As the government shutdown continues, a significant point of contention has emerged between the White House and Republican lawmakers against their Democratic counterparts. Central to the debate is the assertion that Democrats are advocating for free health care for immigrants residing in the United States without legal status. Democrats have firmly refuted this claim.
“Democrats are holding the American government HOSTAGE so they can give FREE health care to ILLEGAL ALIENS,” declared House Speaker Mike Johnson, a Republican from Louisiana, in a social media post earlier this week. Meanwhile, Vice President JD Vance accused Democrats of attempting to “take from the American people in order to give taxpayer-funded healthcare to illegal immigrants.”
The Republicans’ argument revolves around a provision in the Democrats’ funding proposal that seeks to reverse the restrictions imposed by the One Big Beautiful Bill Act. This previous legislation had tightened Medicaid eligibility for noncitizens, but the proposed changes by Democrats would only restore eligibility for immigrants who have some form of legal status or government protection.
Prior to the enactment of the One Big Beautiful Bill Act, U.S. law allowed various categories of immigrants living in the country legally or with government permission to apply for and receive Medicaid, provided they met other eligibility criteria. This included lawful permanent residents, refugees, and individuals granted asylum or humanitarian benefits like “parole.” It is important to note that some of these individuals may have initially entered the U.S. illegally but subsequently received legal status.
The One Big Beautiful Bill Act, signed into law by President Trump over the summer, significantly curtailed access to Medicaid for noncitizens. Under its provisions, coverage was limited primarily to lawful permanent residents and certain immigrants from specific Pacific islands. Those who had been granted humanitarian parole, as well as refugees and asylees, were excluded. This legislation could potentially leave around 1.4 million immigrants without health insurance coverage, according to an analysis by KFF, which utilized data from the Congressional Budget Office.
In contrast, the Democrats’ current funding proposal aims to reinstate the eligibility criteria for Medicaid that existed prior to 2025, thereby reopening access for immigrant groups that were excluded earlier this year. It is crucial to emphasize that all individuals in these categories are in the U.S. legally or with government permission.
Historically, U.S. law has rendered individuals living in the country without legal status ineligible for most federal benefits, including Medicaid. However, Trump administration officials have alleged that some lawfully present immigrants were allowed entry under dubious circumstances during the Biden administration. They claim that the Biden administration granted entry to these individuals through a “magic wand,” allegedly in violation of federal immigration law.
Those granted parole under the Biden administration, including Venezuelans and Ukrainians, entered the U.S. with government authorization and were permitted to work and reside in the country. The Trump administration has since suspended these parole programs and revoked the legal status of many who entered under them.
The legal status of refugees and asylees, who were previously eligible for Medicaid, remains undisputed. Both groups are on a pathway to permanent legal status and eventual U.S. citizenship.
While those living in the U.S. without legal status are not eligible for federal Medicaid, the program does allow for reimbursement to hospitals providing emergency care to uninsured immigrants. According to KFF, this emergency funding for noncitizens constitutes less than 1% of total Medicaid spending. The One Big Beautiful Bill Act reduced the amount hospitals could receive for such emergency visits, a measure that the Democrats’ funding plan seeks to reverse.
Democratic leaders have consistently denied any intention to fund health care for undocumented immigrants. Their stance is clear: they will not support a short-term funding extension that allows the government to reopen unless Republicans agree to extend Affordable Care Act tax credits, which have benefited millions of Americans by lowering their health insurance costs.
“Federal law prohibits the use of taxpayer dollars to provide medical coverage to undocumented individuals. And there is nothing in anything that we have proposed that is trying to change that law,” House Democratic Leader Hakeem Jeffries stated on Tuesday. “We are fighting for the health care of the American people.”
Some Republicans argue that restoring federal Medicaid funding cut by the One Big Beautiful Bill would enable Democratic-led states to allocate more state resources to health care for immigrants residing in the country unlawfully. An analysis by KFF indicates that more than a dozen states comprehensively cover health care for low-income children without legal immigration status using state funds. Some states, like California, even provide some form of health coverage to adults living in the country without authorization.
During previous budget discussions, Republicans attempted to penalize these states in Trump’s budget proposal, but that provision ultimately did not make it into the final legislation.
As the standoff continues, the contentious debate surrounding health care and immigration remains a focal point of the ongoing government shutdown, highlighting the complexities and challenges of U.S. immigration policy and health care access.
