← Keeping It Real: Conversations with Jillian Michaels
Keeping It Real: Conversations with Jillian Michaels
Exposed: The Hidden Path to Medical Care for Undocumented Immigrants
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government, if your government plan would provide
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coverage for undocumented immigrants. They told you it was a lie, that it wasn't happening. There's no legislation that gives illegals government subsidized health care in America. And there isn't. So why are billions of your tax dollars footing the bill for it? Well, in today's story behind the story, we're bringing you the whole truth and all the receipts. This one is gonna make you so mad. Here we go. Keeping it Real with Jillian Michaels. 27 million Americans have no health insurance. They earn too much to qualify for Medicaid, which is only 15,000 bucks a year, but too little to afford marketplace insurance premiums. Even with subsidies. They're below the poverty line, but they're still not poor enough. And they get nothing. Right. These are people who were born in America, who paid taxes in America, who followed the rules, who filled out the forms, who answered every question honestly. And then we're told the system has nothing for you, but it had something for someone else. Millions of someone else's. Take a look. Have you met with any of the 1.4 million people who have lost their health insurance just this last year from dropping off of Obamacare? Have you sat down and talked to those folks about the fact they won't have their health insurance again?
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They're almost all illegal immigrants.
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Well, you know what? It sounds like you haven't met with folks like Portia in my district.
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Found 1.5 million illegal immigrants ill. No, no, no. Collecting Medicaid, Mr. Secretary.
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But no matter how many times people on the right say this, people on the left say now, it's not true. It's a total lie. Behold this clip that just went viral several days ago with Abby, Phillip and Scott Jennings. Still not going to illegal immigrants.
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Scott, it really does.
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It's not.
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It really does.
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So it's.
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It does in several blue states.
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Scott. No, it's not.
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It really does.
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Listen, the, the part of the bill that deals with the money that goes to to states. It doesn't say anything about their immigration policy. So, so red state or blue state, those states are getting less money from the federal government. That still has to be dealt with and that has nothing to do with immigration. And again, Medicaid does not go to undocumented immigrants. SNAP does not go to undocumented immigrants. You know, Chip does not go to undocumented immigrants.
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It absolutely.
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I don't know. I mean, Scott, prove me wrong.
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How many blue states. Show me the law states. Mike Johnson showed it. Scott, show me the gigantic poster.
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Show me the US Code where it says that they're allowed to get Medicaid funding. I will, I will put it out on social media. It doesn't. It doesn't exactly. In fact, the law says exactly the opposite.
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When we say they want to give $200 billion back to illegal aliens, these are the specifics. So you can see the final total there. $192.8 billion of your hard earned taxpayer dollars that Chuck Schumer and the Democrats want to give back to illegal aliens. That's a fact and nobody can refute it.
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Now I don't know about you, but she seemed to really speak with conviction. And as much as I don't like Abby Phillip, I damn near believed her. So I googled it. Go ahead, try it. Type in do illegal immigrants get free health care in America? And you're going to get a wall of fact checks that tell you no that these claims are false, that they're misleading, that Republicans are lying and they're fear mongering, that the law is clear. Undocumented immigrants are categorically excluded from Medicaid, Medicare and the Obamacare Affordable Care act marketplace. The AP says so, Snope says so, politifact says so. And guess what? They're not lying. There is no federal law entitling people here illegally to government subsidized health insurance. And yet American taxpayers do spend tax tens of billions, by some estimates hundreds of billions on this every year. So how is this possible, you