California moves toward extending Obamacare to illegal immigrants

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Most Americans say they're happy with Obamacare

During a 2009 address to a joint session of Congress, President Barack Obama told the country that his plans for health care reform would not extend to people who are in the country illegally.

"You lie!" South Carolina Republican Rep. Joe Wilson notoriously shouted. Obama replied, "That's not true."

But only two years after the largest coverage provisions in the Affordable Care Act took effect, the country's most populous state has passed a bill that, in fact, seeks to extend Obamacare to people regardless of their immigration status.

The bill, now before California Gov. Jerry Brown, aims to allow people who are in the country illegally to buy private health insurance on the state's exchange. Its author, Democratic state Sen. Ricardo Lara estimates that 390,000 such immigrants could receive health insurance, but officials who operate the exchange place that number closer to 50,000.

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California moves toward extending Obamacare to illegal immigrants
WASHINGTON, DC - MARCH 04: Ryan Burrows, right, protests with others that are not in support of the portions of the Affordable Care Act on which the Supreme Court of the United States was hearing arguments on Wednesday March 04, 2015 in Washington, DC. (Photo by Matt McClain/ The Washington Post via Getty Images)
Protestors hold placards challenging 'Obamacare' outside of the US Supreme Court on March 4, 2015 in Washington, DC. The US Supreme Court heard a second challenge to US President Barack Obama's Affordable Care Act. The US Supreme Court faces a momentous case Wednesday on the sweeping health insurance reform law that President Barack Obama wants to leave as part of his legacy. The question before the court is whether the seven million people or more who subscribed via the government's website can obtain tax subsidies that make the coverage affordable. A ruling is expected in June. AFP PHOTO/MANDEL NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
Protestors hold placards challenging 'Obamacare' outside of the US Supreme Court on March 4, 2015 in Washington, DC. The US Supreme Court faces a momentous case Wednesday on the sweeping health insurance reform law that President Barack Obama wants to leave as part of his legacy. The question before the court is whether the seven million people or more who subscribed via the government's website can obtain tax subsidies that make the coverage affordable. A ruling is expected in June. AFP PHOTO/MANDEL NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
Demonstrators from Doctors for America in support of U.S. President Barack Obama's health-care law, Obamacare, hold signs while marching in front of the U.S. Supreme Court in Washington, D.C., U.S., on Wednesday, March 4, 2015. A U.S. Supreme Court argument over Obamacare's tax subsidies divided the justices along ideological lines, potentially leaving two pivotal justices to decide the law's fate. Photographer: Andrew Harrer/Bloomberg via Getty Images
Anna Salerno holds a sign and waits with other protestors for President Barack Obama to arrive at the Temple Emanu-El in Dallas, Wednesday, Nov. 6, 2013. President Obama is visiting the charity to thank local volunteers that are working to sign people up for the health insurance under the Affordable Care Act. (AP Photo/LM Otero)
Anti-abortion demonstrators hold signs during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
Anti-abortion demonstrators hold signs during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
Anti-abortion demonstrators hold signs during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
Anti-abortion demonstrators hold signs stating they regret their abortions during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
DORAL, FL - APRIL 23: Joyce Zaritsky, Bob Williams, Serena Perez and Mayte Canino (L-R) show their support for the Affordable Care Act in front of the office of U.S. Rep. Mario Diaz-Balart and Sen. Marco Rubio (R-FL) on April 23, 2014 in Doral, Florida. The protesters wanted to ask the politicians if they still want to repeal their constituents health care now that more than 8 million Americans have signed up for health insurance under the Affordable Care Act. (Photo by Joe Raedle/Getty Images)
A demonstrator in support of U.S. President Barack Obama's health-care law contraception requirement holds up a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
A demonstrator in support of U.S. President Barack Obama's health-care law contraception requirement holds up a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators in support of U.S. President Barack Obama's health-care law contraception requirement hold up a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrator Alan Hoyle holds a bible as he stands outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators in support of U.S. President Barack Obama's health-care law contraception requirement hold up signs outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators opposed to U.S. President Barack Obama's health-care law contraception requirement hold up signs outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators opposed to U.S. President Barack Obama's health-care law contraception requirement hold up signs outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators in support of U.S. President Barack Obama's health-care law contraception requirement hold a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
