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Second Opinion is a weekly Q-and-A series that answers questions from San Diegans on the Affordable Care Act. Ask yours here.

The Question: How will the government find homeless and undocumented people to help them get covered and enforce the individual mandate?

Miccilina Piraino moved to San Diego from the East Coast nine years ago. She pays for basic health coverage through her employer but does not support the Affordable Care Act’s individual mandate, which says all Americans who are able must have health insurance starting next year. She said the provision is an overstep and unfair because access to health care isn’t equitable.

Video by Megan Burks

Here’s Piraino’s question:

“My question and concern is wondering how this program is going to be framed so it is fair to all American people and not just a certain part of the population. How are they going to enforce it so that it’s across-the-board fair to everyone and find those who are either homeless or illegals or have no coverage whatsoever? Are they going to find them and help them, as well as enforce this program?”

The Takeaway: The feds will enforce the individual mandate through taxes, but the requirement to buy health coverage does not apply to everyone.

The individual mandate does not say every person in the United States must get covered. It lays out exemptions for some groups, including members of Native American tribes, certain religious groups, incarcerated individuals, undocumented immigrants and people whose earnings are below the threshold for filing taxes.

Tax filings are the only way the feds can check if you’re buying health coverage. They’re not going to go after people who are living in the shadows, so to speak.

So, homeless and undocumented individuals do not have to get insured. (People living in the country illegally actually aren’t allowed to participate in the new insurance exchanges and Medi-Cal expansion.)

But that doesn’t mean the Affordable Care Act leaves out the homeless altogether. Before the law, Medi-Cal was really only available to families. Starting next year, childless adults can also get coverage that way. So now more homeless people will qualify for regular coverage – not just last-resort treatment in the emergency room.

Homeless services agencies, including Father Joe’s Villages, have been trained to educate and enroll their clients in new health coverage options.

The Orders: Unless you’re exempt or willing to pay a fine, get covered.

Obamacare begins to make the health system more equitable, but in answer to Piraino, some people are still left out.

For those who aren’t exempt and don’t yet have insurance, you have until March 31 to pick a plan.

Check out last week’s Second Opinion: Will Obamacare streamline care for disabled people?

Megan Burks

Megan Burks is a reporter for Speak City Heights, a media project of Voice of San Diego, KPBS, Media Arts Center and The AjA Project. You can contact her...

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