ask? Well, it turns out that there are four structural vulnerabilities that make this possible. Fraud, the emergency room pipeline, state funded health care, and the language war. Two words left undefined in a 2010 law that successive Democrat led administration stretched until they covered populations that Congress explicitly excluded in 1996. So this is the story behind the story of illegal immigrants and subsidized health care that you were never meant to understand. Every mechanism manipulated, every loophole exploited, every dollar lost. So let's start with the conversation. Federal investigators call it the eligibility pipeline. And it works because of a loophole so obvious, so exploitable, that organized crime rings have actually turned it into a production line. But we'll save that part for another day. Federal law requires that when states enroll Medicaid applicants, they immediately get health care coverage for a period of 90 days while their immigration status is being verified. It's called the reasonable opportunity period. Now, Congress built it in with good intentions, right? Don't punish people for slow bureaucracy. But what it created in practice was a guaranteed 90 day window of taxpayer funded health care for anyone willing to walk in, sign a form attesting that they're eligible under the penalty of perjury, which is of course a charge that is never prosecuted at this level. And here's how the verification is supposed to work. The SAVE system, the Department of Homeland Security's database for verifying immigrant status has existed since the 1980s. So states are required to run every new Medicaid or Obamacare applicant through it with true qualified applicants. SAVE generally returns an automated response within seconds. But someone presenting with falsified documents or a stolen identity has no matching record or one that would directly conflict with what they've submitted. Now that is not a quick check. And it triggers an escalation to manual review, which takes time. And here's the trap that's built into the law. State is not allowed to wait for that answer. So federal law requires enrollment to begin immediately while the verification process plays out. So the person who's most likely to be ineligible, the one with a record, the one whose documents don't match, the one who essentially doesn't exist in any federal database, is also the one whose verification takes the longest. And during every single day of that process, their coverage is active, their care is being utilized, and the federal government pays the bill. Now, by the time SAVE comes back with a denial, which is weeks or months later, those claims are processed and closed, the money's gone. There's no mechanism to recoup it. The taxpayer absorbs the loss every time without exception. So that's the first crack. Now here's where it gets worse. Because getting caught doesn't stop anything. There is no limit, none, on how many times somebody can start this process over. And here's why. Because In June of 2024, the Biden administration's Medicaid streamlining rule removed states ability to cap the number of reasonable opportunity periods a single applicant can receive. There is no longer any restriction on how many times one Person can cycle through so they can enroll using a stolen fictitious ID, collect 90 days of coverage, disappear before the denial comes back, re, enroll, repeat. And federal investigators are calling this cycling. The foundation for Government Accountability documented this in October 2025, and they described the number of people who completed reasonable opportunity periods without ever providing proof of legal status as alarming and growing. And to make matters worse, even for those who enrolled legitimately, the moment their circumstances changed, nobody was required to notice. So once someone cleared the front door. States aren't required to re. Verify immigration status for annual renewals. So think about what that means in practice. Okay? A green card holder whose card expired, a pending asylum seeker whose claim was denied but never left the country, somebody whose temporary visa lapsed a year ago, all of them potentially still sitting on Medicaid rolls with no one required to look twice. And at the federal level, nobody was watching the books, either. Cms, the agency that funds Medicaid and sets its rules, they weren't running the existing enrolled population back through federal databases. No systemic audit. Not once. Now, this did change on August 19, 2025, when the Trump administration began sending every single state a monthly report identifying enrollees whose immigration status could not be confirmed. And states were required to verify and remove anyone found ineligible the first time in the program's history. First time. So now you're probably thinking, well, this is resolved, right? No one intended to give these benefits away via fraud. The loophole's closed. So what's the big deal? Why are these politicians shutting down the government over this? Well, remember I said there are four mechanisms by which an illegal immigrant receives benefits. That was number one. So now let's move on