Experts: Immigrants' health care claim false

The failed negotiations in Congress that triggered the government shutdown Wednesday hinged on federal subsidies that have helped millions of Americans afford health insurance - and on Republicans' false claims about whether immigrants are eligible for those benefits.

The subsidies, known as enhanced premium tax credits, have helped to lower or offset premiums for Affordable Care Act plans but are set to expire at the end of the year.

President Donald Trump and Republicans in Congress have falsely claimed that Democrats want to offer the subsidies to immigrants living in the country without legal permission. Vice President JD Vance said on social media that Democrats were demanding health care for "illegal aliens."

Immigrants living in the U.S. without legal permission have never been eligible for federally-funded health insurance, including ACA plans or the enhanced premium tax credits, health policy experts told the Houston Chronicle. And Democrats' proposal to extend the subsidies does not include any health care for immigrants living in the U.S. illegally.

"People who lack legal status in the U.S. have never been eligible for marketplace coverage or tax credits, and there's nothing different about that now," said Katherine Hempstead, a senior policy officer at the Robert Wood Johnson Foundation.

Democrats have pushed back on Republicans' claims, with Senate Minority Leader Chuck Schumer calling them "a lie." Democratic lawmakers want to undo some provisions, including Medicaid cuts, in the so-called "One Big Beautiful Bill" that Congress passed this summer.

The new law restricts certain lawfully present immigrants, such as refugees and people who have been granted asylum, from enrolling in federally-funded health insurance or receiving subsidies for ACA plans.

In Texas alone, an additional 2 million people have signed up for ACA health insurance plans since the enhanced premium tax credits were created, said Lynn Cowles, the health and food justice director at the nonprofit Every Texan. She said Republicans should vote to extend the subsidies, and stop making "bogus" claims about who is benefiting from them.

"The big picture here is that this policy, the enhanced tax credits, makes health care more affordable for everybody," Cowles said. "And this is just a clear misrepresentation of who's getting tax credits and why they're important."

Here's what to know about the subsidies, who is eligible for them and the fight over health care.

Special tax credit

Congress created the enhanced premium tax credits in 2021 through the American Rescue Plan Act, commonly known as the COVID-19 stimulus package. Lawmakers extended them in 2022 through the Inflation Reduction Act.

The nonprofit health policy organization KFF estimates the tax credits have resulted in 22 million Americans saving an average of $705 per year on ACA health insurance.

Enrollment in the ACA marketplace has more than doubled since 2020, to more than 24 million enrollees this year. Enrollment has also doubled in Texas, to nearly 4 million in 2025.

The tax credits are set to expire at the end of the year. If they do, the Congressional Budget Office has estimated the higher cost of premiums could lead to an additional 4.2 million Americans becoming uninsured by 2034.

Health policy experts have also said there is urgency for lawmakers to act before the ACA marketplace's open enrollment period begins Nov. 1, or Americans could see higher prices when they go to sign up for health insurance.

Who has benefited?

Small business owners, small business employees and self-employed individuals account for roughly half of ACA enrollees, Hempstead said. The ACA marketplace can also be an important resource for students, early retirees, farmers and freelancers.

"The individual market is there for people who don't get an offer of coverage from a job, and don't qualify for Medicare or Medicaid," Hempstead said.

A KFF analysis estimated that 48% of ACA enrollees are affiliated with a small business. For those individuals, the marketplace functions as the "main source of comprehensive health insurance outside of traditional employer coverage," according to KFF.

If the tax credits expire, ACA premiums could increase by more than 115% -- or $456 annually -- in Texas, according to a KFF estimate. Higher-income enrollees and adults nearing retirement age could see larger increases, according to the estimate.

Immigrant care

Immigrants who lack permanent legal status have limited access to health care in the United States. They are largely ineligible for programs like Medicare, Medicaid and the Children's Health Insurance Program.

Certain "qualified non-citizens" -- such as green card holders, refugees and asylees -- had been eligible for Medicaid and CHIP if they meet other eligibility criteria, such as residency requirements. But the sweeping tax breaks and spending cuts law that Congress passed earlier this year excludes certain immigrants, including refugees and asylees, from those programs.

The law also excluded certain immigrants -- including refugees, asylees, and individuals with temporary protected status -- from receiving subsidies for ACA health insurance plans.

The Congressional Budget Office determined that 1.4 million lawfully present immigrants will lose health coverage by 2034 due to the changes in the law.

Federal law does require hospitals to provide emergency medical treatment to all patients, regardless of citizenship or immigration status. That treatment is often covered by emergency Medicaid.

In Texas, immigrants who lack permanent legal status are only eligible for emergency Medicaid if they meet other eligibility criteria, such as residency requirements, according to Texas Health and Human Services.

'Sleight of hand'

During a press briefing Wednesday, Vance doubled down on the Republicans' claims and said Democrats are pulling from former President Biden's playbook.

"We all know that there are very various ways in which the Biden administration waved away illegal immigration status. They gave parolees, they gave asylum claims to people who weren't really claiming asylum," he said. "So, what the Democrats are engaging in is a sleight of hand. They're saying, 'No, no, no. Those weren't illegal aliens who were getting health care benefits' even though everybody knows they were in the country illegally."

Aaron Reichlin-Melnick, a senior fellow at the American Immigration Council, said Democrats' main goal is to restore benefits for U.S. citizens.

"The number one demand at the top of the Democrats' wish list is Affordable Care Act subsidies. And that is completely unrelated to immigration," he said.

Reichlin-Melnick said Republicans could be crafting their messaging due to two large groups of immigrants who came in under the Biden administration. Cubans and Haitians were granted parole status and federal benefits for one year under a law passed in 1980.

But the Trump administration stripped the parole status of those immigrants who came in under Biden. The "Big, Beautiful Bill" kept those benefits for future Cuban and Haitian immigrants.

"All of this is to say, while Democratic demands are to restore broad cuts affecting millions of Americans, it is possible that some of those cuts affected a small population of immigrants," he said. "The Democrats' demand to reverse those (cuts) is not about those immigrants. That is an ancillary issue."

Immigration reporter Julián Aguilar contributed to this article