Leading up to the government shutdown on Wednesday, congressional Republicans and Donald Trump have repeated misleading claims that Democrats were trying to pass a resolution that would provide “free healthcare for illegals”. It’s become a well-rehearsed refrain fueling GOP lawmakers as government funding lapsed this week.
At the White House on Wednesday, the vice-president JD Vance said the Democrats’ spending plan “would have undone” the work of the One Big Beautiful Bill Act (OBBBA) – which ended the eligibility of many types of lawfully present immigrants to access federally funded health coverage, like Medicaid, Medicare and Affordable Care Act (ACA) subsidies for private health insurance.
Meanwhile Republican leadership on Capitol Hill has maintained their colleagues across the aisle are holding the government “hostage”, while dueling funding bills continue to fail in the Senate.
“They have made a decision that they would rather give taxpayer funded benefits to illegal aliens, than to keep the doors open for the American people,” said Mike Johnson, the Republican House speaker, in a news conference on Thursday.
Democrats have lambasted Republicans’ claims.
“Not a single federal dollar goes to providing health insurance for undocumented immigrants. NOT. ONE. PENNY,” said the top Senate Democrat, Chuck Schumer. “Republicans would rather lie and shut down the government down than protect your healthcare.”
In an interview with ABC News, on the first day of the government shutdown, House minority leader Hakeem Jeffries fact-checked Republican claims. “Federal law prohibits the use of Medicare, Medicaid, the Children’s Health Insurance Program and the Affordable Care Act to provide health insurance in any way, shape or form, to undocumented immigrants. Period, full stop,” he said. “And Democrats aren’t trying to change that.”
By framing the issue as being about illegal immigration, it shifts the debate to ground that is politically “friendlier” for the GOP, according to Jonathan Oberlander, professor of healthcare policy at University of North Carolina at Chapel Hill.
“[Republicans] absolutely do not want to talk about the healthcare provisions,” Oberlander said. “Whereas Democrats, in general, don’t want to talk a lot about immigration. They do want to talk a lot about healthcare and people losing health insurance, and so that’s exactly what they’re doing.”
Undocumented immigrants remain ineligible for federally funded health insurance, and are only able to receive emergency Medicaid treatment, according to longstanding US laws. Instead, Democrats’ funding patch seeks to reverse many of the cuts to Medicaid that are set to take effect after Trump’s sweeping domestic policy agenda passed earlier this year.
This includes allowing lawfully present noncitizens – which includes several groups, such as refugees and asylum seekers, those with Temporary Protected Status (TPS), and survivors of domestic abuse and human trafficking who are awaiting visas or documentation – to still enroll in certain federal health care programs. All of these immigrants have entered the country legally and are accounted for by the federal government.
The congressional budget office (CBO) estimates that the impact of the OBBBA will leave around 1.4 million lawfully present noncitizens without coverage.
While the impasse in Washington continues, vocalizing any of this nuance seems futile, says Oberlander. “These are all groups that potentially could command political sympathy, but I’m not sure they can break through the misinformation, the toxic environment and the restrictive era we’re living in right now,” he added.
“I think what they [Democrats] are going to do, and what they have been doing, is simply to say this has nothing to do with undocumented immigrants. This is not about them. You’re taking health insurance away from Americans.”
According to Michael Trujillo, a veteran Democratic strategist, Republicans have been able to land their messaging around the government shutdown by playing “offense”, mainly because Democrats’ language of preservation is harder to sell.
“What we’re trying to do is keep what people have today,” Trujillo said.
Trujillo noted that Democrats also have to “repeat the lie” in order to dismantle Republicans’ rapid and spurious claims that their funding bill will provide healthcare for undocumented immigrants.
“If their [Republicans’] debate is, we’re accusing you of liking sour milk. And then our response is, ‘we in fact do not like sour milk’. Well, guess what, sour milk just became the issue,” Trujillo said.
This week, Karoline Leavitt said that programs like TPS are a “complete abuse of the immigration system” that allow “illegals from all over the world to get free benefits”, while speaking to reporters. Since returning to office, Trump has attempted to end temporary protections for several countries through a series of lawsuits with varying degrees of success.
Notably, the White House press secretary was unclear when answering a question from a reporter, who asked whether doctors should treat patients in emergency rooms regardless of their immigration status – which is required under federal law. “I don’t speak for emergency rooms across the country, I speak for the president of the United States,” she replied.
Through their continuing resolution, Democrats are also trying to remedy the OBBBA’s cuts to Medicaid dollars hospitals receive from the federal government – for emergency care they are mandated to provide to individuals who do not have an eligible immigration status, but would otherwise qualify for Medicaid. According to a recent analysis by KFF, this kind of emergency Medicaid spending accounted for less than 1% of the program’s total expenditure between 2017-2023.
Larry Levitt, executive vice-president for health policy at KFF, said the false claim about who is getting access to healthcare has been the “biggest effort at misinformation on a health policy issue since Republicans claimed that the Affordable Care Act included ‘death panels’”.
“I’m sure it’s an effective talking point to say the Democrats want to expand health care for undocumented immigrants, but it’s just not true,” he said.
A key aspect of the Democrats’ funding bill, and one they have emphasized more than the reversal of the cuts in the Republican budget law, is a permanent extension of the widely popular ACA premium tax credits, which are set to expire at the end of this year. KFF estimates that healthcare costs are set to double for the vast majority of enrollees when these subsidies lapse. Meanwhile, the CBO has projected that around 4 million people stand to lose their health insurance if enhanced tax credits expire at the end of 2025.
“My sense is that they [Democratic leadership] would take a deal if they just get the subsidies extended,” Oberlander said. He also underscored that Democrats’ push to reverse the wider healthcare cuts in the president’s sweeping tax legislation may be more of a statement than a demand: “They want to call attention to the fact that Republicans enacted them and what the consequences are, but they know, realistically, there’s no chance that they’re going to reverse what they just passed.”