to that language war that I referenced a bit earlier. Okay? This traces back to a single piece of legislation signed by President Clinton in 1996. It was called the Personal Responsibility and Work Opportunity Reconciliation Act. God help me. Known as P R W O R A. That one wasn't easy. And I think I have to say it a few more times as I continue to talk to you. This was established as one foundational rule, okay? Only qualified aliens are eligible to receive federal public benefits. The law was explicit. It named exactly who qualified and exactly who did not, and it categorically excluded undocumented immigrants. Now, that has never changed, actually, so stick with me here. There was no ambiguity. There was no gray area. And for 14 years, both parties understood what it meant because the language left no room for interpretation. Now, under the original law, qualified meant lawful permanent residents, refugees, people who are granted asylum, conditional entrance and people granted parole by the US Government. Everybody else, DACA recipients, pending asylum seekers, holders of humanitarian visas, people with temporary protected status like the Somalians in Minneapolis. They all got nothing. Zippo, nada, zero. Okay? And even the qualified immigrants, they had to wait five years before accessing most federal benefits with some very limited exceptions for refugees, asylees and non citizen veterans who had served in the US military. That was the hard line as drawn in 1996. And as I said for 14 years that held the right Window treatments change everything. 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You can find We'll do it live on BillORiley.com YouTube or wherever you download your podcast. Now, in 2010, Barack Obama signed the ACA, or otherwise known as Obamacare, otherwise known as the Affordable Care Act. To understand what it did, you need to understand what it added. So Medicaid had existed since 1965. It's the government's free health insurance program for low income Americans and the qualified immigrants that I just listed. It's funded jointly by the federal government and the states and it has strict income limits, strict eligibility rules. And if you qualify, you pay nothing or close to nothing for coverage. If you don't qualify, you get nothing. Now, before 2010, that was essentially the only option for people who couldn't afford private insurance, Medicaid or nothing. Now, the ACA created a second option that had never existed before. The marketplace. And this is a federally run exchange where people who don't get insurance through an employer can shop for private health insurance plans. And for people whose income falls between 16,000 and 63,000 a year, the federal government pays a subsidy directly to the insurance company on their behalf, reducing or in some cases, eliminating their monthly premium entirely. So the lower your income, the more the government covers. Now, this is where things get, we'll say Muddy. When a Democrat led Congress wrote the aca, it extended marketplace subsidy eligibility to immigrants who were locked out of Medicaid by the five year waiting period. They had a very precise legal tool available to do this. Qualified alien. They could have written qualified alien into the law, a term that was already defined in the 1996 law that covered exactly that population. But they didn't use it. Instead, they wrote lawfully present. Now, that phrase didn't exist as a defined term anywhere in federal immigration law. And what it did was it left an entirely undefined description in the statute, handing the power to define it to executive branch regulators. That would be the Department of Health and Human Services and more specifically cms. IT Centers for Medicare and Medicaid. Okay? And they're the ones who write the rules governing who qualifies for Medicaid and ACA marketplace plans. So this is malleable then. The Department of Homeland Security determines and administers immigration status categories. In other words, are you daca, are you tps, are you a refugee? So both agencies, as I said, are malleable. They are controlled by whoever sits in the White House. Small businesses are the backbone of the American economy. But getting funding from traditional banks is an uphill battle, to say the least. And of the 36 million small businesses in the US over 70% of them report needing additional capital every year. So while revenue is at an all time high, big banks are tightening standards and approving fewer loans than ever, leaving owners stuck with mountains of paperwork. But if you want bank rates without the bank delays, check out Cardiff Co Jillian for up to $500,000 in same day funding. Cardiff is the largest privately held small business lender in the US having funded over $12 billion since 2004. Their application takes less than five minutes. It has no impact on your personal credit, and approvals happen in minutes with same day fund. Banks try to lock out small businesses. Cardiff has the key. And big banks may not want to approve your business loans, but Cardiff does. So if you've been in business for at least a year and you're pulling in $20,000 a month in