How the House Budget Bill Attacks Health Care and Nutrition for Immigrants, Children, and Everyone Else

When segments of a population are unable to access health care and nutrition assistance from the federal government, public health outcomes are undermined for everyone. U.S. law is already unfairly restrictive for federal programs: undocumented immigrants are not eligible for federally funded Medicaid, subsidized private insurance on the Affordable Care Act (ACA) marketplaces, Medicare, or the Supplemental Assistance Nutrition Program (SNAP). Now, Congress is angling to make our laws even more cruel and regressive. The House of Representatives has passed legislation with sweeping exclusions to federal assistance programs for lawfully residing immigrants and cuts to federal funding for states that extend health care for immigrants. 

This House-passed so-called “One Big Beautiful Bill Act” proposes to strip services from the most vulnerable, including people seeking asylum and trafficking survivors, to finance tax cuts for the wealthiest.   

Background

Immigrants’ access to federal health and economic support programs are based on a byzantine system of exclusions. As a result, lawfully present non-citizens go without health insurance at a rate double that of U.S. citizens. The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), passed by a conservative Congress under then-Speaker Newt Gingrich, banned many immigrants from federal public benefit programs. Since undocumented immigrants already were ineligible at that time, the law excluded or imposed waiting periods for many lawfully residing immigrants to become eligible for programs like Medicaid, the Supplemental Assistance Nutrition Program (SNAP), Federal Student Aid, and others – with profoundly harmful effects.  

But, importantly, Congress did not eliminate eligibility for all immigrants from these programs. It made exceptions for humanitarian immigrants, such as refugees and persons granted asylum. In later years, Congress restored eligibility for some groups and expanded eligibility to include certain survivors of domestic violence and trafficking. Other federal programs use different eligibility rules. Medicare allows lawfully present immigrants to enroll in coverage, but only if they have worked a sufficient number of years in the U.S. The private insurance plans available on the Affordable Care Act marketplaces and financial assistance are open to lawfully present immigrants. Under the federal tax system, tax credits are always available to all work-authorized taxpayers. 

The reconciliation legislation passed by the House of Representatives would upend these rules. Not a single undocumented immigrant would lose federally funded public benefits because they are already ineligible for such assistance. Instead, the bill attacks immigrant communities’ health and nutrition in four main ways:  

1. stripping lawfully present immigrants’ access to federal programs;  
2. stripping health coverage from low-income green card holders;  
3. cutting Medicaid funding for everyone in certain states targeted for coercive retribution; and  
4. delaying Medicaid coverage for citizens and immigrants alike.  

Members of Congress must oppose this bill, which steals health and nutrition from our communities to fund unprecedented spending on mass deportations and tax cuts for the richest 1%.  

1. Stripping Lawfully Present Immigrants’ Access to Federal Programs

Under the legislation, many lawfully present immigrants, including people with humanitarian protections like refugees, asylees, and victims of trafficking, would be stripped of access to SNAP, Medicare, ACA tax credits, and Federal Student Aid. Only Lawful Permanent Residents (green card holders), persons eligible for the Cuban Family Reunification Parole Program, and Pacific Islanders from Palau, Micronesia, and the Marshall Islands residing in the U.S. under a Compact of Free Association would retain their access to these federal programs. All other non-citizens would be banned. 

Many of these categories of immigrants who would lose access to these programs are unlikely to be able to return to their countries of birth, so these cuts would harm U.S. communities in the long run. Refugees and asylees are vetted through a rigorous process that affirms they cannot go home due to potential persecution. Survivors of trafficking who are cooperating with criminal investigations, or survivors of domestic violence seeking a future away from their abusers, will not have access to benefits that help allow them and their children to live safely away from their abusers or traffickers. 

Other low-income immigrants who are authorized to live and work in the U.S. will be left without any viable health coverage options. Many long-term residents who have worked at least 10 years in the country would lose Medicare coverage, depriving older adults and people with disabilities of medical care. Tax credits for coverage through the Affordable Care Act marketplaces would be inaccessible to many lawfully present immigrants, closing off access to affordable private health insurance options. In addition to hurting many families, these changes set terrible new policy precedents, denying Medicare to those who have paid into it and denying a tax credit to work authorized taxpayers.  

