Exploring the Republican assertion that the shutdown is so the Democrats can give health care to undocumented immigrants
With quantities of dollars and people
This is my first post.
I’m trying substack out as a way to make an occasional comment about the U.S. Health Insurance system on issues that I think are not being covered clearly enough in other accessible places, or just aren’t being said at all.
I expect to have only occasional things to post, and I don’t intend on any sort of paid subscription option.
The Issue:
We are now about 2 weeks in to the government shutdown, with the Democrats trying to get both an extension (they’d really like to make it permanent) of the ACA expanded subsidies for on-exchange plans, as well as reversals of the various cutbacks in the Medicaid / ACA-expanded-Medicaid system that the Republicans put in that “Big Beautiful Bill” of a few months ago.
The Republican “talking point”, where the Republicans assert the shutdown is so the Democrats can give health care to undocumented immigrants, we have examples of:
Vance, (in response to a question from a reporter?/shill?) , Republican Congressperson
Using some readily-available sources, and using in part a White House post (and actually we’ll see some interesting input from Dr. Oz on Fox via youtube as well), we can explore the issue. In numbers of people, and dollars. (The explanation will cover the 2 items that Vance brought up in his handling of the “talking point” above, a few minutes into where that video starts.)
So, in dollars, what the Democrats are trying to get back, the amount is about $1.5 trillion over 10 years, to to be applied as I indicated above. (Note: in earlier versions of this post, I used $ 1 trillion, based on the NY Times reported number, more than $1 trillion . ( From this NY Times article .) However, subsequently I have seen $1.5 trillion, and this is also the number the Republicans are using.
Now, unfortunately the news sources get a little sloppy, and leave off the unit of time. So I have to clarify it’s $1.5 trillion over the next 10 years. Not one year.
It’s not needed to address the Republican claim, but to make sure everyone is oriented about how much money it is, $1.5 trillion in 10 years is $150 billion a year. An important trick is to get rough per capita per year for the U.S., you multiply the number of billions by 3, so it’s about $450 per person per year. (U.S per capita annual GDP is something like $87,000; total health spending is about 18% of that, which is around $15,000 a year, spent by employers, governments, and individuals.)
So the claim, “talking point”, I guess they call it, was the Democrats were shutting the government to fund health care for undocumented immigrants.
If you trace that, federal funding for healthcare for undocumented, “not-legally-present” people, through the ACA or Medicaid or any federal source, is prohibited, with one exception: emergency medical.
A few states, like California, do fund, on their own, non-emergency care for undocumented immigrants. (In California, it’s through the Medi-Cal program.) But its illegal for a state to use federal funds for that. (If there were widespread violations of this legal requirement, so many people are involved that someone would blab, and we’d all find out about it.)
The “illegals” in question, only in a very forced sense: If you check around (I used this factcheck ), there are some immigrants that Republicans were calling or thinking of as “illegal”.
Specifically, it seems to be 2.8 million people who otherwise would have been undocumented, that Biden did grant “parole” to. Parole, factcheck reports, is a legal permission granted to noncitizens to temporarily live in the U.S. for “urgent humanitarian or significant public benefit reasons.” Biden did extend parole to 2.8 million immigrants from countries such as Cuba, Haiti, Nicaragua and Venezuela (all of which has been reversed by Trump).
So, the 2.8 million, who had this “legally-present” status, could get ACA on-exchange or Medicaid or other federally-funded coverage, if they otherwise qualified. (Right now, with Trump’s reversal, they can’t. But that reversal might not hold in court. So maybe later on they can again.)
Now, 1.2 million of those 2.8 million actually did get the coverage or subsidies.
That’s about the full case the Republican have. The funding for 1.2 million people who were “legally present”, but they consider really “undocumented”.
Quantities:
People. 1.2 million really “undocumented” by Republican thinking, rather forced, for whom the Federal government pays for some or all of health care.
Predictions are around 20 million total (mostly legally here, including citizens, green card holders) will gradually lose coverage. (Source: plot within here.)
People Bottom Line:
So, in people count, 1.2 million of 20 million. If you think of them as “undocumented” rather than “legally present”, that’s about 6%.
There’s also a lot of people who are going to be really financially hurt with the return of the 400% of Federal Poverty Level “subsidy cliff”, not uncommonly having to pay 20% or more for health insurance premiums, even if they can manage to keep their insurance. (You can figure that out from some of the maps here , and you may want to poke around the link at the end of that article, or healthcare.gov, to explore further. If you use healthcare.gov, remember that people over 400% of FPL, which is, say for a couple, about $86,000 a year, get no subsidy if the Republicans have their way. Try a 62 old couple. It will vary by state. Laramie County, Wyoming, I know has very high premiums for a couple, aged 62. And many other places.)