revenue, you can apply now for up to $500,000 in same day business funding at Cardiff Co. Jillian again, that's Cardiff Co Jillian, real growth, fast funding. Cardiff borrowed better. Their leadership is appointed by the President and serves at the President's pleasure. So whether the term legally present was sloppy drafting or deliberate ambiguity, it's a matter of debate. But what's not debatable is what happened next. The undefined phrase became an open invitation. And the Democrat led administrations that followed didn't hesitate to accept it. So from 2010 onward, under the Obama administration, CMS began quietly expanding what lawfully present meant. And each expansion moved another population from the gets nothing column, the potentially eligible column. So first this only applied to the ACA marketplace, but eventually it bled into Medicaid itself. States and federal agencies began asking, well, if somebody's lawfully present for aca, aren't they also lawfully present for Medicaid purposes? Under Obama, CMS began validating broader and broader interpretations. Well, then, May 2024, the Biden administration stretched it as far as it has ever gone. You're shocked. I'm. I'm sure you're shocked. Biden's HHS and CMS published a five final rule that explicitly extended lawfully present status to people who had been categorically excluded since 1996. DACA recipients. Which is one thing, but also, this is key. Pay attention, pending asylum seekers. And that's a big deal, because here's what Biden's rule changed in practice. Okay? If somebody crosses the border illegally, files an asylum claim as a defense against deportation, and then is released back into the country, their immigration status shifts overnight from illegal alien to asylum seeker with a pending claim. That single reclassification, triggered by nothing more than paperwork, makes them potentially eligible for federally subsidized healthcare. Not when a judge approves their case. The moment they file, the healthcare kicks in immediately. They just chill and they wait for a court date to have their asylum case adjudicated in, like, I don't know, seven to 10 years. Not hyperbole. There are over 1.4 million asylum cases that are currently pending in U.S. immigration courts. The system resolves roughly 7% of that backlog per year, with new cases continuing to pile on. So for seven to 10 years, while that individual's case sits untouched in a backlog system, American taxpayers are funding their health care coverage. And at the end of that wait, the majority of asylum claims are denied. They were never supposed to be here. They were never supposed to qualify. But they qualified in the interim. And you paid for every year of it. The 1996 law drew a hard line, okay? The 2010 ACA left a phrase undefined, and the Biden administration used that phrase to move an entire population from one side of the line to another. Now, in July 2025, congressional Republicans and President Trump passed the One Big Beautiful Bill Act. And Section 7, 1109 is their solve for everything that I just described to you. It's a direct attempt to reverse the Biden era expansions and restrict eligibility back toward the original 1996 framework. Beginning this year, October 1, 2026, both federal Medicaid matching payments and subsidized ACA marketplace coverage are restricted to US Citizens, lawful permanent residents, Cuban and Haitian entrants under a specific 1980 law, and COFA migrants who are citizens of three Pacific island nations with the legal right to live in the United States. Under a long standing military treaty, refugees, asylees, DACA recipients and Temporary Protected Status holders lose eligibility entirely effective January 1, 2027. And the one big beautiful bill will also close the 90 day self attestation window that I told you about earlier. So under the new law, verification must occur before coverage begins. Oh no coverage unless you're verified. The loophole closed and this is why on October 1, 2025, the federal government shut down for 43 days. Congress needed to pass a continuing resolution to keep the government funded. Democrats refused to vote for the Republican version unless it included a repeal of the One Big Beautiful bills healthcare restrictions, specifically the cuts to Medicaid and ACA eligibility for the populations described above. The Senate held vote after vote. Neither side moved and the government went dark. Federal workers went without pay. Government services ground to a halt. Surely you remember Mike Johnson engaging in this argument over and over again on the nightly news. Take a look.
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They want to spend $1.5 trillion and they want to return hardworking taxpayer dollars to to fund health care for illegal aliens. It is in their bill. Go to speaker.gov and see it for yourself. Page 57, section 2141. They're using this for political games and it is shameful and real people are getting hurt.
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Well that I have looked at that text. It doesn't explicitly say what you are indicating but unauthorized immigrants are eligible for it does.
