House Republican Reconciliation Bill Takes Away Health Coverage, Food Assistance, Tax Credits From Millions of Immigrants and Their Families

The House Republican reconciliation bill would impose massive cuts in food assistance, health care coverage, and other supports for people with low incomes^[1] and singles out immigrants with lawful status and their families for particularly cruel restrictions on assistance. These measures would partially pay for the bill’s trillions of dollars in tax cuts heavily weighted to the wealthy,^[2] as well as its $50 billion for border wall construction and around $150 billion for a large detention and deportation apparatus^[3] that threatens family separation and unjust treatment of immigrants and others who get swept up by the deportation dragnet.

Although congressional Republicans have falsely claimed that the cuts targeting immigrants are aimed at people without a documented immigration status, the reality is that people who lack documentation already do not qualify for these benefits. Instead, the cuts would primarily impact immigrants who lawfully live and work in the U.S. and U.S. citizen children in immigrant families.

At the same time, the Trump Administration is taking steps to terminate lawful status for hundreds of thousands of people granted humanitarian parole, Temporary Protected Status (TPS) holders, and others who have sought refuge in this country. The combination of these changes and the new restrictive policies would leave people more hungry, less healthy, less able to buy food for their children (who are often U.S. citizens), and less able to contribute to their communities.

Taking Away Health Coverage

The House reconciliation bill, passed in the early hours of the morning of May 22 by a one-vote Republican majority, would take away health coverage that millions of immigrants who are living and working lawfully in the U.S. now receive through various sources, including the Affordable Care Act (ACA) marketplaces, Medicare, and Medicaid.

ACA Marketplaces

The House bill would bar many lawfully present immigrants from qualifying for premium tax credits and cost-sharing reductions that help people afford health insurance in the ACA marketplaces. It would also bar the same group from qualifying for health coverage from the Basic Health Program, which Oregon and Minnesota use to provide coverage to people with low incomes rather than through the ACA marketplace. (People without a documented immigration status are already barred from purchasing coverage in the ACA marketplaces, contrary to House Republicans’ claims.)^[4]

Under current law, only individuals who are lawfully present in the U.S. may receive financial assistance to buy marketplace coverage.^[5] But the bill radically narrows which categories of immigrants would qualify, taking away assistance from numerous groups of immigrants who all have lawful immigration statuses: people granted asylum; refugees; special immigrant juveniles who have been abused, abandoned, or neglected by a parent; TPS holders; those granted humanitarian parole (based on a determination that their urgent humanitarian needs cannot be met in their home countries); and certain victims of domestic violence, labor or sex trafficking, and other serious crimes, among others.

The only groups eligible for assistance to afford marketplace coverage would be U.S. citizens, people with lawful permanent resident status (LPRs, also known as green card holders), certain Cubans paroled into the U.S. under a specific family reunification program, and people from the Federated States of Micronesia, Republic of the Marshall Islands, and Republic of Palau who live and work in the United States under Compacts of Free Association (COFA).

The bill would also take away premium tax credits and cost-sharing reductions that help low-income people who are lawfully present but ineligible for Medicaid due to their immigration status buy marketplace coverage. The ACA included a provision that allows people in these groups to qualify for premium tax credits and cost-sharing reductions even if their incomes are below the poverty line.

Medicare

The bill would also take Medicare away from people with lawful immigration status. Medicare is an earned benefit, meaning that only people who themselves (or whose spouses) have worked in the U.S. for at least 40 quarters — ten years — qualify. Currently, lawfully present immigrants who meet this work history test as well as other program requirements are eligible for Medicare. The House bill would restrict access so that only citizens, LPRs, certain Cuban parolees, and people residing in the U.S. from COFA nations would be eligible. As a result, people with TPS as well as refugees, those granted asylum, and certain survivors of domestic violence, labor or sex trafficking, and other serious crimes, among others, would be stripped of Medicare eligibility.

While many refugees and asylees ultimately convert to LPR status, some are unable to due to health or other limitations. People with TPS, a long-standing form of immigration relief that administrations from both parties have used to enable people in humanitarian need to live and work lawfully in the U.S., generally have no pathway to LPR status. They may therefore pay Medicare payroll taxes for years into a system they will never benefit from, subsidizing U.S. citizens and LPRs while being left with no health coverage when they need it.

