Adriene Hill: This week marks one year since President Obama signed the healthcare reform law. The law requires everyone to have insurance and sets up exchanges where individuals can compare policies. But there is a big group of immigrants living in this country who won't be be part of the plan.
And as Jennifer Collins reports, that has some states thinking about reforming reform.
Jennifer Collins: There are about 11 million undocumented immigrants in this country, and this is how most of them get their health care.
Medical assistant: Maria Morales.
At a crowded free clinic or local emergency room. Most illegal immigrants don't have health insurance. Those who do typically buy it on the individual market, where premiums can be sky high. Under reform, the new exchanges will make individual policies more affordable. But the federal law prohibits illegal immigrants from using the exchanges. Sonal Ambegaokar is a health policy attorney with the National Immigration Law Center.
Sonal Ambegaokar: So we will still have the issue of certain uninsured people going to the emergency room as their primary source of care and having that cost shifted to all of us.
In California, that cost is already more than $1 billion a year. Mike Odeh is a health policy associate at Children Now. He says California set up its insurance exchange to require insurers that want to participate to also create alternatives for illegal immigrants and others who can't use the exchange.
Mike Odeh: It calls for these outside options by requiring insurance companies to offer similar plans outside of the exchange at the same price.
Odeh says other states are looking at adopting California's model.
Odeh: Some people call it the residual markets, the shadow exchange.
He says bringing in immigrants, who tend to be young and healthy, would help insurers offset the cost of the sicker people that they would be required to take on.
Arturo Vargas Bustamante studies immigrant health care at UCLA.
Arturo Vargas Bustamante: It's definitely controversial because it's like an indirect way of offering coverage to this population.
But Vargas Bustamante says, the real question is whether undocumented immigrants will be able to afford the policies, whether they're in the shadows or not.
I'm Jennifer Collins for Marketplace.