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It says very simply they want to repeal the changes that we made in the Working Families tax cut. One Big beautiful bill. And what those changes were is it removed health care going to illegal aliens. It removed all the fraud, waste and abuse and the Congressional Budget Office CBO said it achieved the desired result. They project it'll save almost $200 billion. Chuck Schumer's proposal on page 57 wants to return that $200 billion of taxpayer funds to pay for illegal aliens and other non citizens. That is a fact and you can check it out on my website speaker.gov don't trust me? Look at Chuck Schumer's own paperwork. Here are the facts. The proposal does not provide health Care for illegal immigrants. Illegal immigrants cannot buy health care under the Affordable Care Act. They cannot receive health care subsidies. Illegal immigrants are ineligible for Medicare, Medicaid, and the Children's Health Program. The Democratic bill does not make them eligible. It does, actually, because what it does is it unwinds the changes that Republicans put into the big beautiful bill, the big signature legislation that we passed and signed into law on July 4th that has been very successful in ensuring up Medicaid for the people who are actually eligible to receive it. What we did in the bill, and the CBO just verified this three weeks ago, the Congressional Budget Office, the nonpartisan arbiters of everything up here, they said that those provisions have helped to reduce premiums. Why? Because we got ineligible recipients off of Medicaid. Illegal aliens and able bodied young men who are riding the wagon who are not eligible to be there. Medicaid is intended for specific populations of U.S. citizens, I.e. young, pregnant women who are down on their luck. The disabled and the elderly. They. Those resources are being drained from those folks. And so we fixed that. We reduced fraud, waste and abuse in the program. Chuck Schumer's counter proposal on the CR would reverse that. That is a simple fact. The CBO did not say illegal immigrants. You've made your point. Right.
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When the shutdown finally ended on November 12, 2025, Democrats didn't get what they wanted. The continuing resolution that passed left the one big beautiful bill's health care restrictions fully intact. The immigrant eligibility cuts stood. Now, Republicans claimed that it was the Democrats holding the country hostage to restore health care for illegal immigrants. Democrats called it fighting to protect legal immigrants who were losing coverage they had legally held for years. As you can see, both statements are technically accurate, but incomplete. So the Republicans are pointing at the asylum seekers, people who cross illegally filed a claim and access years of federally subsidized coverage before ultimately being denied. That's real. That's documented. But their broader argument goes further. None of these populations, not DACA recipients, not TPS holders, not pending asylum seekers, or ever supposed to be eligible under the 1996 framework. The law explicitly excluded all of them. The eligibility that they gained was never voted on by Congress. It was handed to them by the Biden administration through a regulatory definition of two words that Congress left undefined in 2010. So Republicans argue, accurately, that Biden manipulated the legal framework to cover populations that the 1996 law deliberately excluded. The one big beautiful bill is their correction. Now, Democrats are pointing at the DACA recipients, right? These are people who were brought here as children who've lived here for decades through no choice of their own. By the way, the refugees and asylees who fled documented persecution, the TPS holders whose home countries were destroyed by war or disaster, and they're saying, hey, listen, calling all of them illegal aliens deliberately conflates meaningfully different situations. Most of these people built lives here legally, paid taxes and followed every rule the system gave them, only to have those rules stripped away overnight. Now both groups exist inside the same bill. Neither side is lying to you. They're just leaving out all of the nuance that doesn't serve them. But here's the contradiction that the Democrats can't escape. So if you're going to argue that Obama and Biden had the legal authority to expand the definition of lawfully present and they used it, okay, the argument's legitimate. But it contains a fatal flaw. If the sitting President's administration has the power to redefine who qualifies, well, that power doesn't just belong exclusively to Democratic presidents, it belongs to whoever sits in the White House. You can't argue that Obama and Biden had the legal authority to expand the definition while simultaneously arguing that Trump doesn't have the legal authority to narrow it. It's the same power, it's the same agencies, it's the same two undefined words lawfully present. So the only thing that's changed is who's holding the pen. 