An Afghan refugee caresses her 9-day-old infant inside the pediatric ward of a medical treatment facility in 2021 at Joint Base McGuire-Dix-Lakehurst, N.J. Refugees are among the lawfully present noncitizens facing the loss of federally funded health care coverage. (Photo by Barbara Davidson/Pool/Getty Images)

An estimated 1.4 million immigrants who are in the country legally but are not citizens stand to lose their government-subsidized health care coverage under the sweeping tax and spending bill President Donald Trump signed into law this summer, according to estimates from the nonpartisan Congressional Budget Office.

The One Big Beautiful Bill Act cuts federal spending on Medicaid, the joint federal-state health insurance program for low-income people. It also places new eligibility restrictions on lawfully present immigrants, including refugees and asylees, who are enrolled in a variety of government-subsidized health programs: Medicaid, the Children’s Health Insurance Program (CHIP), Medicare and Affordable Care Act marketplaces.

Immigrants who are in the country illegally have long been ineligible for federally funded health coverage.

But seven states — California, Colorado, Illinois, Minnesota, New York, Oregon and Washington — plus the District of Columbia have extended state-funded coverage to some income-eligible noncitizen adults regardless of their immigration status. Fourteen states plus the district provide state-funded coverage to noncitizen children whether they are here legally or not.

The new restrictions in the One Big Beautiful Bill Act, combined with other Trump policies limiting public benefits for immigrants, put those states in a financial bind. With less federal money to provide health benefits to immigrants who are here legally, states will be hard-pressed to maintain their programs that offer coverage to all immigrants, regardless of their legal status.

“We’re taking a giant step backwards from that public health and preventive health measure by excluding more people and draining federal resources from states that need it,” said Tanya Broder, a senior counsel specializing in immigrant health policy at the National Immigration Law Center, an advocacy group.

“And the result will be that our health — individually, as families and as communities — will be in jeopardy, and the health care infrastructure that serves all of us will also be compromised,” Broder said.

Already, some states that had offered health coverage aid to all immigrants — regardless of status — have been pulling back.

To help close a $12 billion deficit, California Democratic Gov. Gavin Newsom in June signed a state budget that bars immigrants who are here illegally from enrolling in the state’s Medicaid program, known as Medi-Cal. Current enrollees between the ages of 19 and 59 will have to pay a new $30 monthly premium beginning in 2027. In July 2026, the state will eliminate dental care for noncitizens.

Illinois in July ended its state-funded health coverage program for all immigrants ages 42 to 64. The state still operates a state-funded plan for residents 65 and older regardless of immigration status, but enrollment has been paused. And Minnesota also plans to exclude adult immigrants who are here illegally from a program that used to provide coverage regardless of immigration status.

New York is in an especially tough spot, since its state constitution prohibits discrimination against lawfully present immigrants in providing public benefits.

“States have had some type of leeway to fund resources for migrant communities if they want to,” said Medha Makhlouf, a law professor and the founding director of the Medical-Legal Partnership Clinic at Penn State Dickinson Law who studies immigrants’ access to health care. “But now this [federal] law makes it difficult for them to do that.”

Making it less attractive to stay

Jessica Vaughan, director of policy studies at the Center for Immigration Studies, a nonprofit group that backs stricter immigration policies, said these efforts are part of both Trump’s larger anti-immigration stance and “Congress’ interest in getting rid of any incentive or benefit for people who are in the country illegally.”

“It’s a way of making it less attractive for people to stay here illegally, right?” Vaughan said. “They’re trying to give people reasons to leave rather than reasons to stay.”

As noncitizens who are here legally lose access to federally funded benefits, the demand for state-funded coverage is “likely to increase,” Drishti Pillai, director of immigrant health policy at KFF, a health policy research group, told Stateline.

“However, at the same time, states are facing increasing budget pressures, especially with the Medicaid cuts,” Pillai said. “So it’s almost a double whammy, where there will likely be increased demand for state-funded coverage programs, but also states will have fewer resources to cover people.”

Makhlouf said the Trump administration’s policy changes reflect a broader strategy of stripping public benefits from marginalized and poor communities.

