Immigrants Without Legal Status May Lose Health Care In States

Summary

Summary of NPR Politics Podcast Episode: "Immigrants Without Legal Status May Lose Health Care In States"

Release Date: May 22, 2025
Host: Miles Parks

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1. Introduction to the Issue

In this episode of NPR Politics Podcast, host Miles Parks delves into the pressing issue of healthcare access for immigrants without legal status in the United States. Parks highlights recent developments in two pivotal states—Minnesota and California—where legislative changes threaten to roll back healthcare coverage for this vulnerable population. The discussion underscores the complexities of state budget negotiations, political dynamics, and the real-world impacts on affected individuals.

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2. Minnesota’s Healthcare Policy Changes

Budget Negotiations and Legislative Dynamics

Minnesota is currently navigating a challenging state budget negotiation amidst a closely divided legislature—comprising 101 Democrats and 100 Republicans. The legislative session, which concluded on May 19th, necessitates a special session to finalize the budget. A critical point of contention has emerged around the inclusion of immigrants without legal status in the state's public health insurance program, Minnesotacare.

Republican Demands and Democratic Compromises

Republican lawmakers have leveraged the budget negotiations to push for the exclusion of adults without legal status from Minnesotacare. Specifically, Republicans advocate for removing coverage for adult immigrants, a stance that has compelled Democrats to consider significant compromises to secure budget approval.

Governor Tim Walz’s Position

Governor Tim Walz has publicly expressed his reluctance to exclude immigrants from healthcare coverage. Despite his opposition, Walz acknowledges the need for compromise in the face of a nearly evenly split legislature. In Rolling out the proposed agreement, Walz stated:

"I don't think everybody to be happy in this. I think many of us compromised."
—[03:23] Governor Tim Walz

Walz prioritized maintaining healthcare coverage for children, ensuring that minors remain eligible under Minnesotacare even as adult coverage faces potential removal.

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3. California’s Healthcare Policy Changes

Governor Gavin Newsom’s Budget Proposal

Contrasting Minnesota, California is grappling with a substantial $12 billion budget deficit. In response, Governor Gavin Newsom has proposed freezing new enrollments in the state's Medicaid program, Medi-Cal, for adults without legal status. This measure aims to curb escalating healthcare costs without abruptly cutting off existing coverage.

Legislative Process and Political Environment

California’s legislative environment poses different challenges. Despite being a predominantly Democratic state, significant pushback has emerged from within the Democratic caucus, particularly the Latino caucus, which vehemently opposes the freeze on adult enrollments. Senator Lena Gonzalez, a Democrat representing Los Angeles, articulated the internal conflict:

"We can look at options for budget cuts elsewhere... without always having to look at our most underserved communities."
—[05:32] Senator Lena Gonzalez

Meanwhile, Republicans criticize the proposal for maintaining existing coverage through a freeze, arguing it perpetuates spending on healthcare for individuals without legal status.

Governor Newsom’s Stance

Governor Newsom remains steadfast, emphasizing the necessity of adjusting healthcare expenditures to address the budget deficit. When questioned about the negotiations, he remarked:

"I don't want to be in this position, but we are in this position."
—[06:28] Governor Gavin Newsom

He further clarified that the approach focuses on modifying the comprehensive nature of care rather than cutting off coverage entirely.

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4. Impacts on Migrants

Minnesota’s Scenario

In Minnesota, approximately 20,000 individuals have enrolled in Minnesotacare since its expansion to include immigrants without legal status, with around 3,000 being children. Under the proposed changes, adults will lose eligibility and be removed from the program, while children will retain their coverage until 2026.

California’s Scenario

California has seen a significant enrollment of 1.6 million immigrants without legal status in Medi-Cal. If Newsom’s proposal is adopted, enrollment for adult immigrants would cease in January of the following year. Experts and lawmakers warn that this freeze would likely lead to increased emergency room visits, as uninsured individuals forego preventive care.

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5. Public Opinion and Political Implications

Public Reactions and Advocacy

Public sentiment varies between the two states. In California, there is robust support for Medi-Cal coverage for children without legal status, but opinions are divided regarding adults aged 18 to 49. In Minnesota, community backlash includes appeals from religious groups, immigrant advocates, and healthcare providers emphasizing the personal and financial repercussions of losing coverage.

Political Ramifications for Governors

Both Governors Walz and Newsom are potential candidates for the 2028 Presidential election, adding a layer of political strategy to their healthcare decisions. Governor Walz’s actions may be interpreted as necessary compromises in a tightly divided legislature, potentially appealing to bipartisan voters. Conversely, Governor Newsom faces scrutiny over his policy shifts, with some perceiving his actions as inconsistent with his previous stances on issues like homelessness and spending.

