Amid a stalemate over government funding, Republicans have repeatedly accused Democrats of demanding free health care for immigrants in the country illegally in return for their support of a federal funding bill.
It’s a misleading message circulated widely by Republican leaders in the House and Senate, as well as by President Trump and Vice President Vance.
Trump on Monday posted an AI fake of Senate Minority Leader Chuck Schumer (D-N.Y.) saying: “If we give all these illegal aliens free health care, we might be able to get them on our side so they can vote for us.”
In the White House briefing room Wednesday, Vance used the phrase “illegal aliens” or “illegal migrants” five times in his opening remarks before taking questions.
“Democrats say that they care a lot about lowering health care costs … what they have done instead is to shut down the government because we won’t give billions of dollars to health care funding for illegal aliens,” Vance said.
Democrats’ budget proposal would not change eligibility for immigrants
The core of the attacks center on the Democratic spending proposal, which seeks to extend enhanced Affordable Care Act (ACA) tax credits set to expire at the end of the year and roll back Medicaid cuts in the mega tax cut and domestic policy law signed by Trump in July.
People who are in the country unlawfully cannot get federally funded health insurance. They aren’t eligible for Medicaid, and they can’t get subsidized coverage through the ObamaCare marketplaces. The Democrats’ budget proposal does not make them eligible for these programs.
A memo released Wednesday by the White House claimed the provisions Democrats want repealed “would result in the federal government spending nearly $200 billion on healthcare for illegal immigrants and non-citizens over the next decade.”
Health experts and state policy officials say the claims are misleading at best. The Democrats are demanding health care concessions, but those don’t involve health insurance coverage for immigrants lacking permanent legal status.
‘Big, beautiful bill’ at center of dispute
The GOP’s One Big Beautiful Bill Act, signed into law in July, restricts eligibility for Medicaid, the Children’s Health Insurance Program, and subsidized ACA health plans to only a small subset of “lawfully present” noncitizens.
Most groups of “lawfully present” noncitizens have authorized or legal immigration status, like refugees and asylum recipients. It can also include those in the Deferred Action for Childhood Arrivals program.
The Congressional Budget Office estimated that 1.2 million people would lose subsidies and their health care coverage because of the eligibility restrictions, but it did not characterize those immigrants as illegal or unauthorized. They have permission to be in the U.S.
“What H.R. 1 does is it takes away tax credits, not from illegal immigrants … but from legal immigrants who were rightfully eligible, people who came to our country and did things the right way. We’re talking about asylees. We’re talking about refugees. We’re talking about humanitarian parolees,” Jessica Altman, executive director of Covered California, the state’s ACA exchange, told The Hill.
“Next year, Covered California will have to take federal tax credits away from 119,000 people because of those changes,” Altman said.
‘Matching funds’ provision was removed from final bill
Separately, the White House memo details a provision in the “big, beautiful bill” it claims was “being used by states to draw down federal matching funds used to provide Medicaid benefits for illegal immigrants.”
But that’s not accurate.
Some states use their own funds to provide coverage to children lacking permanent legal status and at least some low-income adults. But there is no provision in the law penalizing states for doing that. It was included in an earlier version but removed during debate because it violated Senate rules.
The provision in question concerns how states use Medicaid provider taxes.
“It’s almost like they ran out of talking points, and they’re still using the same talking points they used for the House-passed reconciliation bill,” said Edwin Park, a Georgetown University research professor, referring to a previous version of the GOP tax bill.
Emergency Medicaid reimburses hospitals for care of uncovered patients
The other claim being raised by Republicans is that Medicaid is reimbursing hospitals at higher rates for immigrants than for low-income Americans.
“If you’re an American citizen and you’ve been to the hospital in the last few years, you’ve probably noticed that wait times are especially large and very often somebody who’s there in the ER is an illegal alien. Why do those people get health care benefits at hospitals paid for by American citizens?” Vance said Wednesday in the White House briefing room.
Medicaid payments for emergency care at hospitals may cover immigrants who would not otherwise qualify for the program, but it is a reimbursement for hospitals, not health insurance coverage for immigrants.
“You’re trying to offset the cost of EMTALA responsibilities, which is the requirement that you have to care for someone who comes in with an emergency condition,” Park said, referring to the Emergency Medical Treatment and Labor Act.
The tax cut law reduced funding to a program called Emergency Medicaid that reimbursed hospitals for emergency services provided to certain immigrants — but only in Medicaid expansion states. It includes immigrants not eligible for federally funded insurance, some of whom lack permanent legal status.
According to health research organization KFF, spending on Emergency Medicaid represented less than 1 percent of total Medicaid spending in fiscal 2023. The provision in the law saved about $28 billion over a decade — less than 3 percent of all the health care cuts.
Regardless of who pays for it, hospitals are required to provide life-saving care to patients who show up at emergency rooms. If it’s not covered by federal funds, the cost of those visits will likely be shifted to private health insurers, meaning higher premiums.
