Republicans are working to enact legislation aimed at restricting health care access for undocumented migrants. A key focus is Medicaid, with several GOP lawmakers arguing that it serves as a “magnet” for illegal immigration.
The Context
The GOP introduced legislation in Congress to prohibit states from using federal Medicaid funds to provide health care benefits to undocumented immigrants.
The ruling party is looking to cut Medicaid to fund tax cuts for the top earners, according to the left. Across the aisle, Democrats oppose the move to slash funding.
Meanwhile, several states are pushing through legislation targeting health care costs for migrants without legal status.
The Nation
The legislation would ensure that states that extend Medicaid benefits to illegal immigrants do so using their own state funds without relying on federal taxpayer dollars. The Protect Medicaid Act has been introduced in past congressional sessions and seeks to prevent what the GOP calls a financial burden on American taxpayers.
Republicans have been highly critical of using taxpayer resources for health care benefits for undocumented immigrants.
Senator Bill Cassidy, a Louisiana Republican, is introducing the bill, which is co-sponsored by Republican Senators Roger Wicker and Cindy Hyde-Smith of Mississippi and John Barrasso of Wyoming.
“We should focus on making America healthy again instead of straining our medical system and burdening American taxpayers,” Cassidy said.
“Working as a doctor in California, I saw that free health care is a magnet for illegal immigration.”
Representative Richard Hudson, a North Carolina Republican, has introduced companion legislation in the House. The bill has been introduced in past congressional sessions, and supporters hope for stronger momentum this time.
“What I’m concerned about is the folks who depend on Medicaid, you know, it’s a lifeline for vulnerable Americans, like seniors in nursing care, individuals with disabilities, pregnant women, children living below poverty, and so I want to preserve and strengthen the program and make sure it’s there for the people who really need it,” Hudson told Newsweek.
“I’m open to making the policy the best we can, but again, my goals are saving the taxpayers money, preserving Medicaid for those who are vulnerable, and the third benefit here is that these benefits are a magnet for people to come here illegally, and so I want to stop the flow of illegals,” the congressman said.
Hudson called for legislation to “defend the taxpayers.”
“Their money is not intended to go to this. In fact, it’s illegal to spend the money on these illegal immigrants,” he said.
“This could make a real difference to hard working Americans, it could help them,” he added.
Democrats oppose the cuts to Medicaid, arguing it would undermine the health and well-being of the most vulnerable populations.
Representative Adriano Espaillat, a New York Democrat, said in a statement: “We stand united against the Republican budget that slashes at least $1 trillion from Medicaid, threatening 80 million.”
A report from the Congressional Budget Office estimates that federal and state spending on Emergency Medicaid for undocumented immigrants reached $27 billion between fiscal years 2017 and 2023, according to KFF.
This spending represented less than 1 percent of total Medicaid expenditures during this period, and in some years, it accounted for less than 0.5 percent. In fiscal year 2023, Emergency Medicaid spending amounted to $3.8 billion, 0.4 percent of overall Medicaid spending.
Meanwhile, Republican Representative Kevin Kiley of California has introduced the No Medicaid for Illegal Immigrants Act, a bill aimed at preventing states from using federal and state Medicaid funds to provide services to undocumented immigrants. The legislation includes an exception for emergency medical care.
“The No Medicaid for Illegal Immigrants Act will save California taxpayers billions of dollars each year,” Kiley said. “This common sense legislation ensures that taxpayer-funded healthcare benefits are preserved for those who lawfully qualify, prioritizing the needs of American citizens and legal residents while promoting fairness and fiscal responsibility.”
California
This proposed legislation comes as California faces a $6.2 billion budget shortfall in its Medicaid program for 2025, potentially forcing Governor Gavin Newsom and state lawmakers to reconsider health care coverage for some of the 15 million recipients, including immigrants. The state’s costly expansion of Medicaid to all low-income adults, regardless of immigration status, has exceeded initial budget projections.
The deficit arises just a year after California expanded Medicaid to offer free health care to all low-income adults, regardless of immigration status—a move far more expensive than anticipated.
Additionally, the state is preparing for potential financial strain if congressional Republicans move forward with plans to cut billions from Medicaid, which could put coverage for millions at risk. California currently provides free health care to over a third of its 39 million residents.
“Governor Newsom’s reckless policy of offering Medi-Cal to every illegal immigrant in the state is jeopardizing access for legal California residents. If the Legislature refuses to rein Newsom in, we are prepared to do so in Congress,” Kiley said in a statement.
According to estimates from the Legislative Analyst’s Office, this initiative will cost Californians approximately $8 billion annually.
“California taxpayers have already been forced to cover over $8.5 billion for this program this year alone—and now, Newsom is scrambling to find another $6 billion just to keep it afloat through June. This is completely unsustainable,” California Senate Minority Leader Brian Jones told Newsweek.
“Let’s be clear: Health coverage does not mean access to care. As Newsom expands Medi-Cal beyond its limits, everyone suffers from diminishing care—including the most vulnerable in our communities, such as the elderly and veterans, he continued.
“Democrats and the governor are picking priorities, and they’re prioritizing people who have come into our country illegally over people who immigrated here legally, and people who are citizens. We need to immediately stop new enrollments of illegal immigrants and get Medi-Cal back on track to serve the people it was meant for.”
California first extended health care benefits to low-income children without legal status in 2015, later expanding the program to include young adults and individuals over 50. Last year, the program was extended to cover adults aged 26 to 49.
The recent expansion to cover all low-income adults has cost the state an additional $2.7 billion, exceeding budget projections due to an underestimation of the number of people who would enroll. California officials noted that they only had one month of data when they made the budget projections.
The state has not disclosed the exact number of enrollees under the expansion. However, last year, officials estimated that around 700,000 residents living in the United States illegally would gain full health coverage, enabling access to preventive care and other treatments.
Arizona
A proposed bill in Arizona aims to examine the health care costs associated with illegal immigrants, following concerns over the impact on taxpayers and hospitals in California. State Senate Bill 1268 would require hospital forms to ask individuals about their immigration or citizenship status, including whether they are in the country illegally. The bill also mandates that hospitals and the state government track costs potentially borne by taxpayers due to an individual’s immigration status.
“This is a bill that I have run to promote accountability. It in no way compromises a person’s ability to be served and treated at a hospital,” Republican state Senator Wendy Rogers, the bill’s sponsor, said.
The bill passed the state Senate with a 17-12 vote along party lines and through the Republican-majority House. It will go to Democratic Governor Katie Hobbs for final approval or a potential veto.
Texas
Last year, Texas Governor Greg Abbott issued an executive order mandating hospitals to gather data on the health care costs associated with treating undocumented migrants in the state.
Medical staff who treat undocumented migrants will be forced to collect and send information on those patients’ citizenship status to the state, according to the order that Abbott signed in August 2024.
Abbott’s executive order will force medical officials to disclose costs related to the care of migrants without legal status.
This means the Texas Health and Human Services Commission must “assess costs to the Texas public hospital system imposed by the federal government’s open-border policies.”
According to the order, the HHSC must provide regular reports to state authorities. The state government will require quarterly reports on the costs, with annual reports directed to the governor’s office.
“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Abbott said.
As Republican lawmakers across the U.S. continue to push for legislation restricting health care access for undocumented migrants, the debate surrounding Medicaid and the financial burden it places on taxpayers ramps up.
While GOP officials argue that these measures are necessary to preserve resources for American citizens and legal residents, Democrats strongly oppose such cuts, warning that they will harm vulnerable populations who rely on Medicaid for essential health care.
As the legislative battle continues to unfold, the future of health care for undocumented migrants hangs in the balance.
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