MIAMI, FL - SEPTEMBER 20: Deborah Dion (L), Hattie Coleman and other protesters gather in the office of Florida State Rep. Manny Diaz as they protest his stance against the expansion of healthcare coverage on September 20, 2013 in Miami, Florida. As the protest took place, the Republican led House in Washington, D.C. by a 230-189 tally passed a short-term government spending plan that would eliminate all funding for 'Obamacare.' The Florida State government is also working against the Affordable Care Act by refusing to set up its own health care exchanges and they also have highlighted concerns about the navigators, federally funded workers who will help enroll people in health plans. (Photo by Joe Raedle/Getty Images)
Anti-abortion protesters pray outside the US Supreme Court on the third day of oral arguements over the constitutionality of the Patient Protection and Affordable Care Act on March 28, 2012 in Washington, DC. The 26 states challenging the law argue that Obama's Affordable Care Act must be completely repealed if the requirement that all Americans buy health insurance -- known as the 'individual mandate' -- is found to be unconstitutional. AFP PHOTO/MLADEN ANTONOV (Photo credit should read MLADEN ANTONOV/AFP/Getty Images)
A masked pro-Obamacare demonstrator stands outside the US Supreme Court June 25, 2012, in Washington, DC, as they await the court's ruling on the Healthcare Reform Law. The court announced the decision on healthcare will not happen before June 28. AFP PHOTO/Jim Watson (Photo credit should read JIM WATSON/AFP/GettyImages)
Anti-abortion protesters pray outside the US Supreme Court on the third day of oral arguements over the constitutionality of the Patient Protection and Affordable Care Act on March 28, 2012 in Washington, DC. The 26 states challenging the law argue that Affordable Care Act must be completely repealed if the requirement that all Americans buy health insurance -- known as the 'individual mandate' -- is found to be unconstitutional. AFP PHOTO/MLADEN ANTONOV (Photo credit should read MLADEN ANTONOV/AFP/Getty Images)
UNITED STATES – MARCH 27: Rep. Michele Bachmann, R-Minn., speaks during the Tea Party Patriots rally protesting the Affordable Care Act in front of the Supreme Court as the court hears arguments on the health care reform bill on Tuesday, March 27, 2012. (Photo By Bill Clark/CQ Roll Call)
UNITED STATES – MARCH 27: Tea Party Patriots supporters hold signs protesting the Affordable Care Act in front of the Supreme Court as the court hears arguments on the health care reform bill on Tuesday, March 27, 2012. (Photo By Bill Clark/CQ Roll Call)
Ronald Brock moves his anti-Obamacare sign as protestors, press, and passersby wait for decisions in the final days of the Supreme Court's term, in Washington, Wednesday, June 25, 2014. The court has yet to announce its finding in Sebelius v. Hobby Lobby Stores. The chain of arts-and-crafts stores does not want to provide insurance coverage for certain forms of contraception that it finds objectionable on religious grounds. The justices ruled Wednesday that a startup Internet company has to pay broadcasters when it takes television programs from the airwaves and allows subscribers to watch them on smartphones and other portable devices.The justices said by a 6-3 vote that Aereo Inc. is violating the broadcasters' copyrights by taking the signals for free. (AP Photo/J. Scott Applewhite)
Protestors block traffic near the White House in Washington, Thursday, June 5, 2014. In response to President Obama’s decision to delay the deportation review he ordered from the Department of Homeland Security, United We Dream protested near the White House to highlight the urgency of the administration acting now. (AP Photo/Susan Walsh)
Carlos Padilla of Seattle, Wash., holding flags, and other protestors block traffic near the White House in Washington, Thursday, June 5, 2014. In response to President Obama’s decision to delay the deportation review he ordered from the Department of Homeland Security, United We Dream protested near the White House to highlight the urgency of the administration acting now. (AP Photo/Susan Walsh)
Demonstrators display signs during a protest on West Florissant Avenue in Ferguson, Missouri on August 18, 2014. Police fired tear gas in another night of unrest in a Missouri town where a white police officer shot and killed an unarmed black teenager, just hours after President Barack Obama called for calm. AFP PHOTO / Michael B. Thomas (Photo credit should read Michael B. Thomas/AFP/Getty Images)
Pakistan protesters from the Jamaat-e-Islami party gather around a protester dressed as US President Barack Obama effigy during a pro-Palestinian demonstration against Israel's military campaign in Gaza, in Karachi on August 17, 2014. Indirect talks between Israelis and Palestinians for a long-term truce in Gaza resumed on August 17, 2014, with just over a day left before a temporary ceasefire is set to expire, a Palestinian official said. AFP PHOTO/Rizwan TABASSUM (Photo credit should read RIZWAN TABASSUM/AFP/Getty Images)
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The legislation is being considered not only at a time when presidential candidates are campaigning in the Golden State but as those running have made health care and illegal immigration central platforms in their bids for the Oval Office, finding that their views on the topics have ignited voters' passions. To critics of the law, the bill signals another broken promise of Obamacare.