Penalizing States That Provide Health Coverage to Certain Immigrants

The House bill would levy severe penalties on states that have adopted the Medicaid expansion under the ACA if the state provides certain categories of immigrants (including many who have lawful immigration statuses) with access to comprehensive health coverage, regardless of the source of funding for that coverage.

Medicaid has strict, long-standing eligibility requirements that prohibit anyone who is undocumented from enrolling and also bar many people with lawful immigration statuses from accessing coverage. A 1996 law created the “qualified alien” immigration standard to be used in determining eligibility for Medicaid; a narrow list of immigration statuses are defined as “qualified,” and many people with “qualified alien” status are only eligible for Medicaid after they have had that status for five years.

The House bill would impose a penalty on states that provide comprehensive health coverage to people who are not U.S. citizens or “qualified aliens,” even if the state solely uses its own funds or private funds to provide this coverage or the state provides coverage permitted under the federal Medicaid or CHIP programs.

States that operate programs with the following criteria would trigger a sizable penalty:

• Programs funded solely by state funds in 16 states and the District of Columbia that provide comprehensive health coverage to people who are not citizens and do not have a “qualified alien” status.
• Any comprehensive coverage (including Medicaid) to people granted humanitarian parole (and that status is granted for at least one year). This group would otherwise meet the federal immigration-related eligibility requirement for federally funded Medicaid after a five-year waiting period, but for the purposes of this penalty, the House bill excludes them from the “qualified alien” standard, meaning that states would trigger the penalty if they continued to cover this group in Medicaid.
• Potentially, Children’s Health Insurance Program (CHIP) coverage to children and pregnant adults who are “lawfully residing” in the U.S., a more generous eligibility standard than the strict “qualified alien” standard. The House-passed bill exempts states that have taken up this “lawfully residing” option (created by 2009 legislation) to provide coverage through Medicaid, but the bill language is unclear as to whether the penalty could still be levied on states that have taken up this option under CHIP.

Any state that provides comprehensive coverage to individuals described above would be penalized with a cut in its federal matching rate for covering the ACA Medicaid expansion population — an entirely different group of people — from 90 to 80 percent. This would double its state cost for the Medicaid expansion group. (See Table 1.) (For states that have not expanded Medicaid but that cover one or more of these groups, no penalty would apply.)

This policy is a direct affront to state sovereignty, placing enormous pressure on states to reduce or terminate coverage programs that their lawmakers have adopted and that they have a legal right to provide or face devastating cuts to Medicaid expansion funding. It goes beyond coercion by imposing a direct, virtually unavoidable penalty on some states. New York, for example, is required under its state constitution to provide health coverage to certain individuals who do not have a “qualified alien” status.^[6]

The bill would also result in unequal treatment among the states. For example, states that have not taken up the Medicaid expansion, including Florida and Georgia, would not be penalized for taking up the CHIP “lawfully residing” coverage option, while states that have expanded Medicaid, such as Pennsylvania and Virginia, would lose significant federal funding for continuing their CHIP “lawfully residing” options.

Taking Away the Child Tax Credit

The bill would strip 4.5 million children who are U.S. citizens or lawful permanent residents of eligibility for the Child Tax Credit if even one of their parents files taxes without a Social Security number (SSN), according to estimates by the Center for Migration Studies.^[7] (In married-couple families, both parents would need an SSN; in single-parent families, just the parent claiming the child would need an SSN.) While these children would be eligible for the $500 Credit for Other Dependents, which the 2017 tax law created for certain dependents who don’t qualify for the Child Tax Credit, families with low incomes who do not have tax liability don’t receive it. Research shows that children in low-income families that receive income supports like the Child Tax Credit have better health and educational outcomes during childhood, as well as higher earnings as adults.^[8]

Around 1 million children are already denied eligibility for the Child Tax Credit under current law because they do not have an SSN. The bill would go much further by denying the credit to children who are U.S. citizens and lawful permanent residents who live in immigrant families.^[9] Note that the bill even takes the credit away from a child who has one U.S. citizen parent, even if the other parent is lawfully residing in the U.S. but does not have an SSN. (This would happen if the second parent had a student visa, for example.)