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6. Conclusion

The episode concludes by highlighting the delicate balance state leaders must maintain between fiscal responsibility and humanitarian considerations. As Minnesota and California navigate their respective budget crises, the fate of healthcare coverage for immigrants without legal status remains uncertain, leaving thousands vulnerable to losing essential medical services.

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Notable Quotes:

• Governor Tim Walz:
  "We didn't expect everybody to be happy in this. I think many of us compromised."
  —[03:23]

• Senator Lena Gonzalez:
  "We can look at options for budget cuts elsewhere... without always having to look at our most underserved communities."
  —[05:32]

• Governor Gavin Newsom:
  "I don't want to be in this position, but we are in this position."
  —[06:28]

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This comprehensive summary encapsulates the key discussions, stakeholder perspectives, and potential implications surrounding the proposed healthcare policy changes affecting immigrants without legal status in Minnesota and California. Listeners gain insight into the intricate interplay of politics, budgetary constraints, and the human impact of these legislative decisions.

Transcript

[Ann Marie Baldonado]

This is FRESH AIR contributor Ann Marie Baldonado. I talked with actor Cole Escola about their hit Broadway play, O Mary. Cole plays an unhinged alcoholic Mary Todd Lincoln, who's an aspiring cabaret performer.

[Dana Ferguson]

If that makes no sense, that's part of the point.

[Ann Marie Baldonado]

You can find my interview on the FRESH AIR podcast. Hi there. This is Larissa, and I'm enjoying the rainy sounds of spring in the Midwest here in the United.

[Miles Parks]

This podcast was recorded at 1:34pm on Thursday, May 22, 2025.

[Ann Marie Baldonado]

Things may have changed by the time you hear this, but I'll be looking for the flowers following these spring showers. Enjoy the show.

[Miles Parks]

I feel like I just started using a white noise machine to sleep, and now I'm the vibes are okay waking up. Hey there. It's the NPR Politics podcast. I'm Miles Parks. I cover voting. And today on the show, healthcare for migrants who are in the US without legal status. So in recent years, we've seen some blue states expand coverage for those folks, but now we're seeing a rollback. And I'm joined today by reporters from two of the states where this is playing out right now. And I'm joined here by reporters from two of the states where this is playing out now. Cap Radio's Laura Fitzgerald in California and and Minnesota Public Radio's Dana Ferguson in St. Paul. Hi to you both.

[Dana Ferguson]

Hello.

[Miles Parks]

Thanks for being here. So, Dana, let me start with you. Walk me through exactly what's happening in Minnesota and also the reasoning that Governor Tim Walz is giving for the proposed changes.

[Dana Ferguson]

Sure. Just to give folks a sense of what's going on here, we're in the midst of some negotiations about the state budget. Our legislative session closed up on the 19th, and there's still some work to be done in a special session. The biggest pieces of the budget aren't resolved yet. And also, just to give folks a sense, it's about as evenly divided here in our legislature as you can be. There are 101 Democrats, 100 Republicans. And so compromise is a big part of what's going to get us out of here. And Republicans came into negotiations for a budget with a condition that they wanted to see coverage Minnesotacare, which is the public health insurance program for low income people, change so that it no longer includes coverage for immigrants in the country without legal status. And specifically what they landed on is taking away coverage for adults. So we're just waiting for something to get buttoned up. But that's been a big part of it. And Governor Walz has said he doesn't like this idea, but they really want to get a budget passed.

[Miles Parks]

That's what I was going to say. So this is not something that Democrats are in favor of now, too. It's not like they've changed their mind on this issue. It's just basically the budget is top priority.

[Dana Ferguson]

That's exactly right. The governor and other Democrats have said if they had it their way, this would not be part of the conversation. But they recognize that they're in a nearly evenly split legislature, so something had to give. And they said to keep some other policy provisions they really wanted and fought hard for under Democratic control the last two years. This is what they were willing to sacrifice. And here's what the governor said as they rolled out this agreement.

[Gavin Newsom]

And I'm not going to sugarcoat how difficult this was then.

[Dana Ferguson]

These lawmakers are there.

[Gavin Newsom]

They have their voice heard. We'll vote on this. We didn't expect everybody to be happy in this. I think many of us compromised.

[Dana Ferguson]

The governor noted that again, he really didn't like this deal. It was hard to make, but he wanted to make sure kids were kept on for their coverage, and that's something that they were able to agree to.

