by GRAYCE MCCORMICK | The National News Desk
TOPICS:
HUNT VALLEY, Md. (TNND) — A prominent feature of President Donald Trump’s so-called “big, beautiful bill,” according to him, is that it “kicks millions” of immigrants living in the U.S. illegally off of Medicaid, “to protect it for those who are the ones in real need.”
There are a few caveats – and half-truths – in this claim.
First and foremost, undocumented immigrants are not eligible for Medicaid or Medicare benefits. That means no long-term care, prescriptions or routine care is covered for them.
The only healthcare that might be “covered” for them is emergency care – emergency room visits, emergency dialysis, childbirth and any life-saving care – but it’s less for the benefit of the migrant as it is to help hospitals recoup the cost of treating them.
Mixed-status families often receive care for their children, even if the parents aren’t covered.
Hospitals can request reimbursement for the cost of emergency medical assistance to undocumented immigrants, which is paid for by both state and federal money in a pot known as Emergency Medicaid funding. Hospitals cannot legally turn away any individuals during a medical emergency, regardless of legal status.
A report by the Congressional Budget Office estimates spending for that pot of money reached $27 billion between 2017 and 2023, less than 1% of total Medicaid expenditures during this period. In some years, that marked less than 0.5%.
When it comes to Medicaid, the joint federal-state government program that provides coverage for low-income individuals and families, lawfully present immigrants took up roughly 6% of the total Medicaid budget for fiscal year 2023.
Only about 0.4% of total Medicaid spending in 2023 went toward emergency care for undocumented immigrants. That’s still roughly $3.8 billion out of $900 billion in total spending per year.
When it comes to Medicare, the federal health insurance program for people aged 65 years and older, lawful immigrants take up an estimated $30 to $50 billion per year based on enrollment. An estimation from 2017 finds that indirect or emergency care for undocumented immigrants accounted for roughly $20.8 billion per year. In 2023, total Medicare spending reached $1 trillion.
And, immigrants contribute more than they cost.
In 2017, lawful immigrants paid $13.7 billion more into Medicare than they got. From 2000 to 2017, undocumented immigrants added $35 to $65 billion in Medicare taxes, without receiving benefits.
Trump’s wide-ranging House budget bill makes changes to Medicaid at the state level, not at the federal level, like White House officials and congressional Republicans are claiming.
Senate and House Republicans and White House Press Secretary Karoline Leavitt have all claimed in social media posts and news conferences that the bill “removes 1.4 undocumented immigrants from the program.”
The claim is misleading.
It actually addresses states that use their own taxpayer dollars to provide Medicaid-covered services to immigrants lacking legal status, or to provide subsidies so they can buy health insurance themselves. The bill’s language penalizes states that provide “any form of financial assistance” for health coverage or “any form of comprehensive health benefits” to immigrants living in the country illegally “regardless of the source of funding.”
If they continue coverage, federal funding for the Medicaid expansion population, typically low-income adults, drops from 90% to 80%.
Fourteen states and Washington, D.C., expanded coverage to undocumented immigrants with their own funds. But they also cover children regardless of immigration status, and seven of those states and D.C. cover some adults regardless of immigration status.
Experts say this means millions of undocumented immigrants won’t lose Medicaid coverage because of this bill; they don’t have coverage to begin with, and it’s not targeting the emergency Medicaid coverage either. Rather, children who are U.S. citizens whose parents are undocumented, or immigrants authorized to live in the U.S., like refugees and those granted asylum, will lose coverage.
These states can either stop covering undocumented immigrants to preserve their federal funds, or keep covering them and take the federal funding hit, which would mean less money overall for U.S. citizens.
The bill also tightens eligibility for Medicare. Immigrants who are authorized to live in the U.S. but aren’t legal permanent residents (refugees, asylum seekers and those with Temporary Protected Status) will no longer qualify for Medicare unless they’re green card holders, COFA migrants living in the U.S., or certain immigrants from Cuba.
These immigrants will also be barred from getting health insurance from the Affordable Care Act or the Deferred Action for Childhood Arrivals policy.
Curtailing immigrants’ access to federal benefits will save some federal dollars, but won’t come close to the major budget savings Trump and his allies are touting.
Supporters of the state-level programs available for undocumented immigrants and others without permanent residence argue that it makes states and the country healthier overall. More immigrants can work if they can visit doctors without fear of retaliation and stave off small health concerns before they worsen, or manage chronic illnesses.
Studies have shown immigrants, regardless of legal status, have lower health care costs than their U.S.-born counterparts, and also subsidize Americans’ health care by paying more through health insurance premiums and taxes than they utilize.
But opponents of insuring immigrants point to the CBO projection that this will reduce the federal deficit by $11 billion between 2025 and 2034 – a 0.03% reduction of the current $36 trillion debt and counting.
Leave a Reply