María Sánchez immigrated to the Chicago area from Mexico about 30 years ago. Now, at 87, he continues to live in the United States without papers. Like many long-time immigrants, they have worked — and paid taxes, including for Medicare — all that time.
But Sánchez never had health insurance, and when he turned 65, he couldn’t sign up for Medicare. He has never had preventive care or exams. She has had no physical checkups, no cholesterol measurements, or mammograms.
“Nothing, nothing, nothing,” he said.
When she became ill, she was slow to seek medical attention until she was so ill that she was hospitalized twice for pneumonia. Finally, last year he obtained coverage through a pioneering program in Illinois for undocumented seniors that went into effect in December 2020.
Democratic-led states, like Illinois, are increasingly opening public insurance programs to undocumented immigrants. A dozen already covered children; even more provided prenatal coverage. But now, they are covering adults living in the country illegally, and some are expanding coverage for seniors, who are more expensive and a bigger political challenge than children.
These expansions recognize the costs these patients can impose on hospitals. But these policies are under harsh criticism from former President Donald Trump and other Republicans, who seek to present his opponent, Vice President Kamala Harris, as the face of irresponsible immigration policies.
Republicans point to the expansion of Medi-Cal coverage in Harris’ home state of California to immigrants of all ages regardless of their legal status, arguing that this affects American citizens.
It is a frequent complaint of Trump. “She goes around saying, ‘Oh, Trump is going to do bad things with Social Security,’” he said of Harris at a Sept. 13 press conference. “No, she’s going to do it because she’s putting these illegal immigrants on Social Security, on Medicare, and she’s going to destroy those programs, and people are going to have to pay.”
Harris’ choice of Minnesota Gov. Tim Walz as her running mate has added fuel to Republican attacks at the intersection of immigration and health policy.
Hoping to portray Democratic presidential candidate Kamala Harris as extreme on immigration, former President Trump and his supporters have said she wanted to provide free, taxpayer-paid health benefits to immigrants in the country without legal permission. But this statement leaves out key details.
Under a law signed by Walz, immigrants living undocumented in Minnesota will be able to get health coverage starting next year through the state’s MinnesotaCare program for low-income people who are not eligible for Medicaid.
The topic is of great interest to some Americans. At a forum in Las Vegas on Oct. 10, an audience member identified by Univision as Ivett Castillo asked Harris what his administration would do about health care for people like his mother, who had emigrated from Mexico without authorization many years ago. . , worked his entire life until his death this year without having received “the kind of attention and service he needed or deserved.”
“What are your planes, or do you have planes, to support that subgroup of immigrants who have been here all their lives, or most of them, and have to live and die in the shadows?” Castillo asked.
Harris cited her past support for a path to citizenship for undocumented residents, and for a bipartisan border security bill that Senate Republicans blocked earlier this year at Trump’s insistence.
“This is an example that there are real people suffering because of the inability to put solutions before politics,” Harris said.
Even without these policies, immigrants can receive free or affordable primary care at community clinics across the country, assuming they know it’s an option and feel safe in the facilities.
But primary care cannot meet all medical needs, especially as people age and develop more complex health problems and chronic diseases. So immigrants often rely on charity care, go into debt or, like Sánchez, avoid the doctor. Some even return to their home countries to receive care.
Illinois, where Sánchez obtained coverage, was a pioneer in extending insurance coverage to unauthorized migrants. Now, six states and the District of Columbia—all led by Democrats—cover at least some older, low-income immigrants under Medicaid or Affordable Care Act (ACA) waivers.
Minnesota will become the seventh year. State funds are used for these expansions, since federal funds generally cannot cover people without legal status.
It remains to be seen whether and how quickly more states will follow this trend, and if Trump wins the White House, his administration will likely try to curb this trend, given that he has promised mass deportations.
Coverage for all immigrants remains a difficult proposition both economically and politically, and the non-citizen population cannot thank by voting. Immigrant health initiatives in several other states have failed or been scaled back.
Maryland, for example, decided to open its Obamacare marketplace to people living in the state illegally starting in 2026, but without taxpayer subsidies for their premiums.
Still, there is enough activity in the states for immigrant health advocates to believe something has changed. The severity of the pandemic and its disparate impact helped generate support for covering 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 really showed that, when you look at the disparities in who got Covid, who was exposed to Covid, and who died from Covid.”
Access to health care in the country has long been an obstacle for immigrants, even those with papers. People with green cards must wait five years to get coverage under Medicaid or other government health programs. Some resident seniors have to pay additional premiums for Medicare Part A — the part that covers hospital care — if they have not worked at least 10 years in the United States.
The new state health programs close these gaps, said Shelby Gonzales, vice president of 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 filled quickly, but some spots were reserved for people 65 and older, Leong said. Earlier this year, the state opened its Obamacare marketplace to immigrants living in the U.S. illegally.
Oregon and Colorado also now offer some coverage to people in their states who lack legal status, although Colorado’s program does not attract many older immigrants, according to data recently presented to the ACA’s marketplace oversight committee.
New York has covered undocumented immigrant children for years, and the state’s Medicaid program opened in January to all adult immigrants regardless of status. About 25,000 people signed up in the first four months, according to New York Medicaid Director Amir Bassiri.
Back in Illinois, María Sánchez said her new coverage has changed her life, and possibly saved her life. His bouts of pneumonia were serious, in part because he delayed care. After his second hospitalization, he required follow-up cardiac care. The hospital did not charge him for his stay.
But now, with your “medical card,” you can see a doctor. His heart condition is under control. You have seen a dentist. He’s going to have cataract surgery. “With my medical card, I have peace of mind,” Sánchez said.
Illinois has gradually added coverage for other age groups; in the summer of 2022, he reduced eligibility to age 42. That means immigrants like Gaby Piceno, 45, can age more healthily.
“I don’t have to worry anymore,” she said, referring not only to herself, but to her family.
But expanding coverage has cost more than projected in Illinois. People like Sánchez and Piceno, already registered, are still covered, but this year new registration stopped. More people signed up than expected, and many continued to seek care in more expensive hospital emergency rooms rather than doctors’ offices, said the state’s acting insurance commissioner, Ann Gillespie, who was a state senator in Illinois when the scheme was developed. program.
The state is now moving covered immigrants to Medicaid managed care plans, hoping to reduce the cost over time.