Obamacare explicitly bars people in the country illegally from its provisions, but a loophole called the "innovation waiver" allows for states to change portions of the law, as long as they make coverage available to more people and as long as the federal government doesn't have to pick up the tab, among other requirements. The bill, which would require that a request for a waiver be filed, first must be approved by the state legislature and the governor before the waiver can be considered by the federal government.

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Though the California bill does not come with federal subsidies that make health insurance more affordable to low- and middle-income people, critics fear it's heading that way.

"This is a two-step process: Open the door to the exchanges, but when no one can afford to buy insurance you come back and add the subsidies," says Ira Mehlman, a spokesman for the Federation for American Immigration Reform. "This is the first step in another misrepresentation of the Affordable Care Act. It was sold to the American people on the fact that you wouldn't have to subsidize health care for illegal immigrants."

Jesse Melgar, a spokesman for Lara's office, reiterated that the bill did not provide for federal subsidies and says the question of whether the state would pay for them would be part of an ongoing conversation. He stressed that the focus was on passing the waiver and says the bill would give families with mixed immigration status – for instance, those in which adult children are U.S. citizens but their parents aren't – the ability to sign up for the same plan, potentially making it easier for them to get care.

RELATED: 21 hacks to reduce your health care costs

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California moves toward extending Obamacare to illegal immigrants

1. Use Generics

If your doctor prescribes you a brand-name drug, ask whether it would be OK to use a generic substitute. Generics can be significantly less expensive, and often there’s no difference in outcome. Medicare enrollees who opted for generic drugs saved an average $1,923 per person in 2014, according to a report by the Generic Pharmaceutical Association.

Read: 10 Ways to Survive Rising Health Care Costs

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2. Stick With In-Network Providers

Your insurer has deals with certain providers that will give you the best price and guarantee that the treatment will be covered. Going out of network almost always means that you’ll have to pay higher prices. Out-of-network providers charge patients on average 300 percent more, or higher, than the Medicare rate for many procedures, according to an analysis by America's Health Insurance Plans, a trade association representing the health insurance industry.

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3. Ask for 90-Day Prescriptions

Breaking down the monthly cost, you’ll likely pay less for a prescription for 90 days' worth of medicine than you will for a 30-day supply. Plus, you’ll only have to pay your copay once instead of three times.

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4. Get Moving

In addition to causing poor health, living an inactive lifestyle can have a dramatic impact on your medical bills. Sedentary adults pay $1,500 more per year in health care costs than adults who are physically active, according to a recent study by health advocacy organization Trust for America’s Health.

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5. Get a Pet

Not only can it be rewarding to have a pet, it can have tangible health benefits, too. The decline in office visits and the reduced frequency of obesity associated with pet ownership can lead to a health care savings of about $86 per year, according to a recent report from the Human Animal Bond Research Initiative Foundation.

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6. Shop Around for Care

For elective procedures, shop around to find the best price, and quality, for a procedure within your insurance network. Start by checking Healthcare Bluebook to get a sense of what a fair price for the procedure might be in your geographic area. Then call around to a few providers, and ask for a quote based on your health insurance.