“Everyone who cares about access to health care needs to pay attention to what’s happening to immigrants,” she said. “When it becomes normalized to be able to sacrifice certain people’s humanity or their vulnerability, or to minimize their contributions to society, and say, ‘You don’t deserve access to health care,’ then that can be turned on to any group.”

Under Trump’s domestic policy law, California expects to lose at least $28.4 billion in federal Medicaid funding, according to Newsom’s office.

On the California Senate floor June 27, Democratic state Sen. María Elena Durazo expressed her sorrow at the state’s decision to deny coverage to immigrants.

“I can’t express how much joy I felt when we expanded basic health care,” Durazo said. “Today, that joy that I was so happy about, that joy has turned into pain, that joy has turned into shame.”

Democratic Senate Pro Tem Mike McGuire, however, said the state had little choice.

“We are a state of immigrants, 10.6 million strong. And we will never turn our backs on those who are part of the heart of the largest economy in the United States of America,” McGuire said during the debate. “So we’ve had to make some tough decisions. I know we’re not going to please everyone.”

Obligated in New York

One state, New York, is particularly in a bind, because its constitution requires it to provide coverage to lawfully present noncitizens.

Roxana, 27, has been living in the U.S. under the Deferred Action for Childhood Arrivals program, known as DACA, since she was 8 years old and is using her first name only out of fear she will be targeted. At the end of 2019, she experienced a range of debilitating symptoms, including pelvic pain and chronic fatigue, and discovered a noncancerous lump on her breast.

“Chronic illness has impacted my career trajectory with a lot of fatigue and chronic pain,” said Roxana, who lives in the Bronx, New York.

Roxana cannot get federally funded Medicaid. But she qualified for state-funded public health coverage in New York. A 2001 court case, Aliessa v. Novello, requires the state to offer publicly funded health coverage to all lawfully present residents under the state constitution. So, she could afford to go to the doctor, where she learned that she had a hormonal condition called polycystic ovary syndrome, or PCOS, and she was able to get the lump removed.

New York mostly picked up the tab for immigrants and other lawfully residing immigrants until 2016, when it launched coverage it called the Essential Plan under the 2010 Affordable Care Act, also known as Obamacare. Under the ACA, the plan has no deductibles or monthly premiums for patients, and the federal government has picked up almost the entire cost — 90% — of the plan, a huge economic relief for the state.

Now, New York faces an annual loss of $13.5 billion in federal Medicaid and Affordable Care Act funds. Additionally, the phasing out of premium tax credits for noncitizens under Trump’s law would lead to a loss of $7.5 billion in annual funding to the state’s Essential Plan, which covers 1.7 million New Yorkers.

“These are billions of dollars that are being taken away and out of New York’s delivery system,” Amir Bassiri, director of Medicaid at the New York State Department of Health, said at a United Hospital Fund conference on July 30.

It’s unclear whether and how the state will afford to cover people like Roxana, even though it’s required under the state’s constitution. Like other immigrants, she is terrified that in the face of cuts and shrinking safety net access for noncitizens, she will lose continuous health care coverage and that her condition will get worse.

“My PCOS symptoms have just been getting worse over the years. I really want to try my best with the health access that I have to get it under control.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Rep. Mark Pocan and Sen. Tammy Baldwin | Collage of screenshots via Zoom

Last time the government was on the brink of a shutdown, Democratic leaders rushed to negotiate with Republicans and reached a deal to keep federal agencies open and basic services flowing. Now that deal is about to expire and there seems to be little appetite for compromise in Washington. 

President Donald Trump has directed Republicans “don’t even bother dealing with” Democrats, and the House rammed through a near-party-line resolution to keep the government open that ignored Democratic demands and had no Democratic input at all. 

“We’re not sure how serious they are about actually trying to have something done by September 30,” Wisconsin Democratic U.S. Rep. Mark Pocan, who sits on the House Appropriations Committee, told reporters in his Madison office Wednesday. Trump had just canceled a meeting with Democratic leaders of the House and Senate, and the House isn’t even in session during the last days of September, as the shutdown clock winds down. 