2. Stripping Health Coverage from Low Income Green Card Holders

Currently, lawfully present individuals who are low-income but ineligible for Medicaid due to their immigration status can purchase coverage and qualify for subsidies in the ACA marketplaces. The House bill wipes out this pathway to health care. Immigrants earning below the poverty line and ineligible for Medicaid because of their immigration status will no longer be able to enroll in subsidized ACA coverage.   

With most other categories of lawfully present immigrants excluded from the ACA due to the above discussed proposal, this change will primarily eliminate an important pathway to health care for green card holders who must wait five or more years before becoming eligible for Medicaid. Without any affordable coverage, these families will likely delay going to the doctor for preventive care, which could complicate health conditions and increase costs to the health care system that treats all of us.  

3. Cutting Medicaid for Everyone in States with Welcoming Policies

Not content with the restrictive federal system, the House-passed bill tries to manipulate states that use their own funds to fill gaps in health coverage—an option authorized by the 1996 eligibility law. Approximately 16 states and Washington, D.C., use state funds to cover health care for immigrants that are considered not-qualified for Medicaid. They do so because it benefits everyone in their communities. Most of these programs focus on or only cover children, and some have existed for decades.  

Because Congress cannot cut states’ budgets directly, congressional leaders instead are attempting to coerce them into ending their own programs by targeting their federal funds. When Congress expanded Medicaid coverage for certain low-income adults in the ACA, it agreed to pay 90% of the health coverage of this population. Forty states and D.C. expanded coverage under these terms. The reconciliation bill cuts this rate to 80% for states that cover lawfully present adults not eligible for Medicaid, and/or for undocumented immigrants. This action could result in massive funding losses to states, amounting to billions of dollars, for states that do not bend to the coercion. Two of these states, Utah and Illinois, have trigger laws that end Medicaid coverage under the ACA if the matching rate is reduced. 

This proposal represents unprecedented federal intervention into states’ affairs. It targets not only state-funded, Medicaid-like public coverage for undocumented immigrants, but also any state program that provides comprehensive health benefits or financial assistance for buying insurance. The Congressional Budget Office initially estimated that 1.4 million people would lose coverage if states are forced to cancel their programs rather than endure the punishing Medicaid cuts that would affect everyone in their state. 

4. Delaying Medicaid for Citizens and Immigrants Alike 

Finally, a provision of the bill that may appear to be simply about paperwork will have the real-life impact of delaying or denying Medicaid access for many citizens and immigrants who do maintain eligibility even under this bill. Currently, applicants for Medicaid and certain other federal programs must be allowed a reasonable opportunity to demonstrate their citizenship or eligible immigration status; during this period, they are permitted to access care.  

Many people need time to gather the evidence needed to establish eligibility, which includes birth certificates, passports, and other files and records that may not be immediately accessible when a person needs assistance. Medicaid, therefore, requires states to provide a 90-day reasonable opportunity period to applicants declaring under penalty of perjury that they have an eligible status during which they can receive health care services. The reconciliation bill makes this period optional for states and denies matching funds if the applicant’s citizenship or immigration status is not verified during this period.  

As a result, people who are eligible for Medicaid but face delays producing the proper paperwork or hurdles in the verification process beyond their control will be forced to delay care or take on medical debt. This provision may also inflict financial harm on safety net hospitals which often provide medical care to uninsured patients initially, while helping them to apply for Medicaid. 

Conclusion

The House-passed budget bill would deprive children and families of access to health insurance on a scale not seen in nearly three decades. Our communities are healthier and more successful when everyone has access to doctors, preventative medicine, and critical care. Congress already severely restricts immigrants’ access to health care programs, leaving both lawfully present and undocumented immigrants with the highest rates of uninsurance in the country. This bill would make these health disparities worse, and it would severely restrain states from using their own money and legislative process to make decisions about how to keep their communities healthy. Policymakers must stand in firm opposition to this bill, which will have a devasting impact on immigrants and their families, and leave many Americans unhealthy and underfed regardless of their citizenship or status.