“Even if you have insurance and you play by the rules, you could still pay five to 10 times more than you should if you don’t shop for care,” said Jeff Rice, CEO of Healthcare Bluebook.

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7. Check Your Bill for Errors

Nearly half of Americans say that they’ve received an inaccurate health care bill, according to a Wolters Kluwer Health poll. Protect yourself from overpaying by carefully reviewing every bill that you receive and disputing any potential errors. If anything looks off, or you don't understand a charge, contact the provider.

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8. Carefully Select a Health Care Plan

When it comes to deciding on a health insurance plan, choosing the correct one upfront can potentially save you thousands in medical expenses throughout the year. However, more than 90 percent of workers say they choose the same benefits every year, and almost 80 percent spend less than an hour researching benefit options before making a selection, according to a recent Aflac poll.

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9. Take Advantage of Wellness Programs

Companies are increasingly investing in wellness programs that encourage their workers to take steps — such as signing up for biometric screenings, health assessments and physical activity programs —to monitor and improve their health. To increase employee participation in such programs, a growing number of employers are now offering incentives like money, gift cards, reduced health insurance premiums or contributions to an HSA or FSA, according to a report last year by the National Business Group on Health.

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10. If You're Eligible for an HSA, Use It

If you have a high-deductible health plan at work, then you can fund a health savings account to use for medical expenses. Unlike an FSA, your HSA money is yours to keep and grows over time, so even if you don’t use it this year, you can tap it for medical expenses in the future. For 2016, you can put up to $3,350 for an individual and $6,750 for a family into an HSA to use for medical expenses.

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11. Shop Around for Drugs

Just as medical providers offer different prices, so do drugstores. A recent search on GoodRx.com for a 30-day supply of Lipitor found prices ranging from $10 to more than $90.

Retailers like Walgreens and Costco have prescription savings clubs, which offer a discount on generic prescriptions and often price match their competitors. The Walgreens program also provides a 10 percent discount on care at the store’s health clinics.

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12. Avoid the Emergency Room

Unless you have an actual emergency, stay away from the emergency room. Visiting a doctor’s office or urgent care clinic typically costs much less, and is often a less frenzied experience.

Choose carefully, though, because urgent care clinics that are owned by hospitals could charge the same rate as their parent company. “You’ll pay anywhere from four to 20 times the price by not going to your doctor,” said Adria Gross, CEO of Medwise Insurance Advocacy, which helps people navigate the medical claims system.

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13. Negotiate Your Bills

If you’re paying out of pocket for a procedure, contact a hospital’s billing department upfront to see whether there’s any wiggle room in the price. If you’ve already had a procedure, but can’t afford to pay the bill, there might also be an opportunity to negotiate the size of the bill, or set up a payment plan that makes it more affordable.

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14. Try Telemedicine

More insurers and companies are offering benefits that include telemedicine, in which you can consult with a doctor online or over the phone for minor ailments, at a fraction of the cost of an in-patient visit. The average telemedicine visit is estimated at $40 to $50, compared to an in-person acute care visit at an average estimated cost of $136 to $176, according to a study commissioned by the Alliance for Connected Care. Bonus: You don’t have to leave the house when you’re under the weather.

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15. Consider Medical Tourism

Some 750,000 Americans leave the country every year for health procedures that are cheaper elsewhere or not affordable in the United States, according to the Centers for Disease Control. The practice of “medical tourism,” as it’s known, includes risks, such as trouble communicating or less-safe practices. However, the Medical Tourism Association estimates that traveling for medical treatment can net savings of up to 90 percent.

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16. Bundle Your Costs

Once you’ve reached your deductible in one year, consider scheduling any covered, elective procedures to also take place that year. That way, you can potentially avoid having to pay the full deductible in two consecutive years.

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17. Deduct Your Medical Expenses

You qualify to write off your medical expenses on your taxes if your medical expenses are more than 10 percent of your adjusted gross income, or 7.5 percent if you’re age 65 or older. Qualified expenses include doctor visits and premiums, fertility treatments and hearing aids.

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18. Go to Labs for Blood Work

If your doctor orders blood work or other lab tests, first ask the doctor whether they’re medically necessary. If yes, get the work done in a standalone lab, where prices tend to be cheaper than what you’ll pay by getting work done in a hospital or some doctors' offices.

