Who Pays for Undocumented Migrants’ Healthcare? Reporter Explains

BIANNA GOLODRYGA: Next to Washington, D.C. where a government shutdown is about to enter its fifth week. Negotiations remain at a standstill. The debate over health care funding for undocumented immigrants one of the main sticking points between Democrats and Republicans. And according to our next guest it’s a debate riddled with misleading claims. Washington post reporter David Ovalle tells Hari Sreenivasan his latest article is setting the record straight.

HARI SREENIVASAN: Bianna, thanks. David Ovalle, thanks so much for joining us. You wrote a piece recently, which was very simply titled, “Here’s who pays when undocumented immigrants get healthcare in America.” And this is literally the center of why the federal government is shut down right now. You have Republicans saying that Democrats want to have, you know, undocumented people get free healthcare. And Democrats saying, that’s just not the way the law works today. And you, you point out exactly what’s happening.

 

DAVID OVALLE: I think it’s definitely an issue that’s very nuanced and very gray, and it does not fit neatly into the narratives that really either side are putting out there in terms of what’s going on with the healthcare debate. But the, the reality is taxpayers do pay some for — directly and indirectly —  for care for undocumented people. But it is neither as glaring and as stark as Republicans might have you believe, and some of the talking points that are going on right now, or the debate about the shutdown.

 

SREENIVASAN: Okay. So the Democrats say, ‘Look, that that’s just not how the law works. You, you can’t get healthcare in America if you aren’t documented.’ That said, if an undocumented human being walks into an emergency room because their, you know, arm is broken, they’re going to get healthcare in America. Who pays for that?

 

OVALLE: Right. So at the end of the day the, the Republican, Republicans have really zeroed in on emergency Medicaid. Now, what’s interesting about emergency Medicaid is all of this stems from, from laws that were passed in the 80s under President Reagan that basically said, you cannot, that you cannot deny someone cov — emergency coverage at the emergency room if they come in. And obviously there’s the basic human element, right? We don’t want people not being able to be treated for something like a car crash or for a fall or for some emergency thing. So there is the emergency Medicaid program, which if you are otherwise eligible for Medicaid, then you can get coverage through — you can get — the hospitals can get reimbursed for the services, services that are provided. Okay? 

 

OVALLE: So this is going to be for that very narrow emergency room visit, right? So this may pay for your broken arm if you fall on a construction site, right? 

 

SREENIVASAN: Sure. 

 

OVALLE: But it’s not going to pay for the rehabilitation visits. It’s not going to pay for the ongoing care that you might need afterward. So it’s, it’s really, emergency Medicaid is a, is less than 1% of all Medicaid spending. So it’s, you know, compared to the vast majority of spending that is done for primarily U.S. citizens, it is a very, very small amount of money. But it is something that is explicitly built into law that allows for federal funds to pay for emergency care for people without papers.

 

SREENIVASAN: So if it’s less than 1%, the Republicans also talk about kind of the, the number that you hear in the press is $200 billion, that if the, the provisions are kind of reinstated you know — basically the Big Beautiful Bill rolled back some of these kind of extensions of tax credits. If these tax credits come back in — $200 billion — where’s that number from?

 

OVALLE: Well, there’s a lot of conflation that’s going on, and a lot of the claims that are going back and forth. And so one of the, the, the things that I think is important for people to understand is the Trump administration has, has really zeroed in on people that it believes should never have been afforded any kind of legal status to begin with under the Biden administration, right? So these are gonna be people that got protection under TPS programs, under other, under, under other immigration programs. And so this was a lot of people that came into the United States and were given some sort of legal status. For the Republicans — they say, ‘Well, these are people that should have never gotten any kind of protections. And so therefore, the healthcare that they are afforded because, because of that legal status should not be afforded to them.’

 

So there’s sort of some conflation going on there, because it’s not really the undocumented population that we think of that just snuck across the border and is living and working here. These are people that came in, have had some sort of legal status. Some of it’s in limbo, right? We have hundreds of thousands of people from countries that that are in sort of legal limbo right now because their TPS programs have been, have been pulled back. But there are a lot of people that would fall under this bucket, right? 

 

So some of these numbers get a little bit conflated. But what the Big Beautiful Bill did was it, it, it, it tightened eligibility for a lot of these programs. So some of those people will now no longer be — are now no longer — eligible for any of these federal healthcare programs. And so what rolling back some of those provisions in the Big Beautiful Bill would do wa —  would, would do is give those people back some of that coverage.