Dollars: Now, let’s do dollar cost to the federal government.
We can go to POTUS. They posted this in the last few weeks to back up of their talking point. (I used a Wayback Machine archive copy, rather than the White House site, in case they take it down or change it. But, as of this writing, the White House version is still up.)
So we got:
71109 Ending Medicaid Funding for Most Non-Citizens $6,211
71110 Ending Enhanced FMAP for Emergency Care to Illegal Immigrants $28,200
71117 Closing the California Loophole $34,606
71201 Ending Medicare Funding for Most Non-Citizens $5,096
71302 Ending Obamacare Funding for Most Non-Citizens $91,400
71302 Repealing the Obamacare “Special Rule” for Immigrants $27,300
Total $192,813
(This is all in millions of dollars over 10 years, or, if you ignore each after the comma, it’s billions of dollars over 10 years.)
A little aside: you might note the White House post and its table (extracted above) is different from the talking point in that to fund health care for “illegal immigrants” has been changed to for “non-citizens” or just for “immigrants” (except in item 2). (Must be a lawyer did this, or someone with some kind of sense of what’s true and what’s not true.)
Back to the numbers: If it were all valid, it would be $ 192 billion of more than a $ 1.5 trillion. Which is under 13%.
But only the first, fourth, and fifth items are potentially for those 1.2 million people. (It would be on Medicaid, Medicare, and ACA on-exchange subsidized plans.)
Item number 2 is for emergency care, which is indeed a federal reimbursement to states for undocumented immigrants. But, if a person is having a heart attack or stroke, or would die if untreated from a bacterial infection, are we supposed to not treat them until they show a birth certificate, green card, or passport? If they happen to speak with an accent? (And what if you had an emergency in another country where you didn’t have insurance arrangements? What would you like them to do?)
(Not to mention that the Federal ENTALA law, passed under Reagan, requires they be treated immediately without checking any paperwork.)
Number 3, the California loophole, is a thing where states do sort of cheat on Medicaid a bit, to raise their federal reimbursements from the state-dependent 50% or so that it would typically be, by the state allowing hospitals higher charges to Medicaid than they would otherwise allow, and then taxing the hospitals a bit on what the hospitals get from Medicaid as kind of a little kickback. (It lowers the share that the state pays a little, and increases the Federal share by that same amount.) It has nothing to do with any immigrants. It’s an abuse, and I recall reading in the Times that actually it’s a bit more severe in some Republican states. But, critical thinking of much of the people being what it is, they call it the “California loophole”, and that will take care of it.
Number 6, the ‘Obamacare “Special Rule” for Immigrants’ (“special good treatment for immigrants” in some talking points — that really inflames a lot of people) is that the ACA, cobbled together from pieces of the existing system, can’t give ACA expanded Medicaid to many fully-legal immigrants until 5 they have been here for 5 years. This is because of a prior-to-ACA provision in Medicaid rules. So it uses the ACA exchanges for them, if their income is below 138% of the Federal Poverty Level.
(Normally, if not recent immigrants, being below 138% of FPL they would get expanded Medicaid.) (Detail: unfortunately, about 10 Republican states still haven’t expanded Medicaid, even though 90% of the cost is borne by the federal government. So, in those states, citizens below 100% of the Federal Poverty Level don’t get any health coverage unless their dirt poor in both assets and income and qualify for old pre-ACA Medicaid. Legal immigrants do. If the citizens in those 10 states are worse off than legal immigrants, it’s because the Republican states don’t care enough about their own citizens to pick up 10% of the cost.)
Dollars Bottom Line:
So, bottom line, in dollars, only if you count the 1.2 million “Biden-made legally present” that the Republicans orally called “illegal”, it would be like about $ 100 billion of over $1500 billion. Less than 7%. (And it would be about 0% if you don’t count them.)
What About Dr. Oz? You said we would be hearing from Dr. Oz.
We’ll stay in dollars.
Dr. Oz on Fox via youtube just reported a “shocking investigation” showing a bunch of criminal illegal immigrants received a billion dollars of treatment from Medicaid.
Now, it’s really very unclear what kind of money they got. (He’s very fuzzy on details, and I couldn’t find any backup in writing on the web.) If it’s even anything federally funded that’s not emergency treatment.
Bottom Line Dr. Oz: It’s a billion dollars. At issue is over 1.5 trillion dollars that the Democrats want to restore. So, even if it were all true non-emergency Medicaid federally-funded dollars, it would be 7/100 of 1 percent. (0.07% or one fifteen thousandth.)
We can guess what Dr. Oz thinks about the critical thinking skills of his audience!
Update a day later: I posted a bit more in details, and looking really hard to find any additional elements of truth in the Republican talking point, here.