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A sufficiently motivated future administration with a cooperative Congress could chip away at the boundaries. So the door has been closed, but hasn't been welded shut. The only true fix for this would be to go back to Congress and fix that ACA statute to define what lawfully present means with precision. And until that happens, the underlying vulnerability remains. Two words still undefined, laying in wait for the next administration that wants to use them. Now, that's the trick. And you see it, right? So, two down, two to go. Next up, you've got the Emergency Medical Treatment and Labor act, also known as emtala. Now, this one was signed into law by Reagan in 86, and the problem that it was solving was a real one, right? Private hospitals were turning away poor patients at the door and dumping them onto public hospitals. And there were people that were dying in parking lots. Emt, ala put a stop to it. Simple rule. If your hospital accepts Medicare funding, and virtually every hospital in America does, then you absolutely must examine and stabilize anyone who walks through your emergency room door. No questions about ability to pay, no questions about legal status. You treat them. And to help hospitals cover the cost, the federal government created emergency Medicaid, a program that reimburses hospitals specifically for those stabilization events. Patients arrive in crisis, hospital treats them. Federal government pays the bill for that specific emergency window. And when the emergency is over, the federal obligation ends, right? Clean, limited, defensible. Until it wasn't. Because undocumented immigrants can't buy insurance on the ACA exchanges and don't qualify for standard Medicaid. The emergency room is not just their entry point into the healthcare system during a crisis, it's their only entry point into the system at all. And that's how emergency care became their primary care. So here's what it looks like in practice, right, you got a patient who arrives at an emergency room with a severe complication from untreated diabetes, a condition building for years with no doctor, no medication, no. No management. Under emtala, the hospital has to stabilize them. It just does. And a hospital social worker helps them then file an emergency Medicaid application on the spot. Federal government pays for that stabilization event. Patient is now stable, but guess what? They still have diabetes. And they'll be back. Not even necessarily because someone is gaming the system, but because a chronic condition with no primary care will eventually end up generating an emergency. So the ER becomes the doctor's office, and every visit triggers a federal reimbursement. That cost doesn't disappear, it just arrives later, sicker and more expensive. Reagan's law was designed for a genuine emergency. Somebody collapses, a car crashes, there's a heart attack. You stabilize them and the federal obligation ends. One crisis, one bill. But now, according to the Congressional Budget Office, which is Congress's nonpartisan fiscal scorekeeper, this costs the American taxpayer nearly $4 billion a year. Because taxpayers are now carrying the weight of an entire uninsured population that just has nowhere else to go. And the system ends up overrun. And it no longer works for the taxpaying citizens it was built to serve. Because we've all been in that same reading room, right? Like an average wait of two and a half hours in some states, it's pushing past four hours. An American without insurance who comes through that same door leaves with a bill, sometimes thousands of dollars, and they're expected to pay it. But the undocumented patient next to them has their visit covered by emergency Medicaid, paid by federal taxpayers. No bill, no copay. A system that's already strained by staffing shortages, aging infrastructure, or shortage of hospital beds is now absorbing a growing population that's using the ER as their only source of care. And here's where the honest conversation requires some nuance, because not everybody in that population is the same. The kid who crossed the border illegally last year filed a fraudulent asylum claim as a mechanism to stay and has been cycling through the system ever since, is not supposed to be here. Full stop. The system was not designed for them. But the 22 year old kid who was carried across that same border at age 4 by parents who made a decision they had no say in, who grew up in America, went to school here, was given temporary protection from deportation under daca, but no path to permanent status, works a minimum wage job, can't access employer insurance, and doesn't qualify for any subsidized coverage. Well, that person is a different conversation entirely. They didn't choose this. And when they get sick, they go to the same emergency room because, as I said, they don't have anywhere else to go. Now, the law treats both of them identically. And neither the people demanding mass deportation nor the people demanding open borders are willing to make that distinction out loud. Because the moment you do, the argument gets complicated. And complicated campaign promises aren't particularly popular ones. Is there any resolution in sight? No, not for this pipeline. The one big beautiful bill didn't touch emergency Medicaid. The treatment mandate stands. But what it did do was cut the federal reimbursement rate states receive for emergency care provided to ineligible immigrants, forcing states to absorb a larger share of the bill that they are legally required to generate. But we're never supposed to be generating at this scale. The only real fix is to change what feeds the pipeline. Close the border, process asylum claims in months, not years, and have the people making the claim remain in Mexico while they wait. Have an honest conversation about which populations have a legitimate right