No, Democrats aren’t trying to fund health care for “illegal aliens.”
By Jonathan Cohn
THE REPUBLICAN PARTY’S CLOSING ARGUMENT heading into the government shutdown is a big, brazen lie.
The lie is so big and so brazen that it’s almost not worth addressing, because doing so gives the claim far more credibility than it deserves.
But it’s become ubiquitous in Republican talking points, from the president on down. There’s also a chance some people will believe it, because it feeds into some common misconceptions about health care and immigration policy, as well as preconceptions of how the parties operate. And in a standoff that has been all about political leverage and public opinion, setting the record straight matters.
So let’s get to it.
The claim is about what Democrats are demanding in exchange for their support on a spending bill that would keep the government open past midnight tonight, when funding runs out. Remember, Republicans control both the White House and Congress, but need Democratic votes in the Senate to approve a new spending measure.
The central Democratic demand is about health care: They want Republicans to extend a temporary Biden-era program that has lowered health insurance costs for more than 20 million Americans buying coverage through the Affordable Care Act. And they want Republicans to undo at least some of the dramatic Medicaid cuts that the GOP enacted over the summer, as part of Donald Trump’s “One Big Beautiful Bill.”
Trump and Republican leaders have refused to negotiate. And after flailing about with a few different arguments—including a preposterous claim that Democrats just want to pad the profits of insurance companies—they have settled on a new line: that Democrats want to fund health care for “illegal aliens.”
I put the phrase in quotes because it’s the phrase Republican officials have used over and over again—literally eight times by Vice President JD Vance in one recent Fox News interview, as my Bulwark colleague Will Saletan observed the other day.
Vance made the claim yet again on Monday while standing outside the White House, following a failed negotiation session between GOP and Democratic leaders. At his side was House Speaker Mike Johnson, who’s been putting out the same message, including in a Sunday tweet saying that Democrats “want to give free health care to ILLEGAL ALIENS paid by hardworking Americans.”
And then there is Trump, who has been using the same line in conversations with reporters and on his own social media feeds. On Monday night, he even reposted an AI fake of a press appearance by the Democratic congressional leaders in which the fake Sen. Chuck Schumer says: “If we give all these illegal aliens free health care, we might be able to get them on our side so they can vote for us.” A digitally animated, sombrero-wearing, mustachioed Rep. Hakeem Jeffries looks on as mariachi music plays in the background.
If you’re not too busy gasping at what it says about the president’s state of mind that he’d post this, you might be wondering what on earth he and the Republicans are talking about when they claim Democrats want to fund health care for illegal aliens.
It’s a very good question, because people who are in the United States unlawfully cannot get federally funded health insurance. They cannot sign up for Medicaid. They cannot get federally subsidized coverage through the Affordable Care Act’s online marketplaces.
In other words, what Trump, Vance and the other Republicans are saying is just not true.
SO WHAT COULD THEY HAVE IN MIND with this claim?
It’s hard to be sure, because neither the White House nor Johnson’s office has put out material to substantiate their arguments, or responded to my queries asking for evidence. And when a reporter finally asked the president about it, during a press appearance in the Oval Office on Tuesday, Trump gave a rambling non-response that quickly veered into other immigration-related topics.
In the same press appearance, he said of the Democrats “they want to give incredible Medicare—the Cadillac Medicare—to illegal immigrants.” That’s also not true, in case you were wondering.
As best as I can tell, the Republicans who actually know what they are talking about are zeroing in on a small portion of federal health spending that’s in play as part of the shutdown debate. It’s funding connected either to the Affordable Care Act subsidies Democrats want to extend or to the GOP Medicaid cuts they want to roll back. And they are leaning heavily on a set of two flimsy assertions that appeared in an early September GOP press release and echo claims made by the Paragon Health Institute, an influential conservative think tank.
One of those assertions is about rules that opened up “Obamacare” subsidies to a small number of non-citizens, including some who are in the country because they have protected status. Republicans might not want these people to be eligible for those subsidies. But these people are not “illegal aliens.” They have permission to be in the United States.
The other main assertion is that people here unlawfully are tricking the system, and getting coverage even though they are not eligible. It’s an extension of another highly questionable argument Republicans have made repeatedly over the past few months, which is that many millions of people have been signing up for either Medicaid or subsidized Affordable Care Act insurance fraudulently.
The evidence for that claim is awfully shaky, for reasons you can read here and here and here and here. But even if it were true that millions of Americans were getting Affordable Care Act insurance through deception or error, there’s no reason to think that large numbers of undocumented immigrants would be among them.
