It was at the top of the agenda at the GOP convention: 12 million illegal immigrants have entered the country over the last four years. Cities from Denver to New York City have pulled resources from Americans to reward individuals who came here illegally with free housing, education, activities and universal health care.  

But these policies – supported by then-Senator Kamala Harris – have financial costs and human consequences, and those should not be borne by the American patient or American taxpayer. Yet six states plus D.C. use creative accounting and financing gimmicks, under the guise of “compassion,” to do just that.  

Beginning on January 1, 2024, California’s SB 184 allows all illegal immigrants, including those ages 19-64, to qualify for the state’s Medicaid program, Medi-Cal. After its passage, Democrat Governor Gavin Newsom bragged that California would be the first state in the nation to provide universal health coverage, regardless of immigration status.  

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The change adds, at most conservative, 700,000 adult illegal immigrants living in California’s sanctuary cities to the Medi-Cal rolls and is anticipated to cost $3.1 billion per year. But, by federal law, California cannot use federal taxpayer dollars to fund the program. So how does California pay for it? Federal taxpayer dollars, just laundered with the state’s Medicaid gimmicks.  

California’s Medicaid program is the largest in the country, with a proposed budget of $156.6 billion in 2024. But it’s not just California’s taxpayer money that is being spent – it’s federal taxpayers’ dollars. In fact, California spends nearly three federal dollars for every one, state dollar.  

Aligning with California’s decision to spend taxpayer money on health care for illegal immigrants, the Biden-Harris Administration approved a legal loophole to get the federal government to spend more on the California Medicaid program with the expressed purpose to avoid using the state’s dollars on the Medicaid program.  

In the name of compassion, California operated a decades-long expansion of benefits to more and more people. But to do this, they raided payments to health care providers.  The less these providers got paid to see Medi-Cal patients, the harder it was for the disabled or truly needy to see a provider, leading to dangerously long wait times.  

And with 40% of all Californians on Medi-Cal, there are a dwindling number of providers who can financially afford to see a comparatively larger number of patients. In fact, the approved increase in federal funding was to fund higher provider pay; ironically, when Newsom needed money to solve his $45 billion budget deficit, he pillaged provider pay yet again rather than cut universal health care for illegal immigrants.  

No wonder Medi-Cal patients in California have sued their state’s health commission for providing them with substantially worse access to health care than Californians who had different insurance.  

California might be the most egregious example, but isn’t the only state abusing federal dollars – and American patients – to provide universal health care for illegal immigrants. New York also uses Medicaid dollars to provide health coverage to illegal immigrants, under a similar funding scheme.  

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The Biden-Harris administration granted both Washington and Colorado waivers to use the federal Obamacare program for illegal immigrants, despite the law very clearly prohibiting participation of unlawful residents in Obamacare. The administration limited the use of these waivers for innovative health arrangements by states for American patients, but he has allowed states to use them for illegal immigrants. 

Other, little-known federal agencies, like the Health Resources Services Administration (HRSA) manage the Health Center Program, which provides funding to community health centers that provide low-income Americans access to medical care.  

California’s Medicaid program is the largest in the country, with a proposed budget of $156.6 billion in 2024. But it’s not just California’s taxpayer money that is being spent – it’s federal taxpayers’ dollars. In fact, California spends nearly three federal dollars for every one state dollar.  

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The border crisis has put a financial strain on these providers, increasing the need for federal funding and risking their ability to serve American patients. Other programs at HRSA, like the 340B Drug Pricing Program, have been scrutinized for funding subsidized care for illegal immigrants.  

But Republican governors are fighting back – in Virginia, Governor Glenn Youngkin vetoed a health care bill for not including reporting on the usage of programs, like the one above, to provide care to illegal immigrants.  

In Florida, Governor Ron DeSantis passed a law to require hospitals that participate in the state Medicaid program to merely add in a question on a patient’s immigration status upon emergency room intake. It didn’t force ERs to turn away illegal immigrants, or even force a would-be patient to answer. But the inclusion of the question has reportedly decreased these Medicaid expenditures by 54%.  

Ultimately, the consequences of Democrats’ open borders should not be borne by the American taxpayer – and certainly not the most vulnerable American patient. 

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Hannah I. Anderson is the director of the Center for a Healthy America at the America First Policy Institute.