to be here and which don't. And until that happens, the emergency room doors stay open and the bills keep coming. Which brings us to the fourth way people in this country illegally are accessing American health care. And it's through the states. Fourteen states, all blue. I know another shocker. Currently provide some form of health coverage to undocumented immigrants. California, New York, Illinois, Washington, New Jersey, or Oregon. Massachusetts, Minnesota, Colorado, Connecticut, Utah, Rhode Island, Maine and Vermont, plus Washington, D.C. now, some cover only children. Some cover only elderly immigrants. California and Oregon went the furthest, funding full Medicaid equivalent benefits for all low income residents, regardless of immigration status. California is the starkest example because it went the furthest and it hit the wall the hardest. The program was projected to cost just under $6 billion for fiscal year 2024-2025. The actual expenditure came in almost $3 billion higher than projected. So 50% more than you thought. The 2025-2026 budget allocated 8.4 billion from the state's General Fund for Undocumented immigrant coverage, with 1.6 million undocumented immigrants enrolled out of Medi Cal's total 15 million enrollees. That budget blew up so badly that Governor Newsom actually proposed freezing new enrollment for undocumented adults starting January 2026. So the state that pioneered this expansion is now dismantling it because it can't afford it. Illinois spent 1.6 billion over three years covering healthcare for Undocumented immigrants over the age of 42, enrolling twice as many people as planned. Now, despite canceling the program in July 2025, it had already hit a $200 million deficit by the end of September, one quarter into the fiscal year 2026. Launched their expansion in January 2025, and within three months, over 17,000 undocumented individuals had enrolled. That's double their initial three year projection in three months. Okay. At an estimated cost of $550 million, primarily paid for by Minnesota taxpayers, the state paused enrollment by June 2025 and began winding the program down entirely. Every state that launched one of these programs made the same set of promises. The costs will be manageable. Enrollment will stay within projections. It'll pay for itself. And reduced emergency room visits. And every single one of those promises was broken massively. The programs collapsed, not because of federal pressure, but because the costs exploded past every projection. And there was never enough state taxpayer money to cover what legislators had promised. These programs are supposed to be funded entirely on the state's own dime, by the way, state tax revenue. Cuz hold on. Remember, there's no federal law that provides health care for illegal immigrants, right? Money collected from state residents, who in most cases never voted on these programs directly. But regardless, it was their bill to pay. Federal law prohibits it being any other way. Well, guess what? They found another way. Several states engineered specific mechanisms to blur the line between state funded and federally funded, successfully shifting costs onto federal taxpayers who had no idea it was happening and never agreed to it. The first is the Section 1332 waiver. Under the ACA, states can apply for federal waivers to restructure their insurance markets. Colorado used one to create Omni Salud, which routed federal waiver dollars into a program providing subsidized marketplace coverage regardless of immigration status. Federal money flowing through a state waiver covering people the federal government is not supposed to be covering directly. Okay. Congress introduced legislation to close this in March 2026. The second is administrative mingling. So the states run their undocumented immigrant health care programs through the same private health plan administrators, the same billing systems, the same payment tools as their federal Medicaid programs. So when everything runs through the same pipe, it becomes pretty difficult to separate which dollar is state money and which dollar is federal. I've been doing a little spring reset with my closet lately, focusing more on quality over quantity and just building a wardrobe of pieces that are well made, versatile, and easy to reach for every day. And that's why I keep coming back to Quince. The fabrics feel elevated, the fits are thoughtful and the pricing actually makes sense. 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Quints.com Jillian so in March 2026, the House Committee on Energy and Commerce sent letters to 10 states Colorado, California, Massachusetts, Maine, Nebraska, New York, Oregon, Pennsylvania, Vermont and Washington requesting information on their Medicaid billing practices. The question in every case is the same how much federal money flowed into shared billing pools that also covered people who are never federally eligible. Now the third way that states are pulling this off is what investigators call the lawfully present stretch. So states use the Biden era expanded definition of lawfully presentation to reclassify people who had been on state only funding where the state was supposed to pay 100%. And they used this to move them onto a federal match funding where the federal government picks up 50 to 90% of the cost. 1. Eligibility reclassification on paper, billions shifted from state books to federal ones in actual practice, and Washington has has had it. The one big