For one thing, enrollment systems check citizenship status pretty carefully, by cross-referencing Social Security numbers with data from the Department of Homeland Security. People who apply as non-citizens—say, because they have protected status—must supply other forms of documentation to prove that they have permission to be here and that they qualify for one of the special exemptions allowing them to get coverage.
The system isn’t foolproof; no system is. Maybe some undocumented immigrants are going to the trouble of faking data, and maybe DHS is missing them. But most people in the United States unlawfully steer clear of government programs, precisely because they fear triggering deportation for themselves or loved ones.
“People who are immigrants are afraid, they’re not going to risk exposure,” Shelby Gonzales, vice president for immigration policy at the Center on Budget and Policy Priorities, told me in a phone interview. “We’ve got problems getting people who are fully eligible, people who have been eligible for a long time, to trust that they can provide their information.”
That last part is well known to researchers and analysts. Immigrants legally eligible for federally funded benefit programs like Medicaid are actually less likely to get them than U.S. citizens. And during the first Trump administration, immigrants repeatedly told pollsters and journalists they were afraid to seek out public services—or even, in some cases, basic health care.
IF YOU REALLY WANT to give Vance and the Republicans the benefit of the doubt in a way they never do for their political adversaries—if you want to consider the most defensible part of their claim, for the sake of intellectual honesty—you could zero in on a single provision of the One Big Beautiful Bill (OBBB).
It’s a cut tied to a program called “Emergency Medicaid.”
Emergency Medicaid reimburses hospitals for emergency care they provide to immigrants not entitled to federally funded insurance. This includes people who are here lawfully but not eligible for federal programs. It also includes undocumented immigrants.
The OBBB reduces the federal contribution to Emergency Medicaid, saving about $28 billion in federal spending over ten years. If you squint hard enough, you could argue this is an example of the Republicans cutting funds that had been paying for health care of undocumented immigrants—and that Democrats want to restore that money, insofar as they have said they want to undo the legislation’s Medicaid cuts.
But here are a few other things to keep in mind:
That $28 billion over ten years represents less than 3 percent of the health care cuts within the OBBB and less than 1 percent of total Medicaid spending, according to data from the Urban Institute and KFF.
Only a portion of that money actually finances care for undocumented immigrants. Some of it finances care for people here legally but not yet eligible for Medicaid. An example would be people with work permits and those seeking permanent residency, who by law must wait five years before enrolling in Medicaid.
Emergency Medicaid doesn’t go to individuals. It’s a direct subsidy to hospitals and (in some states) outpatient providers, for care they provide.
A lot of the money is spent on truly emergency services like resuscitating somebody from a heart attack or delivering a baby that hospitals and clinics are obligated to provide, thanks to a 1980s law, signed by Ronald Reagan, that prohibits denying care to people who need stabilizing or life-saving treatment.
One other thing to note is that the cut does not apply to Florida, Texas, and eight other states that have refused to expand Medicaid as part of the Affordable Care Act. So this is a cut that largely spares some of the biggest red states, which could be a byproduct of GOP philosophical priorities lining up with those states’ choices, GOP leaders wanting to protect politically friendly states, or both.
As Georgetown research professor Edwin Park told me: “Emergency Medicaid is about reimbursing providers, especially hospitals, and the Emergency Medicaid provision is actually more about further increasing the cost-shifts to expansion states by lowering the match for Emergency Medicaid reimbursements.”
Add it all up, and even the most expansive, generous reading of the Emergency Medicaid argument wouldn’t come close to validating claims by Trump, Vance, and the other GOP leaders.
“Republican talking points have consistently featured claims that Democrats are trying to provide health care to undocumented immigrants, but this debate isn’t about that,” Larry Levitt, executive vice president for health policy at KFF, told me. “Democrats are looking to restore health coverage for citizens and lawfully present immigrants. It is those groups that will bear the brunt of cuts to Medicaid and the ACA.”
To be perfectly clear: Not a single Democrat has talked about wanting to fund care for people in the United States unlawfully. Instead, what Democrats have said is they want to undo Medicaid cuts projected to leave nearly 10 million Americans uninsured—and extend a temporary Biden-era initiative in order to avoid a jump in health insurance premiums expected to affect 20 million more.
You might agree with that. Or not. You might think tying this to the shutdown makes sense. Or not. But you can say one thing about Democrats’ underlying claims that you definitely can’t say about the Republican counterpart: They are telling the truth.
