One recent morning, I visited a cauliflower field in the Salinas Valley to talk to farmworkers. Over a couple hours, we chatted about their diverse circumstances — their families, their various home countries, their homes in different California communities.

The workers had one thing in common. They all reported feeling much healthier than they had in years.

I’m hearing the same thing from other undocumented workers. For this improved health, they can thank a smart California policy: the expansion of Medi-Cal, the Golden State’s version of Medicaid, the federal health program for the poor. It now covers all Californians, regardless of immigration status.

But that policy is now under threat — precisely because of its success.

California extended Medi-Cal for undocumented immigrants over the last decade, adding low-income children in 2016, young adults in 2020, and adults 50 and over in 2022, and then adults ages 26-49 in 2024.

State officials seemed to think that the declining numbers of undocumented Californians — from 2.7 million to 1.8 million over the past two decades — would limit costs. But enrollment by the undocumented in Medi-Cal has exceeded projections. Most undocumented Californians have been here for decades, and had considerable pent-up demand for health care after lives of hard work.

The state had budgeted more than $2 billion annually for this expansion, but costs this past year were $2.7 billion more than planned, forcing the state to borrow — and making the expansion a political issue.

The higher costs are only partially about immigrant enrollment — the other causes are rising drug prices, health care bills, and the state’s decision to stop counting assets (such as homes or savings accounts) when considering seniors’ eligibility. But anti-immigrant Republicans have blamed the growing costs primarily on the undocumented. Congressional leaders cite the California expansion to justify hundreds of billions in cuts to Medicaid over the next 10 years.

Fearing the cuts’ impact, even California’s progressive politicians have suggested that the state can no longer afford the full expansion. Among these are Gov. Gavin Newsom, who just revised his budget to freeze program enrollment for immigrant adults, and charge $100-per-month premiums to those already enrolled.

This is bad politics — caving to anti-immigrant prejudice only encourages more prejudice. It’s even worse health policy, as I saw in the cauliflower field.

The farmworkers, ranging in age from 32 to 61, told me that getting coverage had allowed them to get care to reduce the pains of years of twisting, pulling, and bending over in the fields.

Newly covered, four had gotten surgeries, for knees, ankles, or feet. Two had had back treatments, needed after years of picking leafy greens. Two — both of whom also worked at nearby vineyard — had shoulder operations.

In a saner country, the results would be seen as successes. And today’s rising costs might be seen as a blip.

None of the farmworkers expected to have more procedures. When you get surgery, you lose work hours and pay. No one wanted to do it again. When I mentioned the controversy over rising Medi-Cal costs, the workers suggested those numbers would decline once the newly covered deal with serious, long-untreated problems.

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Temporary surges in health care utilization aren’t new. There was a similar surge in poor Americans using health care in the first few years after the Affordable Care Act, aka Obamacare, went into effect in 2014. Studies show that the surge produced higher costs, but made people healthier.

Cutting back the expansion won’t save all that much money in a $300-billion-plus state budget — maybe $5 billion over the next four years, according to the governor’s budget proposal.

Meanwhile, excluding people from health care coverage means that they get less preventive care, and get stuck with higher medical bills, debt, or conditions that prevent them from working

Thanks to Medi-Cal expansion, the undocumented people who grow this state’s food or build homes and shopping centers are finally feeling better.

These Californians, our neighbors, haven’t quit on us. Let’s not quit on them now.

Joe Mathews is a columnist for Zócalo Public Square.