Of Course Illegal Immigrants Access Public Health Benefits

Democratic candidates at a 2019 presidential primary debate signal that their healthcare plans would cover illegal aliens.

Amid yet another government shutdown, the finger-pointing on Capitol Hill has intensified. Although the primary disagreement between the parties concerns the fate of pandemic-era Obamacare subsidies, another healthcare-related dispute has consumed the headlines. Would the Democrats’ budget really give healthcare benefits to illegal immigrants? The allegation is valid, but this small dispute distracts from a broader truth: Illegal immigrants already access public health benefits through a variety of pathways, most of which will continue regardless of how the shutdown ends.

The current dispute is driven largely by confusion over who counts as an illegal immigrant. Immigration status may sound like a straightforward concept, but the gray area between legal and illegal has been growing. For example, President Joe Biden ballooned the number of illegal immigrants with Temporary Protected Status (TPS) from 400,000 to 1.2 million during his term. TPS-holders have no legal right to live here, but the government has promised not to deport them until their home country resolves what is supposed to be a major destabilizing condition — a natural disaster, for example — although past administrations have tended to grant and renew TPS for far less.

Similarly, President Biden allowed 2.9 million inadmissible aliens to enter the U.S. via “parole”, which, like TPS, gives them a fixed time period to stay before facing removal. Are migrants with TPS or parole not illegal immigrants? Many do have work permits, which distinguishes them from conventional illegal immigrants. However, since these migrants are still considered inadmissible and removable, and their deferred status is temporary, the Department of Homeland Security and outside experts continue to count them in the illegal category. The Center counts them in our own estimate of the illegal population as well:

Prior to passage of the One Big Beautiful Bill (OBBB), parolees could access Medicaid after a five-year waiting period, just as legal permanent residents can, and they could also qualify for Obamacare subsidies after one year. TPS-holders for their part could access Obamacare subsidies. The OBBB sunsets all of these privileges, but the Democrats’ proposed budget would restore them. Therefore, the claim that congressional Democrats want to give public health benefits to illegal immigrants is indeed true — as long we acknowledge that special statuses such as TPS and parole do not convert illegal immigrants into legal ones.

That dispute is minor, however, compared to the broader reality that illegal immigrants already consume public health benefits through other pathways. Perhaps the most obvious is emergency Medicaid. Illegal immigrants who show up in emergency rooms, including expectant mothers, will generally have their healthcare expenses covered by federal taxpayers. Another avenue is state-level programs. California, Illinois, and New York are among the approximately 14 states that fund coverage for illegal immigrant children. Some states even provide adult illegal immigrants with health benefits.

Furthermore, many illegal immigrants consume Medicaid through their U.S.-born children, who as citizens qualify for all of the benefits that other natives do. The Center has found that 59 percent of households headed by an illegal immigrant consume at least one means-tested benefit, with 39 percent consuming Medicaid specifically.

Some immigration advocates insist that Medicaid for the U.S.-born children of illegal immigrants should not count as immigrants using welfare, but that view is mistaken. Parents are legally obligated to provide medical care for their children. If they do not, and taxpayers step in to do it for them, then the parents receive a financial benefit.

Some additional restrictions could help reduce the public health benefits that illegal immigrants receive. Indeed, the House version of the OBBB would have penalized states that offered benefits to illegal immigrants, but this provision was dropped by the Senate. Still, no set of restrictions can block all such welfare usage. Hospitals will always help people in emergencies, regardless of their immigration status, and the citizen children of illegal immigrants will always be eligible for welfare as long as we have a welfare state.

The ultimate solution to illegal immigrants consuming Medicaid or any other type of welfare is simply to reduce the size of the illegal immigrant population. Fortunately, the Trump administration has shown that controlling the border and deporting people with removal orders is indeed possible. It is those enforcement policies — not simply restrictions on program access — that will ultimately save taxpayers from the burden of illegal-immigrant healthcare.