The bill also contains a number of other anti-immigrant tax provisions. It imposes a 3.5 percent tax on remittances sent abroad by immigrants, while exempting citizens who undertake the same activity; it requires an SSN to claim new tax incentives in the bill, such as the “no tax on tips”; and it denies the American Opportunity Tax Credit and Lifelong Learning Credit to people without an SSN. These unprecedented restrictions on tax code benefits based solely on a person’s immigration status create a higher effective tax rate for people who are following the law and filing their taxes using an ITIN.

Taking Away Food Assistance

The bill would take away food assistance under the Supplemental Nutrition Assistance Program (SNAP) from refugees, people approved for asylum, and other people living in the U.S. lawfully, including certain immigrants who are victims of domestic violence (as well as their children and/or parents) and certain survivors of labor or sex trafficking.

People without a documented immigration status have never been eligible for SNAP, and many people with lawful immigration statuses are already ineligible for SNAP due to program restrictions enacted in 1996. The House bill would go much further, leaving only citizens, lawful permanent residents (after a five-year waiting period for adults), certain Cuban parolees, and COFA migrants eligible for SNAP. All other “qualified aliens” would be denied access to SNAP.

The people who would be cut off SNAP by this provision are primarily refugees and individuals who have been granted asylum, as well as people granted withholding of removal^[10] — people who have fled their homes seeking safety from persecution and violence and have been heavily vetted by the U.S. government to be granted this humanitarian relief. Congress has previously exempted these immigrants from the five-year bar. In 2023, according to program data, 434,000 refugees, people granted asylum, and individuals granted withholding of removal received SNAP. While these immigrants represented only 1.1 percent of SNAP participants nationwide, they were a much greater share in a small handful of states. For example, in Florida and Nebraska they represented roughly 5 to 6 percent of SNAP participants. (Table 2 shows how many refugees and people granted asylum or withholding of removal participated in SNAP in each state in fiscal year 2023.) Roughly 105,000 of these individuals were children and 58,000 were older adults (60 or older) or adults (18-59) who had a disability.^[11] (See Table 3.)

Additionally, we estimate that more than 209,000 other eligible immigrants who were not LPRs — nearly all of whom would lose eligibility for SNAP — participated in the program in 2023.^[12] Of these other eligible immigrants, 64,000 were children and 44,000 were adults 60 or older or who had a disability. (See Table 3.) These other immigrants include certain survivors of domestic violence (as well as their children and parents) and certain survivors of labor or sex trafficking. Many people fleeing war in Afghanistan and Ukraine would also lose eligibility for SNAP, as would other people granted humanitarian parole (if they met a five-year waiting period, as applicable). Additionally, some Afghans and Iraqis who assisted the U.S. during wartime, at grave risk to their own safety, would be excluded.

In addition to the direct harm to immigrants who would lose SNAP eligibility, this provision would also impact U.S. citizen children who live with them. While these U.S. citizen children would generally remain eligible for SNAP, excluding their immigrant household members means they would receive a dramatically reduced benefit level that would not allow the family to afford the groceries they need. In total, we estimate about 98,000 U.S. citizen children lived in SNAP households with immigrants who would lose SNAP eligibility in fiscal year 2023. (See Table 3.)

The Congressional Budget Office (CBO) estimates the House bill provision would take food assistance away from between 120,000 and 250,000 people over the next ten years.^[13] Roughly 50,000 of the immigrants losing their eligibility for SNAP would be children, we estimate, putting them at greater risk of food insecurity and significant harm to their long-term health and cognitive development.

Under CBO’s projections, this provision would result in deeper cuts in the near term, with the largest cut occurring in 2027.^[14] This is likely because many, though not all, people in these statuses have a path to apply for LPR status after a certain period of time. Doing so would restore their eligibility for food assistance as long as they continue to meet the SNAP’s other eligibility criteria. However, adjustment of status is often a lengthy process, and earlier this year, the Trump Administration suspended processing of LPR applications from refugees and people granted asylum. While the Department of Homeland Security has described this as a “temporary pause,” this could leave many of the individuals losing SNAP eligibility without a timely pathway to a status that would restore their eligibility for food assistance.^[15]

Additionally, CBO may be assuming that fewer immigrants in these categories will be admitted in the coming years. The U.S. is currently admitting fewer refugees and making it more difficult for people to apply for asylum, reducing the number of people who would otherwise have been eligible for SNAP.