beautiful bill included a direct financial penalty for the 14 states providing coverage to undocumented immigrants using state funds, cutting their federal Medicaid matching rate for aca expansion from 90% to 80%. And for large states like California and New York, that translates to hundreds of millions of dollars in lost federal funding annually. But the penalty provisions are the least of it. The federal government is now actively clawing back money it believes was fraudulently billed for. So the federal government's position is now explicit. These states are not making good faith errors. They're using federal dollars to cover their own budget shortfalls for non citizen care populations their own legislatures chose to cover. And then they're sending the bill to Washington in the most manipulative fashion possible. And as one Republican legislator put it we're not gonna pay for illegal immigrants in states that are submitting those claims. Why should people living in Mississippi or Texas or Florida be paying for illegal immigrants getting health care in California? So the money's being frozen, the audits are active. And for the first time, the federal government is not tolerating this, not as a policy disagreement, but as what it actually is, which is fraud. Hold on. Okay, the whole. There's no federal law that covers health care for people who are illegal. It cuts both ways because you're correct, it is illegal. But it's happening anyway, which makes it fraud. And these are the facts. So what you do with these facts is up to you. As always, I'm going to tell you where I land. Millions of Americans, people who were born here, who work here, who painted this system every single day, are locked out of the very safety net that their money funds. And this is not just a policy failure. It's the kind of imbalance that breeds resentment, that fractures trust, and that erodes the social contract itself. And the truth is, you don't see it at first glance. Because the reality isn't sitting in the headlines. It's buried in the fine print in definitions and loopholes, in the kind of details that most people don't have the time to dig into. But on issues this consequential, we don't get the luxury of staying at the surface. Okay, so for me, this is not about being anti immigration. It's actually the opposite. I'm pro legal immigration. This country was built by people who came here the right way, who contributed, who assimilated, and who strengthened it over generations. That system works when it's respected. And at the same time, there is room for real empathy here for the kid brought here at 4 years old who had no say. For the legitimate refugee fleeing something most of us cannot even imagine. A serious country can hold both of those truths at once. It can legislate nuance, but nuance requires honesty. And that's where things get murky. Because when policies consistently stretch beyond what was written, when definitions quietly expand, when incentives start to look misaligned with outcomes, people are going to ask, why now? Some will say it's compassion. Others will point out that the census doesn't count immigration status, it counts bodies. And the more bodies a state has, the more seats it gets in the House and the more electoral college votes it controls. Blue states have seen record out migration of American citizens over the last decade. You don't have to be a conspiracy theorist to ask whether any of this is connected. You just have to be willing to ask the question. Because this is bigger than one policy. It's about power. It's about incentives. And it's about whether the system is operating the way you were told it is. Which brings this back to you. None of this changes unless people are paying attention. Not to the slogans, not to the viral clips, to the actual mechanics. Mechanics of how policy works and who it benefits. The two words that Congress left undefined and what happened when nobody was watching. That's what it comes down to. To the difference between the administration that opened the door and the one trying to close it. Because that difference is not rhetorical. It is regulatory. It is billions of dollars. It is the rules that govern your life, written in language designed to make sure you never notice. You've got to notice anyway. Understand what you're voting for. Not just at the top of the ticket, but all the way down. The state legislator that funds health care for the undocumented immigrants with your tax dollars and then sends the bill to Washington. The congressman who leaves critical terms undefined because ambiguity is more useful than clarity. The senator who shuts down the government for 43 days over two words rather than simply defining them. You can have empathy and be practical at the same time. In fact, you must. Because one without the other is naive or cruel. And the goal is a system that works, that's fair, that is enforceable, that honors the people who built it and offers a real pathway for the people who deserve one. That system is possible, but it requires voters who understand what they're actually voting for. And now you do. As always, team, if you're liking the show, please be sure to, like, share, comment, subscribe. It helps us a fricking ton with the algorithm. Thanks so much. We'll be talking to you next time. Thank you so much for watching. If you enjoyed the podcast, please, like, comment, subscribe and share. And make sure to let me know what guests you want to see on in the future.