Asking your doctor for a written lab order and taking it to a national laboratory group, rather than an in-hospital lab facility, could save you up to 90 percent on costs, according to a 2014 study by health care consultant group Castlight.

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19. Insure Yourself

Under the Affordable Care Act, if you can afford health insurance but choose not to buy it, you’ll have to pay a fine when you file your federal tax returns for that year. If you're uninsured in 2016, you could pay a fine of 2.5 percent of your household income, or $695 per adult and $347.50 per child under 18 — whichever is highest. In addition, going uninsured means that one medical emergency could become a financial disaster for you, depleting your savings or causing you to run up unnecessary debt.

Read: 5 Tax Law Changes for 2016 You Need to Know

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20. Strategize With Your Spouse

If both you and your partner have access to health benefits at work, compare the plans offered by both companies. Find out which one offers the richest benefits at the best cost for your family, and whether you might be able to save money by being insured separately.

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21. Move Somewhere Cheaper

The cost of getting insurance via the Affordable Care Act marketplaces plan varies drastically depending on where you live, according to recent analysis by GOBankingRates. Buying a plan in New York, the most expensive state in the country for these costs, for example, would mean signing on for a $3,000 deductible and a $366 monthly premium. A similar plan in New Mexico, by contrast, features a $2,000 deductible and premiums of just $181 per month, less than half of those in a New York plan.

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But it is unclear exactly to what extent people would want to buy plans without subsidies. Nothing prevents people who are in the country illegally from buying health insurance directly from brokers, and the plans offered on the exchange have similar prices to those sold off the exchange.

Mehlman, whose D.C.-based nonprofit calls for strict immigration control, says it is exactly this tension that will lead to subsidies eventually being added, given that the plans are unlikely to be affordable. He thinks that more states would likely follow suit.

Brown has not indicated whether he will sign the bill, and a spokeswoman says they do not comment on pending legislation. Brown has 12 days to veto or sign the measure, and if he does nothing it will become law.

SEE ALSO: Hillary Clinton's Decree on Donald Trump: Be Afraid

California has been moving in the direction of permitting more benefits to people regardless of immigration status. Last year, Medi-Cal, the state's program for low-income residents that is known as Medicaid in most states, opened health care coverage to all low-income children, despite immigration status. An estimated 170,000 children will become eligible at a cost of $40 million to the state this year and $132 million each subsequent year.

Groups who oppose illegal immigration have said they would consider filing a lawsuit against the state or the administration.

"This is the United States, and our legislators should be writing bills for U.S. citizens and not for people who are in the country illegally," says Robin Hvidston, executive director for We the People Rising, a group that opposes illegal immigration. "It sends the message to the world, 'Come to California illegally, you will have bills written for you.' It acts as a magnet for the world to have people illegally in the state."

Tim Jost, professor of Washington and Lee University School of Law, says a lawsuit is possible but unlikely to achieve its objectives.

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"With the Affordable Care Act, people sue about absolutely everything," he says. "Most cases have been dismissed for lack of standing." Because the lawsuit would be political and not legal, Jost added, it would be difficult to show that people had been injured because of the law, and a lawsuit would likely be dismissed.

If Brown signs the waiver bill, members of the Department of Health and Human Services and the Department of Treasury will have up to 225 days to make a decision about whether to approve it. The timeline means all of this could happen before Obama leave office.

It's unclear what the administration would do. Obama has tried through executive action to protect roughly 4 million people in the country illegally from deportation, but that move is being considered by the Supreme Court. On the other hand, as of June 30, 2015, his administration discontinued subsidies and cut off health insurance coverage for 423,000 people who, after multiple outreach efforts from federal health officials, did not provide proof of their citizenship or immigration status, according to the Centers for Medicare and Medicaid Services.

The government already funds some health care for immigrants who are in the U.S. illegally. Under the Emergency Medical Treatment and Active Labor Act, for instance, hospitals are reimbursed when they provide emergency and maternity care for low-income people who need it, regardless of immigration status. Immigrants in the country illegally also can receive medical care through government-funded community health clinics.

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