access to Care Act in 2024 to let undocumented immigrants buy insurance through Maryland’s marketplace, and California Assemblymember Joaquin Arambula introduced AB 4 in 2024 to expand Covered California to all adults regardless of immigration status; both measures seek state-level pathways around federal restrictions. The Maryland measure cleared both chambers and awaited the governor’s decision, while California’s AB 4 proposed a state-subsidized “mirror marketplace” and estimated roughly 520,000 adults could qualify if status barriers were removed [1] [2] [3].
1. Who put these bills on the table and why it matters
Maryland’s Access to Care Act was advanced by Democratic lawmakers including Delegate Bonnie Cullison and State Senator Antonio Hayes, framed to allow undocumented residents to access the state health insurance marketplace by seeking a federal waiver to permit enrollment, with the Maryland Legislative Latino Caucus publicly supporting the initiative. Proponents presented this as a way to extend equitable access and reduce uncompensated care costs, arguing the state marketplace could legally be used if federal permission is granted, and the bill’s movement through both chambers made it a notable 2024 legislative effort [1] [3].
2. California’s AB 4: a “mirror marketplace” pitched as inclusion
California Assemblymember Joaquin Arambula introduced AB 4 to expand Covered California by creating a state-run, state-subsidized “mirror marketplace” so immigrant adults would be eligible for ACA-like plans regardless of immigration status. Sponsors highlighted an estimated pool of about 520,000 adults currently excluded due to immigration status and positioned the bill as addressing large gaps where employed immigrants remain shut out of federal safety nets, offering state subsidies to bridge the federal exclusion [2].
3. Legislative status and timing: how far these efforts progressed in 2024
By April 2024, Maryland’s Access to Care Act had reportedly cleared both the state House and Senate and was pending the governor’s signature, marking an advanced stage relative to many state proposals; Maryland’s approach relied on the prospect of a federal waiver to operationalize marketplace enrollment for undocumented residents. California’s AB 4 was introduced in May 2024 and framed as a structural expansion of Covered California, but available reporting in 2024 characterized it at an earlier stage focused on policy design and estimating affected populations [3] [2].
4. Different legal and policy pathways: waiver strategy vs. state subsidies
The Maryland proposal depended on obtaining a federal waiver to legally allow undocumented immigrants to enroll in plans through the state’s ACA marketplace, a legal pathway that requires federal approval and faces administrative hurdles; the Maryland bill’s trajectory highlighted the interplay between state lawmaking and federal regulatory gates. By contrast, California’s AB 4 proposed creating a state-funded parallel marketplace with state subsidies — bypassing federal subsidy restrictions but increasing state budget exposure and implementation complexity [1] [2].
5. Supporters, numbers, and the broader public-health argument
Support for these bills came from Democratic lawmakers and groups such as the Maryland Legislative Latino Caucus, who argued expansion would promote equitable access and potentially lower uncompensated care costs in hospitals and clinics. Advocates cited population estimates to quantify impact — for example, California reporting that approximately 520,000 adults would qualify for Covered California plans if not for immigration status restrictions — using these figures to frame urgency and fiscal trade-offs [2].
6. What critics and alternative viewpoints would likely raise (noted omissions)
Reporting in 2024 emphasized proponents’ case but left open several implementation and political challenges: federal approval is uncertain for waiver-based plans, state budgets would shoulder subsidy costs in mirror-market models, and opponents could frame expansions as incentivizing illegal immigration or fiscal imprudence. The 2024 coverage did not provide detailed fiscal analyses on long-term cost impacts or firm federal responses, leaving room for contention and political framing in subsequent debates [3] [2].
7. Bottom line: who introduced bills in 2024 and what to watch next
In short, Democratic lawmakers Bonnie Cullison and Antonio Hayes were central sponsors of Maryland’s Access to Care Act, and Assemblymember Joaquin Arambula sponsored California’s AB 4 in 2024; both aimed to extend marketplace access to undocumented immigrants through different mechanisms. Key near-term indicators to watch are gubernatorial action in Maryland, administrative responses or waiver decisions at the federal level, and fiscal analyses or amendments in California as AB 4 moves through the legislative process, since those factors determine whether these 2024 proposals become operational policy [1] [2] [3].