Health Coverage Costs May Soon Skyrocket for Millions of People — None of Whom Are Undocumented

Only people with lawful immigration statuses are eligible for health coverage through Medicare, Medicaid, and the Affordable Care Act’s (ACA) marketplace. Nothing in the current budget debate would change that, though Republicans have falsely claimed otherwise. What is true: without congressional action, premiums are about to rise steeply for millions of people across the U.S., putting their health coverage at risk.

Long-standing eligibility restrictions prevent people who are undocumented from enrolling in coverage under Medicare, Medicaid, or the marketplace. Medicaid’s restrictions are especially harsh: to enroll in Medicaid, immigrants must have a “qualified” immigration status, which is a narrow list of statuses that for decades has excluded many people with lawful immigration statuses. Moreover, immigrants with lawful immigration statuses who are eligible for Medicaid and other health coverage programs often don’t enroll due to fear and red tape.

The harmful Republican megabill, enacted in July, further restricts access to federally funded health coverage in Medicare, Medicaid, and the ACA marketplace plans by allowing only U.S. citizens, lawful permanent residents, people living in the U.S. from Compacts of Free Association (COFA) nations, and certain Cuban and Haitian entrants to enroll in coverage.

As these provisions take effect, they will take coverage away from people to whom our nation has granted humanitarian protections, such as refugees, people granted asylum, and certain victims of domestic violence and sex or labor trafficking. This is a stark departure from our nation’s long-standing bipartisan commitment to ensure that vulnerable people who have demonstrated a need for humanitarian protection have access to vital supports that help them find stability as they establish their lives in the U.S.

Congressional Democrats are seeking both to undo the megabill’s more than $1.1 trillion in health care cuts that will take health coverage away from millions of people — most of them U.S. citizens and none of whom are people with an undocumented status — and to extend premium tax credit enhancements that have helped people afford to buy ACA marketplace plans.

Time is running out to make this happen. Already, the over 22 million people with ACA marketplace coverage are getting notifications of their 2026 premiums, and open enrollment begins November 1 (in all states except Idaho, where open enrollment started October 15). Without congressional action, their premiums may skyrocket, and some people will no longer be able to afford coverage at all. To be clear: everyone these increases will impact is required to have a lawful immigration status to enroll in ACA marketplaces, no matter how many times prominent members of the Administration or Congress say otherwise.

The ACA marketplace uses a database run by the Department of Homeland Security to verify eligibility based on lawful immigration status (a process that Medicaid also uses to ensure people meet the more restrictive immigration-related standard). These programs also thoroughly document citizenship status. This was true before the Republican megabill passed and would remain true even if Congress repealed the legislation.

Also true both before and after the megabill’s passage: federal law provides funds to states to reimburse hospitals for providing emergency medical services to people who meet all Medicaid eligibility requirements but are not qualified to enroll because of their immigration status. (This includes both people with lawful immigration statuses who are ineligible for Medicaid — like permanent residents who have been in the U.S. for less than five years — and people without a lawful status.) This Medicaid funding is vital for hospitals that have been legally required since the 1980s to provide emergency services to people seeking care, regardless of their ability to pay.

A harmful provision in the megabill, however, reduces but does not eliminate the federal payment to states that expanded Medicaid under the ACA when they reimburse hospitals for providing this narrow category of emergency medical care. The Senate Democrats’ proposed continuing resolution would reverse this megabill provision that unfairly punishes Medicaid expansion states and potentially hospitals in those states (if their reimbursement rates get cut as a result of less federal funding being available to states).

Reversing the harmful health coverage provisions in the megabill would result in millions of people across our nation continuing to have access to affordable, comprehensive health coverage through Medicare, Medicaid, and ACA marketplaces. It would not provide federal investment in health coverage for people who are undocumented.