Still, House Minority Leader Hakeem Jeffries (D-NY) called the Democratic caucus back anyway, “so I’ll be flying Monday out to Washington,” Pocan said.  “Hopefully they’ll decide we’ve got work to do. But you know, this is something where we don’t run the House or the Senate or the White House.” In other words, if the government shuts down, it’s the Republicans’ fault. Republicans, who don’t appear worried about a shutdown, say the opposite, rolling their eyes at Democrats’ demands that a stopgap government funding bill must reverse Medicaid cuts and extend Affordable Care Act premium tax credits, which are set to expire at the end of the year and without which an estimated 5 million Americans will no longer be able to afford any health insurance at all.

A shutdown means hardship for people who depend on government services and could harm the whole economy, “But at the same time,” Pocan said, “we’re trying to fight for people who lost their health care and other things from what we call the Big, Ugly Law.”

Pocan cited data from the nonpartisan health research organization KFF on likely health insurance premium hikes in Wisconsin if the ACA tax credits are not extended. A KFF calculator estimates premium increases for families of different sizes and income levels in every state. A family of four earning $130,000 per year in Wisconsin could see premiums jump by as much as $1,588 per month or $19,081 per year, according to the calculator.

Nationwide, premiums will soar by more than 75% if the credits expire, according to KFF.

Wisconsin Sen. Tammy Baldwin has called for legislation she introduced earlier this year to make the enhanced premium tax credits permanent to be included in any stopgap bill to avert a shutdown.

In a joint statement, Democratic leaders of the House and Senate criticized House Republicans for ignoring their pleas to address the expiring ACA tax credits, writing, “at a time when families are already being squeezed by higher costs, Republicans refuse to stop Americans from facing double-digit hikes in their health insurance premiums.” 

The sudden jump in health insurance premiums, combined with high costs for consumer goods because of Trump’s tariffs, will hit voters just ahead of the midterm elections, which take place right after the ACA tax credits are set to expire. Politics alone should make the idea of forestalling the sudden cliff appealing. But this is no ordinary Republican party. Back in their districts, ducking in-person meetings with constituents, members of Congress who voted for the Big Beautiful Bill Act to slash health care, food assistance and federal agencies that serve their constituents are still in lockstep with Trump. No wonder they don’t care if the entire government grinds to a halt.

A shutdown will be bad. But what Trump and the Republicans have in store for Americans is worse. 

More than the effects of a shutdown, said Pocan, “I’m far more concerned about what they just did to people that we need to try to fix, and if they’re not willing to have those conversations with us — that’s a big problem.”

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Elementary school students arrive for the first day of school in September in Minnesota. About 3 in 4 children nationwide relied on government-subsidized health care, and 2 in 5 experience disruptions in health coverage during their childhood, according to a study by researchers at the Harvard T.H. Chan School of Public Health. (Photo by Stephen Maturen/Getty Images)

A majority of children in the United States rely on Medicaid or the Children’s Health Insurance Program at some point by their 18th birthday, and many experience periods of coverage loss, according to a study published Wednesday in the journal JAMA.

By their 18th birthday, about 3 in 4 children nationwide relied on Medicaid, CHIP (which subsidizes health care for children and pregnant women in families that earn too much for Medicaid), or the subsidized insurance marketplaces established through the 2010 Affordable Care Act — or experienced a period during their childhood without health insurance, the study found.

Researchers from the Harvard T.H. Chan School of Public Health conducted estimates based on analyses of national data from 2015 to 2019, looking at cumulative coverage rates over the course of childhood. 

The study comes as states grapple with federal Medicaid cuts under President Donald Trump’s One Big Beautiful Bill Act. The tax and spending law will reduce Medicaid funding by $1 trillion and cut enrollment by 10 million to 15 million people over the next decade, according to projections by the Congressional Budget Office.

About 42% of children suffered a period of losing health coverage at any point in time by their 18th birthday, the Harvard researchers found, and 61% had at some point enrolled in Medicaid or CHIP. About 78.5% were at some point enrolled in employment-based insurance.

Rates of children who lost insurance coverage were higher in states that hadn’t expanded Medicaid income eligibility under the Affordable Care Act, often known as Obamacare. Roughly 59% of children in non-expansion states had periods without any insurance coverage — compared with 36% in expansion states. Overall, about 2 in 5 children experienced periods without health insurance, the study found.

