Federal Financing for Public Health Coverage for Undocumented Immigrants
President Trump and his allies in the House and the Senate are claiming that the shutdown is about Democratic efforts to assure the undocumented can enroll in federal health programs like Medicare, Medicaid and the Affordable Care Act. https://www.cnn.com/2025/09/30/politics/fact-check-trump-free-health-care-immigration That is quite simply a bald-faced lie. Instead, they are trying to preserve premium assistance under the Affordable Care Act for US citizens and legal permanent residents, who are the only persons eligible for coverage under the ACA.
The undocumented are ineligible for Medicare, Medicaid, CHIP and the tax credits for individual insurance in the Exchanges. However, they pay Social Security taxes, sales taxes, property taxes, and income taxes to support the programs for which they are ineligible. https://itep.org/undocumented-immigrants-taxes-2024/ Emergency care and deliveries for the low income undocumented can be paid to hospitals and emergency physicians through Medicaid pursuant to a provision of the 1986 Omnibus Budget Reconciliation Act, passed and signed by President Ronald Reagan.
Over 60% of their taxes go to the federal government to pay for programs for which they are ineligible. https://itep.org/undocumented-immigrants-taxes-2024/ Forty percent goes to state and local governments and helps pay for services like education (the biggest share of California state government general fund spending) and police (the biggest share of municipal government general fund expenditures). https://itep.org/undocumented-immigrants-taxes-2024/
In California, the state government has over the past 30 years of discussion and debate decided to cover full scope MediCal for low-income working immigrants regardless of their immigration status, starting with pregnant women and young children. https://www.chcf.org/resource/how-california-made-almost-everyone-eligible-health-care-coverage/ Full scope MediCal for the state’s undocumented is financed with state only funds (about $4 billion). https://www.chcf.org/resource/how-california-made-almost-everyone-eligible-health-care-coverage/ By comparison, California’s MediCal program costs over $150 billion. Of the state’s still remaining uninsured about 500,000 are undocumented workers whose incomes exceed the MediCal financial eligibility limits. The remainder (US citizens and legal permanent residents) are eligible for but not enrolled in public programs or for private employment-based coverage.