Republicans are accusing Democrats of demanding healthcare for illegal immigrants in return for voting to end the government shutdown.

Democrats, in response, are saying that Republicans are lying and that the law already bars illegal immigrants from federal healthcare programs.

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Who’s right? It all boils down to definitions. Read on to learn more.

The claim

Republicans, perhaps most prominently Vice President JD Vance, are arguing that Democrats are shutting down the government because they are seeking funding for healthcare benefits for illegal immigrants in return for voting for government funding.

For example, on Sunday, three days before the shutdown, Vance posted on social media that “Democrats want to take from the American people in order to give taxpayer-funded healthcare to illegal immigrants.”

Specifically, Republicans making this argument point to Section 2141 of the Democratic funding proposal, which would have repealed all health-related provisions from the One Big Beautiful Bill Act, which was passed by Republicans and signed by President Donald Trump in July. Those provisions include measures curtailing immigrant eligibility for federal healthcare programs.

The Democratic counterclaim

Democrats have accused Vance and Republicans of lying on the basis that immigrants who are in the country without any government authorization are barred from healthcare programs.

House Minority Leader Hakeem Jeffries (D-NY), for example, said Wednesday on CNN that “the Republicans know they’re lying about this issue.”

“By the way, current federal law is clear,” he said. “Taxpayer dollars cannot be spent on Medicaid or Medicare or the Affordable Care Act related to undocumented immigrants, and not a single Democrat has raised the issue of trying to reverse that federal law.”

Medicaid is the joint federal-state program that provides coverage for low-income people. Medicare is the federal program that provides coverage for the elderly and some disabled people. Obamacare provides subsidized insurance for individuals and families via state-based exchanges.

Senate Minority Leader Chuck Schumer (D-NY) said Wednesday on the Senate floor that “it’s a lie, plain and simple,” that any federal healthcare dollars are directed toward illegal immigrants.

The reality

It is true that federal law prevents the major healthcare programs from enrolling immigrants who lack any authorization to be in the country.

But immigrants who Republicans argue are “illegal” could gain coverage. They could also benefit from federal funding in other ways.

Disputed categories of immigrants

The OBBBA included several provisions to restrict the eligibility of immigrants for federal healthcare programs. Reversing that part of the law, as Democrats have proposed, would make more immigrants eligible for benefits. Whether any of those immigrants can be characterized as “illegal” is the point in question.

The OBBBA excludes a number of immigrant statuses, including refugees, asylees, and those given special visas as victims of human trafficking or domestic abuse. Altogether, about 1.4 million lawfully present immigrants are set to lose coverage due to the new eligibility restrictions, according to Congressional Budget Office estimates reported by KFF.

One of the categories that the OBBBA barred from benefits, those with “parole” status, is a particular point of contention, as many people who are granted this form of documentation crossed the border into the United States illegally.

According to Black’s Law Dictionary, parole status in immigration law treats the parolee “as if still at the border seeking admission.” The statute limits who can be granted parolee status to “only on a case-by-case basis for urgent humanitarian reasons or significant public benefit.”

Conservatives argue that parole was abused under the Biden administration to allow people to cross the border illegally without consequence. They maintain that many parolees are illegal immigrants, even if they were given a form of legal status by the Biden administration, and thus, before the OBBBA, may have accessed healthcare as authorized immigrants.

In other words, some people who cross the border illegally are no longer “undocumented” by the time they are eligible to receive Medicaid benefits.

For example, José Antonio Ibarra, the Venezuelan man convicted of murdering 22-year-old Laken Riley in February 2024, had been given parolee immigrant status after being apprehended illegally crossing the U.S.-Mexico border in September 2022. Republicans and many media outlets regularly refer to him as an illegal immigrant or illegal alien.

Prior to the passage of the One Big Beautiful Bill Act, Ibarra, on the basis of his parolee status, would have been eligible for Medicaid or Obamacare coverage.

The Center for Immigration Studies estimated in May that nearly 3 million immigrants were granted parolee status between 2021 and 2024.

Indirect spending on illegal immigrants

Another claim put forward by Vance and other Republicans is that taxpayers fund healthcare for illegal immigrants via emergency funding for hospitals. The OBBBA limited this funding but did not eliminate it entirely.

A small fraction of the hundreds of billions in Medicaid spending every year is used to reimburse hospitals for emergency medical care that they are legally obligated to provide to patients, regardless of immigration status.

The Emergency Medical Treatment and Active Labor Act requires that hospitals provide stabilizing medical treatment to all patients, regardless of their ability to pay or insurance status. Some of the emergency services covered under EMTALA include delivering a baby or resuscitating a patient who has had a heart attack.

Hospitals, not immigrant patients, are reimbursed for EMTALA-covered emergency services provided to illegal immigrants.

Costs associated with EMTALA-covered treatments are reimbursed to providers largely through federal Medicaid funds. The CBO estimated in 2024 that, from 2017 to 2023, the federal government spent about $18 billion on “emergency Medicaid services for non‑U.S. nationals who were ineligible for comprehensive Medicaid by reason of immigration status or because they were still within the five-year waiting period.”

The CBO report clarified that it could not distinguish between “qualified aliens” who either had not completed their mandatory five-year waiting period or were granted parole, and non-U.S. nationals “who are in the country illegally.”

In 2023 alone, the CBO estimated, $2.75 billion in federal and $1 billion in state Medicaid funding went toward emergency Medicaid services. That is out of the more than $871 billion, or 18% of national health expenditures, the Center for Medicare and Medicaid Services estimated Medicaid cost that year.

One of the provisions in the OBBBA that would have been undone under the Democratic bill to fund the government substantially decreases the federal reimbursement rate for emergency medical services, shifting more of the costs to state budgets.

Democrats, though, argue that the funding does not amount to paying for healthcare for illegal immigrants. Sen. Ruben Gallego (D-AZ) highlighted on X that the OBBBA does not entirely eliminate emergency funding for illegal immigrant care but does drastically affect U.S. citizens.

“Vance, Trump and GOP didn’t cut emergency room access for immigrants illegal or not with their last budget bill,” Gallego posted. “What they will cut is the insurance coverage of 4 Million Americans and double the insurance premiums of 24 million Americans.”

Ramsey Touchberry contributed to this report.