And states with the strictest income thresholds saw the highest share of kids losing coverage who previously were covered by Medicaid or CHIP at birth.

“Upcoming changes to Medicaid could affect a significant portion of children and worsen already substantial insurance gaps,” senior author Nicolas Menzies, an  associate professor of global health and faculty member in the school’s Center for Health Decision Science, said in a statement. 

“We’re particularly worried about explicit loss of public insurance eligibility for noncitizen children; spillover effects through parental Medicaid coverage losses due to work requirements and more eligibility checks; and state-level cuts to Medicaid.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Main Street in the Wisconsin community of Cambridge. (Photo by Henry Redman/Wisconsin Examiner)

As we begin our seventh year as a carwash marketing agency in Wisconsin, we’re daily confronted with challenges like scaling, taking on investors and staying competitive in a saturated market. Yet consistently the toughest issue to navigate has been how to approach health care for our employees amid national uncertainty.

Since health care is largely tied to employment, one of our earliest priorities was to make sure that we could be in a position to offer affordable, comprehensive coverage to our employees. And here we are, a few years later, still unable to swing it.

With the current federal administration and the recent passage of the One Big Beautiful Bill Act (OBBBA, as we go forward, for brevity and so I don’t need to use those words together), our lofty goal of offering the most basic benefits to our employees seems more of a pipe dream than ever. While we wait for the tax breaks that are promised to trickle down from the top earners who benefit most,  we’re facing a very near-term future of funding cuts and even higher daily costs — and in the realm of health care, an uncertain few months of even higher premiums and more difficult access to basic care. Our Republican representatives are still parading the passage of the OBBBA as a win, but when it comes to the reality of the tax breaks and subsidies that are set to expire within the next few months, the silence from our Republican reps is deafening.

The OBBBA does offer tax breaks and incentives, but outside of a few breaks on  large equipment purchases in our industry, neither our customers, who are mostly small, mom and pop operators, nor we will see any benefit. We’re not in a position to fully depreciate the purchase of a private jet. In fact, because of the OBBBA and  the economic instability associated with tariff threats, we’re now facing the potential of our first year of non-growth.

As small business owners in Wisconsin, we’re watching the numbers come out on the OBBBA and realizing just how uneven this deal really is. More than 70% of the tax breaks will go to the wealthiest one-fifth of households, while the middle class gets just 10%. Here in Wisconsin, the top 1% of earners will walk away with average breaks close to $70,000. For families making under $80,000 a year, the break is less than $1,600.

When we weigh the minimal tax breaks we may see against the drastic losses in support, it’s clear this law shifts the burden onto families, state budgets and small businesses already at their limit. Medicaid cuts, in particular, threaten jobs, health care access and community well-being. The OBBBA is hailed as a win, but truly, it undermines our efforts to provide for our employees and community.

On health care, we’re coming up to a harsh deadline — the lapse of premium tax credits for the Affordable Care Act, an action propagated entirely by Republican lawmakers. With 90% of Americans relying on these subsidies to make coverage affordable, we’re looking at sharp increases in premiums. As a family, we’re already paying nearly $900 per month for non-substantial coverage. This is nearly the cost of our mortgage for coverage that does nothing of the sort — our out-of-pocket payments are ridiculous.

Already, insurance providers are pulling out of key markets in Wisconsin as it is no longer profitable to serve certain areas of the state. How are Wisconsinites supposed to counter this? How do people survive when premiums rise so high, it’s more cost-effective to gamble with one’s health rather than pay rates for coverage that only really serve to prevent complete financial catastrophe after one gets sick?

Ultimately, as small business owners, we can easily see the ripples from the OBBBA and the lapsing of ACA tax credits.

• Premiums will continue to rise to untenable levels.
• Businesses and individuals will have less money to spend.
• Entrepreneurship will stall due to more hesitation to give up benefits in corporate environments.

This legislation does not help small business owners, Wisconsinites, or working families — nor does it promote a healthy local economy. Instead, it burdens those already struggling while directing gains to the top. The damaging effects of these policies will only become more obvious as the new law  unfolds.

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