The emblematic legislation of the budget of President Donald Trump would punish 14 states that offer health coverage to people who live in the country without papers.
These states, the majority led by Democrats, give medical insurance policies to some low -income immigrants -often children -regardless of their immigration status. Defenses claim that politics is humanitarian and that ultimately costs now.
The federal legislation, which Republicans have called a large beautiful bill (a beautiful large bill), would, however, drastically reduce federal medical fees in billions of dollars, unless they reduce those benefits.
The bill was approved with a narrow margin in the House of Representatives on Thursday 22 May and is now moving to the Senate.
Although a large part of the national agenda of Trump is progressing, including large tax reductions that mainly benefit the richest Americans, the legislation also implements considerable cuts on the costs of Medicaid who, according to those responsible for the budget of the congress, will leave millions of people with a low income without medical insurance policies.
If they were to be approved by the Senate, these cuts would be a complex political and economic obstacle for states and Washington, DC, who use their own money to offer medical insurance policies to some people living in the United States without permission.
These states would be reduced by 10 percentage points federal reimbursements for people who fall under the expansion of Medicaid that is performed under the Low Price Health Care Law (ACA).
These cutbacks would cost California, the state that should lose according to $ 3 billion a year, according to A KFF analysisA non -profit organization that focuses on health information that includes KFF Health News.
Together, the 15 affected places (the 14 states and DC) cover around 1.9 million immigrants without papers, according to KFF. The entity indicates that the sanction can also be applied to other states that cover immigrants with legal residence.
Two of the States, Illinois and Utah, have “activation” laws that have to end with their Medicaid extensions such as the federal government reduces its contribution of funds. This means that, unless these states withdraw their activation laws or stop covering people without legal immigration status, many more Americans with a low income can have without insurance.
If they continue to cover people without papers, the remaining states and Washington, DC from the tax year 2027, should contribute millions or billions of dollars every year to compensate for reductions in their federal repayments of Medicaid.
After California, New York could lose most of federal financing: according to KFF about $ 1.6 billion a year.
Senator in California, Scott WienerDemocrat and President of the Senate Budget Committee, said that Trump’s legislation has sown chaos, while the state legislators work to approve their own budget before June 15.
“We must be steadfast,” he said. “California has decided that we want universal medical care and that we ensure that everyone has access to medical care and that we do not allow millions of people without papers to receive first -line care at first aid.”
The Governor of California, the Democrat Gavin Newsom, stated in a statement that Trump’s bill would destroy medical care in his state.
“Millions of people will lose cover, hospitals will close and social security networks will collapse under that weight,” said Newsom.
In his budget proposal of 14 May, Newsom urged the legislators to reduce some benefits for immigrants without papers, with reference to the excessive increase in the costs of the Medicaid State program. If the congress lowers the funds for the expansion of Medicaid, the state could not cover the costs, the governor said.
Newsom wondered whether the congress has the authority to punish the States for how they spend their own money, and said that their state would consider challenging the measure before the court.
The state representative of Utah, Jim Dunnigan, a Republican who helped to promote a bill to cover children in their state, regardless of their immigration status, said that Utah must maintain the expansion of Medicaid who started in 2020.
“We can’t afford it, nor monetary or politics, that our federal funds for expansion are cut,” he said. Dunnigan has not specified whether he believes that the State should cancel its coverage for immigrants if the Republican institution against Sanctions Law becomes.
The UTAH program comprises approximately 2,000 children, the maximum permitted by their law. Adult immigrants without legal status are not eligible. The medical expansion of Utah includes About 75,000 adultswho must be citizens or immigrants with a legal home.
Matt SlonakerExecutive director of the UTAH Health Policy Project, a consumer defense organization, said that the bill of the Federal Chamber leaves the state in a difficult position.
“Politically, there are no big alternatives,” he said. “It is the dilemma of the prisoner: every movement in any direction is not logical.”
Slonaker pointed out that a probably scenario is that state laws eliminate their activation law and then find a way to compensate for the loss of federal funds for expansion.
