Defunding Healthcare: Legal Immigrants Lose Rights
Edited by Adriana Garcia
One HUGE Bill.
On July 4, 2025, President Donald Trump signed a federal tax and spending law with sweeping impacts across Medicaid, the Affordable Care Act (ACA), and food assistance programs, while redefining American immigration policy at large (“One Big Beautiful Bill: Law Summary”). H.R. 1, otherwise known as the “One Big Beautiful Bill Act” (OBBBA), represents a historic restructuring of federal fiscal policy, combining extensive tax extensions with extreme reductions to the social safety net (“H.R. 1—One Big Beautiful Bill Act”). The National Taxpayers Union Foundation describes the law as a way to fuel long-term economic growth (Jennings). The bill also seeks to provide financial certainty by making the 2017 individual tax cuts permanent, introducing targeted deductions for overtime, tips, and small businesses. Analyses from the NAACP Legal Defense Fund contend that the legislation disproportionately advantages high-income earners while weakening vital public programs. The Legal Defense Fund describes the One Beautiful Bill Act as “the largest cuts to food assistance, health care, education programs, and student loan services in U.S. history – while giving tax breaks to the wealthy” (“President Trump’s ‘One Big Beautiful Bill Act’”). The Congressional Budget Office estimates the bill’s health provisions will result in 11.8 million people losing health coverage by 2034, with an additional 5.1 million individuals losing health coverage due to two policy changes outside of the bill: “the final 2025 CMS marketplace rule implementing eligibility changes and the expiration of the ACA expanded premium tax credits” (“One Big Beautiful Bill: Law Summary”). The One Big Beautiful Bill Act significantly affects policies across the United States, including Medicaid.
Medicaid is a joint federal and state program that aids individuals with limited income and resources, covering their medical costs (“June 2026 Medicaid & CHIP”). While the federal government imposes general regulations, every state retains the authority to run its own Medicaid program. Medicaid covers services such as nursing home care and personal care services. Beneficiaries may only be required to pay a small co-payment or fee for services (“What’s the Difference Between Medicare and Medicaid?”). In June 2026, 73,167,389 people nationwide were enrolled in Medicaid and CHIP, as reported enrollment data for June 2026 (“June 2026 Medicaid & CHIP”). Out of these 73,167,389 individuals, 3,565,369 were enrolled in Florida (“June 2026 Medicaid & CHIP”). As a result, about 15% of Florida’s population relies on these public services.
Real Restrictions.
The One Beautiful Bill Act has implemented new and restrictive eligibility requirements that will affect the vulnerable populations who depend on Medicaid. Starting on October first, 2026, some immigrants such as “refugees, asylees (individuals who fled their country for safety), parolees (individuals allowed into the U.S. for temporary stay), and survivors of domestic violence or human trafficking” might see a change in their health coverage due to federal funding cuts to Medicaid (“Stay Covered”). Beginning in 2027, H.R. 1 will extend these restrictions to the Affordable Care Act plan, restricting eligibility for ACA’s premium tax credits, and Medicare eligibility for certain immigration categories (“President Trump’s ‘One Big Beautiful Bill Act’”). The exact number of individuals who lose coverage will ultimately depend on the law’s implementation, individual eligibility circumstances, and the availability of other coverage options. The Congressional Budget Office estimates about 1 million lawfully present immigrants will lose eligibility for government subsidies to buy individual health coverage on Affordable Care Act marketplaces by 2034 (Galewitz et al.). Additionally, the Congressional Budget Office estimates that approximately 100,000 lawfully present immigrants throughout the country will also lose access to Medicare (Lipschutz). The Miami Herald reported that an estimated 177,000 immigrants in Florida could be affected by the Medicaid eligibility changes (Galewitz et al.).
An important distinction exists between lawful and unlawful immigration status. Undocumented immigrants, even before the issuing of H.R. 1, were generally ineligible to enroll in federally funded coverage, including Medicaid, CHIP, or Medicare (Artiga et al.). Now, as a result of these restrictions, even legal immigrants residing in the U.S. may become ineligible for particular public benefits due to federal or state requirements. While losing Medicaid eligibility does not mean losing lawful immigration status, the changes affect access to a specific form of government assistance. The Miami Herald interviewed Ahin, a Syrian refugee who immigrated to the U.S. in October 2024. Ahin developed severe abdominal pain that required intestinal surgery. The surgery and related medical expenses were covered by Medicaid. Ahin explained, “I came here to live a better life,” and followed up by stating, “It’s truly a terrible situation” (Galewitz et al.). She would be one of many legal immigrants seeking asylum in the U.S. who could lose insurance coverage, potentially disrupting their recovery. Uninsured patients may have fewer opportunities to receive preventive care or manage chronic conditions through regular appointments. Some may delay treatment because of cost or may seek medical attention only when their conditions become life-threatening. Healthcare providers may also face additional financial pressure when they treat uninsured patients who cannot pay their medical bills.
The Cost of Coverage.
Losing health coverage may make it more difficult for affected immigrants to afford physician visits, prescription medications, and other essential medical services. While these immigrants could still qualify for Emergency Medicaid, the state numbers suggest hundreds of thousands of immigrants nationally are at imminent risk of becoming uninsured (Galewitz et al.). Significant concerns are growing that the proposed termination process may not provide adequate due process, particularly because the proposal does not specify an expedited appeals process. Administrative errors involving immigration documentation, outdated records, or incorrect eligibility determinations could result in individuals losing coverage even when they may believe they are eligible.
In Florida, with 177,000 impacted immigrants, these restrictions could lead to medical debt and a lack of access to health care, which would impact immigrants, families, healthcare providers, immigration law, and communities at large (Galewitz et al.). As these changes take effect, accurate public information in tandem with clear eligibility procedures will be essential in helping residents understand their options. The debate surrounding Medicaid extends beyond federal spending to encompass access to medical treatment and broader implications regarding immigration policy in the United States.