Contents
Article Summary
Congressional Republicans are considering a budget reconciliation package that includes significant changes to Medicaid and the Affordable Care Act (ACA), with provisions limiting access to health coverage for immigrants. The proposed legislation would make cuts to the Medicaid program and restrict immigrant eligibility for ACA Marketplaces and Medicare. These changes could increase the uninsured rate among immigrant families, including citizen children, and have broader ramifications for the nation’s workforce and economy.
What This Means for You
- Immigrant families may face increased barriers to health coverage, potentially leading to higher uninsured rates and reduced access to care.
- Employers and industries that heavily rely on immigrant workers could experience negative impacts, as lack of access to health coverage may lead to decreased productivity and absenteeism.
- Advocates for immigrant rights and health care access should closely monitor these proposals and engage in efforts to ensure that immigrant families have access to the health care they need.
- Future legislation could continue to target immigrant access to health coverage and benefits, making continued advocacy efforts essential.
Original Post
Introduction
Congressional Republicans are considering a budget reconciliation package that would make significant changes to Medicaid and the Affordable Care Act (ACA), with a number of provisions specifically limiting access to health coverage for immigrants. The House Energy and Commerce Committee released legislative text to meet spending targets that would make significant cuts to the Medicaid program, and the proposed legislation released by the House Ways and Means Committee includes immigrant eligibility restrictions for ACA Marketplaces and Medicare. Beyond these changes, reductions have been proposed in other areas that would have significant impacts for immigrant families, including eligibility restrictions for the Child Tax Credit and the Supplemental Nutrition Assistance Program.
This policy watch discusses key provisions in the draft reconciliation legislation that are aimed at limiting health coverage for immigrant families. These provisions would likely increase the uninsured rate among immigrant families, including citizen children in those families, and have broader ramifications for the nation’s workforce and economy given the role immigrants play.
Proposed Medicaid Changes
Two proposed Medicaid changes would reduce federal funding for states that provide health coverage to immigrants:
- Reduce the federal Medicaid match rate for the ACA Medicaid expansion group from 90% to 80% for states that use their own funds to provide health coverage or financial assistance to purchase health coverage to individuals who are not lawfully residing in the United States. This proposal would affect 14 states plus DC, potentially increasing the uninsured rate and reducing access to care for immigrant families. According to the CBO, 1.4 million more people would become uninsured by 2034, and the federal deficit would be reduced by $11 billion between 2025 and 2034.
- End requirement and federal Medicaid financing for states to cover people while they are verifying immigration or citizenship status. This proposal would prohibit states from claiming federal matching funds during a reasonable opportunity period for verifying immigration or citizenship status, potentially reducing access to care for individuals awaiting verification.
Proposed Changes to ACA Marketplace Coverage
Two proposed changes would impact ACA Marketplace coverage eligibility for immigrants:
- End ACA Marketplace coverage eligibility for DACA recipients. This proposal would exclude DACA recipients, who are mostly working adults without access to an affordable health coverage option, from Marketplace coverage, further limiting their access to health care.
- Eliminate ACA Marketplace coverage for many lawfully present immigrants. This proposal would limit eligibility for subsidized ACA Marketplace coverage to lawfully present immigrants who are LPRs or COFA migrants residing in the U.S., eliminating eligibility for many lawfully present immigrants with incomes under 100% FPL beginning January 1, 2026. The Joint Committee on Taxation estimates that these changes will result in federal savings of about $117 billion between 2025 and 2034.
Proposed Changes to Medicare Coverage
The Ways and Means bill would limit Medicare eligibility to LPRs, COFA migrants residing in the United States, and certain immigrants from Cuba. This proposal would eliminate eligibility for many lawfully present immigrants, including refugees, asylees, and people with Temporary Protected Status. Current beneficiaries subject to the new restrictions would lose coverage one year from the date of enactment of the legislation.
Health Coverage and Economic Implications
Noncitizen immigrants are already disproportionately likely to be uninsured, with limited access to health coverage options. Provisions in the budget reconciliation bills would further curtail access to health coverage for both undocumented and lawfully present immigrants. Overall, one in four children in the U.S. lives with an immigrant parent, including one in ten, or 9 million, who are citizen children with a noncitizen parent. Reduced coverage and access to care may negatively impact the U.S. economy and workforce due to lost productivity, as immigrants play an outsized role in many occupations, including health care, construction, and agriculture.
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