 

SREENIVASAN: Got it. You spoke to individuals who are getting healthcare or not getting healthcare in America, along with the providers, the clinics and so forth in this story. One of the things that you point out is “The more common experience for millions of people living in the United States illegally is that they often forego routine medical appointments, pay out of pocket for specialized care, rely on community clinics, and turn to emergency rooms as a last resort, according to healthcare providers and immigrant advocates.” How does someone who doesn’t have papers in America just kind of navigate normal life, whether it’s the common cold or flu, or whether an ultimately getting to that kind of broken arm example?

 

OVALLE: Look, healthcare in America is complicated for, for citizens, right? Just navigating whether you have healthcare, whether you don’t have healthcare, whether you have some mix of, of charity care and, and government-backed health. But at the end of the day, it’s just as difficult and then some for people without papers. 

 

So I think community clinics tend to be sort of the go-to places for a lot of people without papers — and people who just don’t have money, you know, people who are impoverished. So this will be for very common preventative type things, right? You have a cold, you have you know, maybe you need blood pressure medication, maybe you are, you’re diabetic. And so you go to these, especially like in rural areas and underserved areas where they’re, it’s just, you know, not that much access to healthcare. Those provide a real crucial place for people to get healthcare. 

 

And what’s interesting about that is that there’s, you know, most of them are required by law to serve whoever is in their local area, right? Regardless of whether they’re eligible or not, or whether they have any kind of, of, of documented status, right? So that is built into the law. Now, the Trump administration has been trying to pull back on some of those — the funding that goes toward these types of programs. But again, that also, a lot of that money comes from the state, or is federal money that’s routed through the state, right? So it’s not always as clear cut as federal taxpayer money is funneling down to community clinics. That’s really, it’s, it’s a lot more complicated than that. But that is one way. 

 

And even then, undocumented immigrants still pay for some of their care, for a lot of their care, and moreover, they want to pay for a lot of their care. If you read my story, I, I spoke to a, a medical director at a clinic here in South Florida where I’m based, and she pointed out that a lot of the undocumented immigrants are used to paying for healthcare in their home countries, and they don’t want to come here and just, you know, feel like they’re leaching off the government. They want to pay at least something for some of their care. So a lot of it is done on a sliding scale. So you come in, you’re gonna pay, you know, maybe only $55, $60 for a visit, and the medications will be much more, right? 

 

And so a lot of this is, is —  can get kind of complicated and messy for people, and a lot of times they’ll just forego the care, right? If they have something, then they’ll just go by you know, over the counter Tylenol or medications for your common cold or whatever. And oftentimes they just, you know, they just don’t go unless it’s absolutely, absolutely an emergency.

 

SREENIVASAN: I, I wonder if the people that you spoke with, are they foregoing care that could be preventing further costs down the line?

 

OVALLE: That, and that’s one of the things that, that, that doctors and public health officials and immigrant advocates stress is that by —  if we are cutting off care on the preventative side, it ends up costing taxpayers more when they do go to emergency rooms, right? When there is a complication from diabetes, or there is a complication from cardiovascular disease. By not, by not treating it on the front end we are actually gonna increase the cost on the back end. 

 

And I think where we’re gonna see that take place a lot is in some of the, the immigration enforcement that’s going on. So that’s sort of separate from, from all the debate about taxpayer money going — but you’re, you’re having a lot of people without papers or questionable papers, or maybe people who live in mixed families. So maybe they’re undocumented, but their kids are citizens. And so a lot of them are just foregoing the care because they’re afraid of going out. They’re afraid of getting targeted by immigration enforcement. 

 

And I mean, I’ve, I’ve spoken to, to people at different community clinics who said, ‘Yeah, we were arranging, we’ve had people skip surgeries, we’ve had people not, you know, just skipping appointments because they’re genuinely terrified of going out.’ So that is going to play out in, you know, when you have you know, these, these health conditions that start getting worse and getting worse. And then ultimately when there’s no remedy, then those people are gonna end up going to emergency care. So there is a, a lot of consternation about that. And that’s something that we may end up seeing play out down the road.

 

SREENIVASAN: Are there particular regions or particular industries that affect the type of healthcare needs that some of the undocumented in the United States have?

