With Congress at an impasse over federal spending, Republicans have emerged with a new and misleading talking point: Democrats are shutting down the government to fund free health care for unauthorized immigrants.
It is a message repeated by Vice President JD Vance, the official X account of Senate Republicans and Speaker Mike Johnson.
The Democrats’ budget proposal seeks to extend Affordable Care Act subsidies set to expire at the end of the year, and roll back Medicaid cuts in the tax cut and domestic policy law signed by President Trump in July. But the proposal does not provide free health care for unauthorized immigrants.
Unauthorized immigrants are largely barred from federally funded health care programs. They cannot buy health care plans on government exchanges set up by the Affordable Care Act and therefore cannot receive any subsidies. They are also ineligible for Medicaid, Medicare and the Children’s Health Insurance Program. The Democrats’ budget proposal does not make them eligible for these programs.
Republicans may be referring to the law changing the eligibility requirements for certain immigrant groups. Under the tax cut and domestic policy law, certain groups of “lawfully present” immigrants are no longer eligible for Obamacare subsidies. The Democrats’ proposal would restore that eligibility.
There is no uniform definition for “lawful presence,” a term typically used by federal and state health care and social welfare programs to determine eligibility. Most groups of “lawfully present” noncitizens have authorized or legal immigration status like refugees and asylum recipients, but the term can also include immigrants whose legal status is more complicated, like those in the Deferred Action for Childhood Arrivals program.
Three Republican committee chairmen said in a September news release that the Biden administration had abused “‘lawful presence’ definitions” and, citing an August analysis from the nonpartisan Congressional Budget Committee, said that the Republican law would revoke subsidy eligibility from “1.2 million illegal immigrants or noncitizens.” The C.B.O. did estimate that 1.2 million people would lose subsidies and their health care coverage as a result of the eligibility restrictions, but it did not characterize those immigrants as illegal or unauthorized.
Separately, the federal government does reimburse hospitals for providing emergency care to low-income unauthorized immigrants who are otherwise ineligible for Medicaid. The Republicans’ tax cut and domestic policy law reduced the amount that hospitals receive for emergency services provided to certain unauthorized immigrants in states that expanded Medicaid, but it did not eliminate funding altogether.
More than a dozen states provide government-funded health care for low-income children regardless of their immigration status, and seven states also provide that coverage for low-income adults, according to a breakdown by the health care nonprofit KFF. But those programs are state-funded and are not affected by the federal funding currently debated in Congress.
Earlier versions of the tax cut and domestic policy bill reduced federal funding for those states, but those provisions did not appear in the final version of the bill because of Senate rules.
Linda Qiu is a Times reporter who specializes in fact-checking statements made by politicians and public figures. She has been reporting and fact-checking public figures for nearly a decade.
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