Taxpayers deserve better than symbolic compassion backed by shell games and ballooning deficits.
P resident Trump’s crackdown on illegal immigration has earned no shortage of condemnation from progressive governors across the country. So it may be surprising that many blue-state leaders are quietly rolling back health coverage for people without legal status.
Over the past few months, Democratic governors in California, Minnesota, and Illinois have all arrived at the same conclusion: It’s not practical to offer taxpayer-funded health insurance to undocumented immigrants.
In addition to being wildly expensive, such open-ended largesse jeopardizes health care access for vulnerable U.S. citizens who need the safety net most — single mothers, pregnant women, the elderly, and the disabled.
Even the most vocal champions of undocumented immigration — including California Governor Gavin Newsom, Minnesota Governor Tim Walz, and Illinois Governor JB Pritzker — are acknowledging this reality. All three have either frozen or curtailed Medicaid coverage for these populations in recent months.
As Newsom recently said, “I don’t want to be in this position, but we are in this position.”
He has only himself to blame. Newsom, after all, has aggressively expanded eligibility for Medi-Cal, the state’s public health insurance program, over the past decade. Today, 1.6 million undocumented people residing in California are enrolled in Medi-Cal, which covers roughly 15 million people in total.
This expansion hasn’t come cheap. It’s estimated that the state spends $8.5 billion each year providing Medi-Cal coverage to undocumented residents.
Newsom has paid for some of his Medi-Cal expansion by employing some creative bookkeeping. He has levied taxes on Medi-Cal insurance providers, and then paid that money back to them — boosting overall state Medicaid spending, at least on paper.
Since the federal government matches whatever California pays for Medi-Cal, this strategy enables the state to extract additional funds from Washington — funds that can then be used to pay for coverage for undocumented immigrants.
The One Big Beautiful Bill Act, which President Trump signed into law this past July 4, will curtail — but not eliminate entirely — these state provider tax schemes.
Money is only part of the problem with Newsom’s expansion. By flooding the health care system with a massive population of undocumented patients, Newsom’s policy has restricted the availability of care throughout California.
In 2024, roughly 40 percent of adults in the state couldn’t see a doctor for urgent health needs in accordance with the state’s “Wait Time Standards.”
It’s even harder to see a specialist. In Sacramento County, one in five enrollees had difficulty finding specialty care from providers like cardiologists, rheumatologists, and urologists in 2020 and 2021.
Newsom’s effort to add noncitizens to Medi-Cal’s rolls has only exacerbated care shortages.
The governor seems to be waking up to the mess he has made. His latest budget, signed in June, includes a freeze on new Medi-Cal sign-ups for immigrants residing in California without legal status. Undocumented patients who are already enrolled will have to pay a $30 monthly premium beginning in 2027.
The same story is playing out in Minnesota and Illinois.
In Minnesota, a bipartisan coalition of lawmakers recently voted to eliminate undocumented adults’ eligibility for MinnesotaCare — the state’s taxpayer-funded insurance program for low-income residents. The state projects a budget shortfall of about $6 billion by 2028.
Governor Walz, who only in 2023 celebrated the “landmark” program’s expansion as a progressive milestone, agreed to the rollback as part of a broader budget deal to avoid deeper cuts elsewhere. The decision came amid growing concerns over fiscal sustainability and crowd-out effects on vulnerable American citizens.
Illinois followed suit. Governor Pritzker’s administration is preparing to eliminate the Health Benefits for Immigrant Adults program, which offered public coverage to over 30,000 undocumented residents. Introduced in 2021, the program quickly outpaced cost projections and strained the state’s Medicaid infrastructure.
Illinois’ insurance programs for noncitizens cost taxpayers $682 million in 2024, while the state faces a $3.2 billion budget deficit this year.
Even the nation’s most progressive leaders are confronting the limits of their ideology. When reality hits — when budgets buckle and public systems falter — officials have to make hard choices. Quietly, they’re choosing to scale back benefits for the undocumented, even as they tout their progressive bona fides publicly.
Taxpayers deserve better than symbolic compassion backed by shell games and ballooning deficits. If public health safety nets are to survive and serve those they were built to protect — low-income families, children, seniors, and the disabled — then leaders must prioritize Americans over people here illegally.