 

OVALLE: Well, yeah. I mean, if you think about think about a lot of the jobs that undocumented people have now, right? That — are jobs that Americans that are citizens are more reluctant to take, right? This is farm workers. Farm workers are outside, they are going to be exposed to more sun, where we might have more sun stroke. You might have a region, like I spoke to a clinic a clinic director, a clinic, CEO in, in the Central Valley in California, where there’s a lot of pollution in the air. And so that leads to things like asthma and respiratory conditions. You’re gonna have people who are doing very physical work, right? Think about the physical toll that is taken at a poultry plant, right, at a processing plant in Georgia or, or somewhere else in the south where there are a lot of undocumented people working.Those places are gonna be very taxing on, on your on your, your hands on your limbs or on, there’s gonna be accidents that happen. 

 

So these are very physical jobs that require you know, just a lot of exertion, and ultimately there’s a physical price to be paid for a lot of these jobs. So yeah, I think it’s gonna be certainly a, a factor. Now, immigrants tend to not use as much healthcare. They tend to be more healthy and working age. A lot of the research has shown that. But at the end of the day, there’s still, it’s still a lot of industries that that, you know, are just going to be more prone to, to health conditions.

 

SREENIVASAN: So is there anything that you’ve discovered so far in your research that indicates that there’s a way through this? I mean, because on the one hand, you see just from a number standpoint, look, if these are subsidies that exist for certain populations and ideologically wanna roll these back, that seems like a non-starter. And then on the other hand, you kind of have people who are saying, ‘Look, this is, you know, structurally not the way that healthcare is designed, but if there are any government funds going, it’s because that’s also part of the law that people have to get care at emergency rooms,’ right? So it just seems like there’s a pretty big gap here as we all live through this government shutdown.

 

OVALLE: Yeah. And I think, but I think some of this is going to, a lot of this is gonna go on even when the shutdown is resolved, right? 

 

SREENIVASAN: Sure. 

 

OVALLE: I mean you know, one of the things that the Big Beautiful Bill did was it changed the ratio of how much the federal government pays for emergency Medicaid, right? So so — but at the end of the day, the states will now have to burn a little bit more of the money that goes toward emergency Medicaid, but the money still has to get paid. People still have to get treated at the hospital. So the states are now — and this is not just in healthcare, but this is in a lot of different areas where we’re seeing states taking on more and more of a burden and the federal government sort of withdrawing from, from a lot of these efforts, right? And so we see that in healthcare. 

 

You know, even with, there are programs, certain states that do provide healthcare for undocumented people through separate Medicaid type programs, right? Like California being the most, the biggest example — D.C., a few other states, blue states. So you can get healthcare if you’re eligible for Medicaid through places in California, right? And that’s been a big source of consternation for Republicans who, who believe that that should not happen, right? 

 

But what’s happening now is because there’s budget crunches, because we’re, because the states are getting so much less money from the feds now, some of these states are starting to pull back spending on some of these programs, right? So it’s going to tax the existing healthcare infrastructure that much more, the community clinics that much more. Community clinics are facing a lot fewer dollars from, from Washington and from their state capitals. So it’s going to sort of, like, start trickling down, and that’s when we’re gonna start seeing, you know more emergency room visits, more people suffering conditions because, you know, there’s just less —  it’s just greater barriers to getting care.

 

SREENIVASAN: Look, I’d be remiss in talking to a, a health reporter and not asking about the, you know, the, the plight of what Americans, citizens, who are on the exchanges are starting to experience. They’re getting these notices. How significant of an increase are most Americans likely to see in their premiums with what’s happening right now?

 

OVALLE: If the subsidies are not extended, it’s going to be, it’s going to be quite hefty. And particularly — there’s another story that I did a week before the story that, that we’re talking about today, on on how Republican states are actually going to really suffer a lot with the, the subsidies not being extended. 

 

So here in Miami where I, where I live, you know, it’s, it’s a red county now. It’s a place that has, has backed Trump, and particularly among immigrant groups, many of them have backed Trump. But at the same time, a lot of those people here in, in Hialeah where I, I’m close to is, a very, very Cuban American stronghold that is very, very supportive of Trump, but they are also one of the leading areas, zip codes for Obamacare enrollment, and their premiums are gonna go through the roof. Republicans have really recognized that this is a problem because a lot of their constituents are going to see their healthcare costs go up a lot. 

 

So it’s, it’s, it, it affects everybody. It affects everybody. And I think even in the private markets, right, we’re seeing employer backed healthcare health plans going up as well. So this is something that it’s sort of like, you know, we’re all gonna see this, these prices go up next year. And really that’s, that’s something that we can’t, that none of us can avoid.

 

SREENIVASAN: David Ovalle of the Washington Post, Health and Science Reporter. Thanks so much for joining us.

 

OVALLE: Thank you. Appreciate it.