Utaah has financed its part of the costs of medical expansion with sales tax and hospitals.
“The congress would enable the state of Utah to make a very difficult political decision,” said Slonaker.
In Illinois, the sanction of the Republican party would even have more serious consequences. This is because it can lead 770,000 adults They lost the medical coverage they obtained with the state expansion of Medicaid.
Stephanie AltmanDirector of Health Justice of the Shriver Center on Poverty Law, a defense group based in Chicago, said that it is possible that his state, led by Democrats, withdraws his activation legislation before the expansion of Medicaid is completed.
He added that the state could also avoid the sanction to ask the provinces to finance the coverage for immigrants. “It would clearly be a difficult situation,” he said.
Altman indicated that the bill of the House of Representatives seems to be written to punish the States controlled by Democrats, because they usually offer coverage to immigrants, regardless of their immigration status.
He added that the provision demonstrates the “hostility of the Republicans against immigrants” and that “they don’t want them to come here and receive public coverage.”
Mike Johnson, the president of the United States House of Representatives, proclaimed in May Those state programs that offer public coverage to people, regardless of their immigration status law as an “open felpud”, who invite more people to cross the border without permission. He said that efforts to eliminate these programs have the support of public surveys.
A Reuters-PSOS survey between 16 and 18 May showed that 47% of Americans approve Trump’s draft policy and rejects 45%. The study showed that Trump’s general approval index has fallen by 5 percentage points since he returned to 42% in January, with 52% of Americans rejecting their management.
Here, also known as Obamacare, states to expand adults with income from up to the 138% of the federal povertyor $ 21,597 per person this year. Forty states and Washington, DC, expanded their coverage, which contributed to reducing the national percentage of people without insurance to a historical minimum.
The federal government now covers 90% of the costs of people who are included in Medicaid thanks to the expansion of the Obamacare.
In states that cover the medical attention of immigrants without permission, the Republican bill would reduce the contribution of the federal government from 90% to 80% of the coverage costs for everyone who joins Medicaid under the expansion of ACA.
According to the law, federal medicaid funds cannot be used to cover people in the national articles, except for pregnancy services and emergency situations.
The other states that use their own money to cover people, regardless of their immigration status: Colorado, Connecticut, Maine, Massachusetts, Minnesota, New Jersey, Oregon, Rhode Island, Vermont and Washington, according to KFF.
Ryan LongDirector of relationships with the Congress of Paragon Health Institute, an influential conservative political group, said that even if they use their own funds for coverage of immigrants, states are still dependent on federal funds to “support the registration of non -documented immigrants”.
Long said that the concern that states with activation laws that the expansion of Medicaid can see is a “false track” because states have the opportunity to eliminate their activators, as Michigan did in 2023.
The sanction for offering health coverage to people in the country without papers is one of the different ways in which the Bill of the House of Representatives lowers the federal costs in Medicaid.
The legislation would also transfer more Medicaid costs to states by demanding or adults who fall under the program. The states should also remedy the suitability of the beneficiaries of the expansion of Medicaid every six months, instead of once a year or less, as the majority currently do.
The bill would also freeze the practice of states to burden hospitals, homes of older adults, to control medical care plans and other medical care companies to finance their part of the costs of Medicaid.
In a provisional estimate of 11 MayThe Congress Budget Office (CBO) indicated that, according to the bill approved by the House of Representatives, around 8.6 million people would lose medical coverage in 2034.
This figure will increase to nearly 14 million, according to the CBO, after the Trump government has terminated the new ACA instructions and, as the congress, led by the Republicans, as expected, refuses to extend the improved subsidies to pay the premiums of the commercial health plans that are sold by the markets of the Obamare.
The improved subsidies, a priority of former President Joe Biden, eliminated the monthly premiums entirely for some people who have taken over Obamacare plans. And expire at the end of the year.
This story is produced by Kaiser Health Newsthat publishes California Healthlinean editorial independent service of the California Health Care Foundation.
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