Republicans, preparing to cut Medicaid for US citizens, would prefer to talk about immigrants

Noncitizens are restricted in their ability to access Medicaid, a fact that Democrats bring up to refute Trump and Republicans. But many states offer noncitizens access to their health care programs; funding for those efforts is already under threat in blue states.

In less than two months, Illinois will end its Health Benefits for Immigrant Adults, launched during the Biden administration, citing its higher-than-expected costs. It was a bitter pill for Gov. JB Pritzker, who told Semafor on a recent trip to DC that “if I could afford to do it, I would have a basic level of health care for undocumented people.”

“We have undocumented people who’ve been in the state for 10, 20, 30 years, and they’re paying taxes, holding down jobs, good neighbors, no criminal record,” Pritzker told Semafor. “In fact, they’ve been good, law-abiding residents of the state. And when they get sick, it costs all of us money. So if we can prevent them from getting sick, that’s better.”

Last week, California Gov. Gavin Newsom urged his Democratic legislative supermajority to cap noncitizen enrollment in his state’s Medicaid program, despite his own ambitions for universal health care.

“I don’t want to be in this position,” Newsom said, fending off criticism from his own party. A similar story played out in Minnesota, where Gov. Tim Walz agreed to remove noncitizens from MinnesotaCare this year to meet Republican demands and close a budget gap.

“I’m not going to sugarcoat how difficult this was,” Walz told reporters at a press conference, as Democrats who opposed the change, outside the room, shouted: “Don’t kill immigrants!”

Confident of their own Medicaid messaging, and of the unpopularity of any Republican cuts, Democrats said that their GOP colleagues were simply lying about undocumented people accessing the system.

Democratic lawmakers pushed back by pointing out how the GOP plan would affect US citizens and eligible legal immigrants: coverage losses, as their states are forced to do more with less.

“Let’s be very clear: No federal Medicaid dollars are going to provide health care to individuals who are undocumented,” House Democratic Conference Chair Pete Aguilar,D-Calif. told Semafor on Tuesday.

“Some states, including Washington and the state of California, have chosen to provide health care to everyone — because, mind you, people will get health care,” Aguilar added. “Our state leaders have said we would prefer you have health care than you show up to an emergency room.”

During a Congressional Progressive Caucus rally with anti-poverty groups on Wednesday to oppose the GOP bill, caucus chair Rep. Greg Casar told Semafor that Republicans were lying to cover up an unpopular plan.

“They know that these are the biggest Medicaid cuts in history, and that virtually everybody on Medicaid either works, or is a senior with a disability, or is a child,” said the Texas Democrat — whose state never expanded Medicaid under Obamacare, and would not take the same hit as California or Minnesota if the funding cuts passed.

The failed effort to repeal the Affordable Care Act eight years ago looms over every move Republicans make on Medicaid. They do want to reduce the number of people who get health insurance from the government. But they are more careful now in picking the people who’ll lose out, and they are very confident about a political strategy that portrays Democrats as siding with immigrants.

Doing that sets up a distinction that the Trump-era GOP always enjoys: a nationalist “America First” party, versus a party with a more global, more charitable view of who deserves help.

When Texas bussed migrants to Chicago, New York, and Boston, Democrats struggled to contain public anger that local resources were going to noncitizens. When Kamala Harris replaced Joe Biden on the 2024 ticket, the Trump campaign attacked her co-sponsorship of the 2017 “Medicare for All” bill, which would have made noncitizens eligible for coverage.

“Kamala wants struggling seniors to pay more Social Security taxes, while she gives Medicare and Social Security to illegals,” claimed one ad, with footage of people walking through a border crossing. “That will doom Social Security.”

Democrats are not directly giving any of those benefits to “illegals,” at the state or federal levels. But they also see upsides in the fight now raging over the GOP megabill: They see a clear-cut case of a bill that would pull people off Medicaid to pay for tax cuts for the rich.

In fact, Democrats think that combining those two policies is a mistake Republicans were more careful to avoid in 2017.

If the “big, beautiful bill” becomes law, Democrats will face a messier conflict, seen in blue states that have scaled back coverage.

To keep the current House GOP bill’s expanded Medicaid funding — a piece of the ACA that Republicans will have preserved — they would need to take health care away from noncitizens, even though that risks costing the government more money in the end.

Elana Schor contributed reporting.