Trump wants Harris to pay a political price for generous health care policies for immigrants

Joanna Kenen

Maria Sanchez immigrated to the Chicago area from Mexico about 30 years ago. He is now 87 years old and still lives in the US without permission. Like many long-time immigrants, she worked and paid taxes, including Medicare taxes, all this time.

However, Sanchez never had health insurance, and when she turned 65, she was unable to enroll in Medicare. She has never received any preventive measures or screening tests. No physical activities. No cholesterol tests. No mammograms.

“Nada, nada, nada,” she said in an interview conducted in Spanish. Nothing, nothing, nothing.

When she did get sick, she delayed seeking help until she felt so bad that she was hospitalized twice with pneumonia. Last year, she finally became covered under Illinois’ groundbreaking program for undocumented seniors, which went into effect in December 2020.

Democratic-led states like Illinois are increasingly opening public insurance programs to immigrants without permanent legal status. A dozen were already protecting children; even more provided prenatal protection. But now more states are providing insurance to adults living in the country without authorization, and some are phasing in coverage for seniors, who are more expensive and a tougher political sell than children.

The expansions take into account the costs that patients living here illegally could otherwise impose on hospitals. But the policy has come under fierce attack from former President Donald Trump and other Republicans, who are seeking to put his opponent, Vice President Kamala Harris, on the line for reckless immigration policies.

Republicans point to Harris’ home state of California expanding Medi-Cal coverage to immigrants of all ages, regardless of legal status, claiming it is at the expense of American citizens.

This is a standard complaint about Trump. “She’s going to go around saying, ‘Oh, Trump is going to do bad things to Social Security,'” he said of Harris during Press conference on September 13. “No, she will do that because she puts these illegal immigrants on Social Security and Medicare, and she will destroy those programs and people will have to pay.”

Harris’ selection of Minnesota Gov. Tim Walz as her running mate added fuel to Republican attacks on the intersection of immigration and health care policy.

Under the bill signed by Walz, immigrants living in Minnesota without authorization will be able to obtain health insurance through the state starting next year. MinnesotaCare program for low-income people who do not qualify for Medicaid.

This issue is most important to some Americans. At October 10 town hall in Las Vegas, an audience host for the event, identified by Univision as Ivett Castillo, asked Harris what her administration would do about health care for people like her mother, who immigrated from Mexico without authorization many years ago, worked her entire life and died in that year, never receiving “the type of care and services she needed or deserved.”

“What are your plans or plans to support this subset of immigrants who have been here all or most of their lives and have to live and die in the shadows?” – Castillo asked.

Harris noted that she has in the past supported a path to citizenship for unauthorized residents and the bipartisan Border Security Act, which Senate Republicans killed earlier this year on Trump’s orders.

“This is one example of the fact that there are real people who suffer from an inability to put solutions above politics,” Harris said.

Even without such policies, immigrants can get free or low-cost primary care at community clinics across the country – as long as they know it’s available and feel safe there. However, primary care cannot meet all medical needs, especially as people age and develop more complex health problems and chronic diseases. That’s why immigrants often rely on charity, fall into debt or, like Sanchez, skimp. Some even return to their home countries for care.

Illinois, where Sanchez was covered, was a pioneer in expanding coverage to unauthorized immigrants. Now, six states and the District of Columbia – all led by Democrats – include at least some older, low-income immigrants under waivers from Medicaid or the Affordable Care Act. Minnesota will become seventh next year. State funds must be used for expansion because federal dollars generally do not cover costs for people without legal status.

Time will tell whether and how quickly more states will follow suit, and if Trump wins the White House, his administration will likely try to thwart this trend, given that announced mass deportations. Covering all immigrants is still economically and politically difficult, and the non-citizen population cannot express their gratitude at the ballot box. Immigrant health initiatives in several other states have expired or been reduced.

Maryland, for example, has decided to open its Obamacare exchange to people living in the state without a permit starting in 2026 — but without taxpayer subsidies for premiums.

Still, there’s enough activity in the states to make immigrant health advocates believe something has changed. The severity of the pandemic and its uneven toll have helped build support for care for older immigrants, said Lee Che Leong, senior policy advocate at Northwest Health Law Advocates in Washington state.

“People are looking around and realizing that our health is interconnected, both globally and locally,” Leong said. “The pandemic has really brought that home when you look at the disparities in who got sick from covid, who was exposed to covid and who died from covid.”

Access to U.S. health care has long been an obstacle for immigrants, even those in the country legally. Green card holders must wait five years to be covered by Medicaid or other government health programs. Some older green card holders must pay additional premiums for Medicare Part A – the part that covers hospital care – if they have not been employed in the US for at least 10 years

New state health programs fill those gaps, said Shelby Gonzales, vice president for immigration policy at the Center on Budget and Policy Priorities.

In July, Washington state began covering low-income immigrants in a Medicaid-like program called Apple Health Expansion, using a federal waiver. Enrollment is limited and the program fills up quickly, but some spots are reserved for people 65 and older, Leong said. Earlier this year, the state opened the Obamacare exchange program to immigrants living in the U.S. without authorization.

Oregon and Colorado also now offer some protections in their states to people without legal status, although Colorado’s program has not attracted many older immigrants, according to data recently presented to the committee overseeing the replacement of the state’s Affordable Care Act.

New York has provided care to undocumented immigrant children for years, and in January the state’s Medicaid program opened to all adult immigrants regardless of status. According to New York’s Medicaid director, Amir Bassiri, about 25,000 people signed up in the first four months.

Back in Illinois, Maria Sanchez found her new coverage life-changing and perhaps even saving. Her bouts of pneumonia were severe, partly because she delayed care. After the second hospitalization, she required further cardiological care. The hospital did not charge her any fees for her stay.

But now, with hertarjeta medica” – her medical card – she can see a doctor. Her heart condition is under control. She saw the dentist. He is undergoing cataract removal.

“Thanks to my medical card, I have peace of mind,” Sanchez said.

Illinois gradually expanded coverage for other age groups; in the summer of 2022, eligibility was reduced to age 42. This means immigrants like Gaby Piceno, 45, can age healthier.

“I don’t have to worry anymore,” she said, referring not only to herself but also to her family.

But expanding coverage cost more than Illinois anticipated. People like Sanchez and Piceno, who are already on the list, are still in the program, but new registrations have been suspended this year. More people than expected signed up, and many still sought care in more expensive hospital emergency departments rather than doctors’ offices, said state Insurance Commissioner Ann Gillespie, who was an Illinois senator when the program was established.

The state is moving currently covered immigrants to Medicaid managed care plans, hoping that will lower costs over time.