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WASHINGTON — Republicans are screaming that Democrats just shut down the government because they want free health care for “illegal aliens.”
As the White House put it after Democrats blocked a Senate vote on a funding bill Tuesday, “Democrats put the needs of Illegal Aliens over every American.”
It’s a wildly misleading description of Democrats’ position — and it shows Republicans are worried Democrats will beat them in the messaging battle over the shutdown.
Democrats refused to support a “clean” Republican bill that would have funded the government into November amid intense pressure from their progressive base not to cooperate with Republicans and the Trump administration. It was an unusual move for Democrats, who in the past have insisted the government remain open.
In early September, groups like Indivisible urged Democrats to make clear demands as a condition for supporting a funding bill. Democrats settled on health care — an issue on which they have a sizable polling advantage over Republicans.
“In an environment where the cost of living is already too high, our position is a simple one: Cancel the cuts, lower the costs, save health care,” House Democratic leader Hakeem Jeffries (D-N.Y.) said Tuesday. “We’re willing and able to find a bipartisan path forward to fund the government in a way that actually meets the needs of the American people in terms of their health, their safety and their economic wellbeing.”
Democrats’ official position in the shutdown standoff, as laid out in an alternate funding bill, calls for undoing the $1 trillion in Medicaid cuts Republicans enacted earlier this year, plus extending subsidies for middle-class Americans who buy health insurance from Affordable Care Act exchanges.
Democrats have signaled that the latter item, the Obamacare subsidies, is their main demand. Republicans have said they are open to negotiating an extension, while insisting it’s not appropriate to do so as part of the broader funding fight. It’s unlikely they would ever support undoing the Medicaid cuts, which they used to pay for a small portion of the $4 trillion in tax cuts in their signature legislative achievement this year, the so-called One Big Beautiful Bill.
It’s because of the “cancel the cuts” demand that Republicans say Democrats want health care for undocumented immigrants. Even though undocumented immigrants have long been ineligible for Medicaid, the new law reduced funding for “emergency Medicaid.” The program reimburses hospitals for emergency services for patients who would otherwise be eligible for Medicaid but aren’t because of their immigration status, whether they’re undocumented, have parole status, are lawfully present on a temporary basis or are lawfully present but in a five-year waiting period.
Vice President JD Vance offered the clearest explanation of the Republican talking point on Wednesday morning, though it was not entirely accurate.
“A lot of emergency health care at hospitals that are provided to illegal aliens, that was funded by the federal government,” Vance said. “We turned off that funding because, of course, we want American citizens to benefit from those hospital services, not to be taxed, and then to have those hospital services go to illegal aliens.”
Vance overstated what the law does — it reduces, rather than eliminates, federal funding for emergency Medicaid, in some states. In its evaluation of the Republican legislation, the Congressional Budget Office said the provision would save $28 billion over a decade, amounting to about 2% of its Medicaid savings.
The CBO has previously said it can’t tell how much of the $19 billion in emergency Medicaid spending from 2017 through 2023 actually went to “illegal aliens,” but the overall sum amounts to 1% of Medicaid spending during that time period.
Anthony Wright, director of Families USA, a progressive health care advocacy group and think tank, noted that hospitals are required by law to provide access to emergency services regardless of a patient’s ability to pay and regardless of whether they have papers.
“This issue is about whether emergency rooms get reimbursed, not whether undocumented immigrants get coverage or not,” Wright told HuffPost. “It is a way to reimburse emergency rooms, to help make them whole and keep them open.”
The law also blocked Medicaid spending and Affordable Care Act subsidies to certain legal immigrants, including people on work visas, which the CBO estimated would reduce the number of lawful immigrants with insurance coverage by 1.4 million.
“President Trump and congressional Republicans turned off that money to health care funding for illegal aliens,” Vance said, referring to immigrants who gained legal status during the Joe Biden administration.
Overall, the One Big Beautiful Bill Act, as it was called, is expected to boost the uninsured population by 10 million. Democrats say the Medicaid cut, combined with the premium tax credits expiring at the end of the year for 22 million more, amounts to a Republican-caused health care crisis.
So far, Republicans aren’t decisively winning the public opinion battle over the shutdown, with 38% of voters blaming Republicans and 27% blaming Democrats in one recent survey. Democrats have staged frequent press conferences and given many interviews talking about health care as the reason for the impasse.
“Donald Trump and Republicans have shut the government down because they don’t want to provide health care to working-class Americans,” Jeffries said Wednesday. “Federal law prohibits the use of Medicare, Medicaid, the Children’s Health Insurance Program and the Affordable Care Act to provide health insurance in any way, shape or form to undocumented immigrants. Period. Full stop. That’s the law. And Democrats aren’t trying to change that.”