The House has passed a budget bill that could significantly impact states offering health coverage to immigrants without legal status. This bill, dubbed "One Big Beautiful Bill, " aims to reduce federal Medicaid funding for these states. The affected states, mostly led by Democrats, provide healthcare to low-income immigrants, often children, regardless of their legal status. Advocates for this policy argue that it is both humane and cost-effective in the long run.

    The bill's passage in the House was narrow, and it now moves to the Senate. It includes substantial cuts to Medicaid, which could leave millions of low-income individuals without health insurance. The cuts would affect states and Washington, D. C. , which use their own funds to provide health insurance to some immigrants. California, with the most to lose, could see a reduction of up to $3 billion annually. New York would also face significant losses, around $1. 6 billion each year.

    The bill's impact on states with "trigger" laws, like Utah and Illinois, is particularly noteworthy. These laws mandate the termination of Medicaid expansions if federal funding is reduced. This could leave many low-income Americans uninsured. States would need to find alternative funding to maintain their Medicaid programs, starting from the 2027 fiscal year. This situation presents a political and economic challenge for these states.

    The Affordable Care Act, or Obamacare, allowed states to expand Medicaid to adults with incomes up to 138% of the federal poverty level. This expansion has contributed to a historic drop in the national uninsured rate. The federal government covers 90% of the costs for individuals added to Medicaid under this expansion. However, the Republican bill would reduce this contribution to 80% for states covering immigrants without legal status.

    The bill also includes other Medicaid cuts, such as requiring states to verify adults' work status and recertify enrollees' eligibility every six months. It would also freeze states' practice of taxing healthcare companies to fund their share of Medicaid costs. The Congressional Budget Office estimates that, if passed, the bill could leave about 8. 6 million more people without health insurance by 2034, rising to nearly 14 million after new ACA regulations and the expiration of enhanced premium subsidies.

    States like California and New York have expressed strong opposition to the bill. California's Governor, Gavin Newsom, has stated that the bill would devastate healthcare in his state. He has also questioned the federal government's authority to penalize states for their spending decisions. Utah and Illinois face significant challenges due to their trigger laws, which could lead to the termination of their Medicaid expansions. However, advocates suggest that these states could repeal their trigger laws or find alternative funding to maintain their programs.

    The bill's passage in the House has sparked a debate about the role of the federal government in healthcare and the treatment of immigrants. It has also highlighted the political and economic challenges faced by states offering healthcare to immigrants without legal status. As the bill moves to the Senate, its impact on these states and the millions of people who rely on Medicaid for healthcare remains to be seen.

HEALTHCARE FUNDING IMPLICATIONS

Medicaid's Political Battle: States vs. The House

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