Over the course of the six-week shutdown — which may be ending soon — President Donald Trump has repeatedly made the false claim that Democrats “want $1.5 trillion for health care for illegal aliens.”
The $1.5 trillion is the total estimated cost over 10 years of the spending bill that Democrats had put forward at the beginning of the shutdown. As we’ve written before, Democrats have sought an extension of enhanced Affordable Care Act subsidies and a repeal of some health care measures concerning Medicaid in the One Big Beautiful Bill Act, among other funding.
Democrats also want to restore health care for “lawfully present” immigrants affected by the OBBBA.
Lawmakers are closing in on a deal to end the government shutdown, with the Senate passing a procedural vote on Nov. 9. The shutdown began on Oct. 1.
Trump has made the claim about the $1.5 trillion many times. For example, Trump said in an Oct. 19 interview with Fox News’ Maria Bartiromo, “They want $1.5 trillion for health care for illegal aliens that come into our country.” In his Nov. 2 “60 Minutes” interview, the president said the money would go to “prisoners and drug dealers” and people “that came into our country from mental institutions.” On Nov. 7, he again said, “We’re not going to give $1.5 trillion to people that came into our country illegally.”
That claim is “totally false,” Leonardo Cuello, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families, told us in a phone interview.
“The legislation being advocated by Democrats as requisite to reopen government would be around $1.5 trillion over 10 years but the large majority of that is not due to immigration, especially ‘illegal aliens,'” Kent Smetters, faculty director of the Penn Wharton Budget Model, told us in an email.
“In fact,” he said, “the current spending on undocumented workers every year is less than $5 billion, mostly due to emergency-only care that is not reimbursed and, therefore, absorbed by Medicaid. These services cover labor and delivery, trauma, and other urgent conditions.”
Under federal law, hospitals are required to provide emergency medical care to people regardless of their immigration status.
Before Trump started making the false claim in mid-October that Democrats wanted to spend $1.5 trillion on health care for “illegal aliens,” the White House had released a memo claiming that the Democrats’ proposal “would result in nearly $200 billion spent on healthcare for illegal immigrants and other non-citizens over the next decade.”
That’s misleading, but the reference to “non-citizens” is defensible.
That claim is mostly based on the Democratic proposal to repeal portions of the OBBBA — recently rebranded by the Trump administration as the Working Families Tax Cut Act. Some of those provisions pertain to immigrants who are “lawfully present.” The term refers to noncitizens with “qualified” immigration status that makes them eligible for Medicaid or the Children’s Health Insurance Program, as the health policy organization KFF explains. This includes lawful permanent residents, refugees, parolees, and individuals granted asylum, among others.
Julia Gelatt, associate director of U.S. immigration policy at the nonpartisan Migration Policy Institute, told us for an earlier article that the term “lawfully present” is “not a category fully defined in immigration law” and is “a politically contested categorization.”
The OBBBA changed the criteria for Medicaid enrollment to exclude those granted asylum and parolees.
But those provisions don’t affect access for people illegally in the country, Cuello told us. Immigrants living in the country illegally are prohibited by law from receiving federally funded comprehensive coverage.
Whether the health care changes in the OBBBA are repealed or not, “it makes no change to coverage of undocumented immigrants,” Cuello said.
The OBBBA also limited the federal matching funds used to reimburse hospitals that provide emergency care to immigrants. Democrats proposed repealing that. This provision “is at least related to undocumented immigrants, but it does not actually impact coverage,” Cuello explained in an Oct. 2 blog post. “[H]ospitals must still provide the health care, and states must still pay them for the health care, it’s just that the federal government will pay a smaller share of the cost.”
When we asked the White House for evidence to support the president’s claim, spokeswoman Abigail Jackson first sent links to the memo tallying almost $200 billion — $193 billion — for “healthcare for illegal immigrants and other non-citizens.”
When asked about the president’s claim of $1.5 trillion, though, Jackson said, “President Trump is right — rather than support the bipartisan CR they supported 13 times during the Biden Administration, Democrats proposed a $1.5 trillion CR to provide free health care to illegal aliens. This absurdly partisan ploy is why Americans are now missing out on paychecks and benefits. Democrats should reopen the government immediately.”
But, as we said, the $1.5 trillion is the 10-year total of the entire funding bill.
“The original [White House] value of $193 billion is certainly reasonable as it applies to legal immigration,” Smetters said. “The $1.5 trillion is incorrect as applied to any type of immigration, legal or not.”
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