White House Memo: Repeal Could Trigger Nearly $192B in Healthcare Spending for Noncitizens, White House Says
A White House memo obtained by Fox News projects that repealing the healthcare title of the Working Families Tax Cut Act at Democrats’ insistence could trigger just over $192 billion in federal healthcare spending for noncitizens over the next decade, citing six provisions that would be undone — including changes to Medicaid and Medicare funding rules and an alleged “California loophole.” Reporting and analysts note important caveats: unauthorized immigrants are generally ineligible for Medicaid/Medicare and cannot buy ACA coverage, independent analyses (KFF/CBO) have produced different estimates for legal‑status immigrant proposals (about $131 billion), some GOP claims about state funding mechanisms have been denied by California officials, and the dispute is tied to broader budget fights including renewal of enhanced ACA premium tax credits.
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📌 Key Facts
- A White House memo obtained by Fox projects roughly $192 billion (reported elsewhere as about $200 billion) in federal healthcare spending over the next decade for undocumented immigrants if Democrats’ repeal demands are met; the memo ties that projection to repealing the healthcare title of President Trump’s Working Families Tax Cut Act.
- The memo lists six specific provisions that would be undone, including ending Medicaid funding limits for most non‑citizens, ending enhanced FMAP for emergency care for unauthorized immigrants, ending Medicare funding for most non‑citizens, and closing a so‑called “California loophole”; it says Democrats demand repeal “as a condition of keeping the government open for four weeks.”
- Republicans allege California uses a Medicaid “provider tax” mechanism to draw federal matching dollars that are then pooled to pay for non‑emergency care for undocumented immigrants; that claim was advanced on the record by GOP figures (e.g., Steve Hilton, CATO’s Michael Cannon) but was denied by Gov. Newsom’s office and rebutted by KFF’s Jennifer Tolbert as unrelated to provider‑tax waiver language.
- Reporting and experts note unauthorized immigrants are generally ineligible for Medicaid and Medicare and cannot buy ACA coverage in most cases, which undercuts sweeping GOP claims about broad entitlement access; however, some states (for example, California and Illinois) have chosen to allow unauthorized immigrants to enroll in certain state‑funded programs.
- A KFF analysis of CBO estimates found a $131 billion federal‑spending increase tied to Democrats’ proposals for immigrants with legal status; CBO did not provide a comparable estimate for proposals covering unauthorized immigrants.
- Emergency Medicaid — the program that reimburses hospitals for emergency care provided to unauthorized immigrants — comprises less than 1% of total Medicaid spending.
- The broader dispute, including whether Congress will renew “enhanced” ACA premium tax credits that lower marketplace premiums, is tied to an imminent federal funding lapse around the Sept. 30 appropriations deadline; CBS reported experts (including KFF’s Cynthia Cox) warning of ripple effects if the standoff contributes to a shutdown.
📚 Contextual Background
- U.S. federal rules prohibit undocumented immigrants from receiving federal funds for health coverage through Medicare, Medicaid, and the Affordable Care Act's premium tax credits (as of 2025-10-05).
- Medicaid is a government health insurance program for people with low incomes or disabilities and is funded jointly by state and federal governments.
- Medicaid spending is typically one of the largest components of U.S. state budgets.
📰 Sources (4)
GOP hits Democrats over health care, unauthorized immigrants. What’s behind the claim?
New information:
- Explainer clarifies that unauthorized immigrants are ineligible for Medicaid/Medicare and cannot buy ACA coverage in most cases—contradicting sweepingly framed GOP claims.
- Article cites a White House memorandum claiming roughly $200 billion (similar to prior $192B figure) as the administration's spending estimate.
- Cites a KFF analysis of CBO estimates finding a $131 billion federal‑spending increase linked to Democrats’ proposals for immigrants with legal status; no CBO estimate for unauthorized‑immigrant measures was available.
- Provides operational detail that Emergency Medicaid—used to reimburse hospitals for emergency care to unauthorized immigrants—comprises less than 1% of total Medicaid spending.
- Notes some states (e.g., California and Illinois) have chosen to allow unauthorized immigrants to enroll in certain state‑funded programs, providing nuance on state‑level variation.
California using backdoor to get federal funds for illegal immigrant healthcare, GOP says, Dems say nonsense
New information:
- Specific GOP claim that California is using a Medicaid 'provider tax' mechanism to draw federal matching dollars that are then pooled to pay for non‑emergency healthcare for undocumented immigrants.
- Quotes and sourcing: Steve Hilton (making the California allegation on the record), Michael Cannon (CATO) arguing provider taxes enable the draws, and Jennifer Tolbert (KFF) rebutting the claim as unrelated to provider‑tax uniformity waiver language.
- Newsom office denial to the L.A. Times: 'This is false — CA does not do this.'
White House memo says Democrats' plan could spend $200B on healthcare for illegal immigrants
New information:
- A White House memo obtained by Fox News Digital projects just over $192 billion in federal spending on healthcare for illegal immigrants over the next decade if Democrats' repeal demands are met.
- The memo explicitly ties the projected cost to repealing the healthcare title of President Trump's "big, beautiful bill," also called the Working Families Tax Cut Act.
- The memo lists six specific provisions that would be undone — including ending Medicaid funding limits for most non‑citizens, ending enhanced FMAP for emergency care for illegal immigrants, ending Medicare funding for most non‑citizens, and closing a so‑called 'California loophole' — and includes the phrase that Democrats demand repeal 'as a condition of keeping the government open for four weeks.'
Breaking down fight over health care tax credits as shutdown looms
New information:
- Issue: Whether Congress will renew 'enhanced' ACA premium tax credits that lower marketplace premiums
- Timing: The dispute is tied to an imminent federal funding lapse — described as happening 'next week' around the Sept. 30 appropriations deadline
- Source: CBS News interview/segment featuring Cynthia Cox of the Kaiser Family Foundation explaining potential ripple effects