[Miles Parks]

Laura, how does this compare to what's happening in California?

[Ann Marie Baldonado]

Yeah, well, Governor Gavin Newsom is also proposing this change amid a pretty bleak budget outlook. The state facing a $12 billion budget deficit. And so he says in order to save the state some money, you know, medical, that's what we call Medicaid out here. It's, it's way over budget. And there, there needs to be cuts to this program. Newsom's proposal, it's a little different, though, than what's going on in Minnesota. It's a freeze on new enrollments. So it won't cut anybody off from program, from the program or from coverage. Like, like in Minnesota, kids could also stay on on Medi Cal. And California also has some more time to figure this out. State lawmakers have until June 15 to adopt a final budget. So there's still about a month or so of negotiations to go before they figure out what's going to happen with this new proposal.

[Miles Parks]

But there's also the other big difference here between the two states. Right. Is the political environment. And California is a much more Democratic state than Minnesota is. Is, are Democrats in the legislature going along with this proposal?

[Ann Marie Baldonado]

Yeah. So Democratic lawmakers in the legislature's Latino caucus pushing back on this proposal pretty, pretty fiercely. They fought hard for this expansion in the first place. And now just a year after the Full expansion went into effect. It's being paused. I spoke with Senator Lena Gonzalez. She's a Democrat who represents parts of Los Angeles. And this is what she told me. We can look at options for budget cuts elsewhere. We can be a little bit more mindful of how we do this without always having to look at our most underserved communities. And, you know, folks right now are seeing rich people get richer, billionaires, you know, leading. And they're thinking, where. Where am I in this space?

[Dana Ferguson]

Where.

[Ann Marie Baldonado]

Where do I fit in? And I keep working really hard with no. With no end in sight for additional attacks. It's just. It's really hard to swallow. So Gonzalez says they're trying to find ways to maintain this coverage during the last month of budget negotiations. Maybe look for other places where they can negotiate with the governor's office on. On different places to cut. And then, like you said, Republicans are a super minority in California, but they're also criticizing Newsom for this proposal because it doesn't actually cut anyone off. It's just a freeze. So Republicans say that this is basically a budget proposal that's allowing the state to continue spending for health care for people without legal status, which is something they opposed from the get go. I asked Newsom about how he sees these negotiations going over the next month or so with the legislature, and he said it's pretty much a hard line for him. This is how he summed it up.

[Gavin Newsom]

I don't want to be in this.

[Ann Marie Baldonado]

Position, but we are in this position.

[Gavin Newsom]

And instead of rolling back the program, meaning cutting people off for basic care, we have to adjust the comprehensive nature of the care.

[Miles Parks]

Health care for anyone, I feel like, does become a pretty quickly an emotional issue for some lawmakers. Have you seen that, Dana? And how some lawmakers have been talking about it or have been trying to. To sway walls one way or the other?

[Dana Ferguson]

Yeah, they really have. At Governor Walz's press conference last week, we heard members of his own party, Democrats, pounding on the door and yelling out in opposition to this idea. They said they really don't want to go the opposite direction after making this health insurance accessible to folks who'd never really had it before, had seen serious benefits from it. They shared stories about how adult immigrants who'd never had coverage before were able to get cancer care care for various medical diagnoses that they not had access to previously. And for a number of them, it was really personal. They were sons and daughters of immigrants. They were friends and community members who had fought for this coverage, and they really told the governor, Governor Walz, that he shouldn't go in this direction as part of a compromise.

[Miles Parks]

Okay. Well, we're going to take a quick break, and when we get back, we'll talk more about how some of these policies could actually impact people.

[Gavin Newsom]

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[Ann Marie Baldonado]

Level today, I'm Tanya Mosley, co host of FRESH air. At a time of sound bites and short attention spans, our show is all about the deep dive. We do long form interviews with people behind the best in film, books, tv, music and journalism. Here our guests open up about their process and their lives in ways you've never heard before. Listen to the FRESH AIR podcast from NPR and whyy.

[Miles Parks]

And we're back. So, Dana, let's talk about how these proposals would actually impact people. Do we have any sense of what that would look like in Minnesota?

[Dana Ferguson]

Yeah, we know that about 20,000 people have enrolled since this program was expanded to include immigrants without legal status. Again, 20,000 new people. About 3,000 of those are kids. So the kids that are on the program would still be eligible, could continue into 2026, but those adults would no longer be eligible and would be removed if they're currently accessing coverage. The governor has said that that was really important to him. That was a big point of the compromise and something he wanted to keep.

[Miles Parks]

And what about California, Laura, how many people have used this program since it's been expanded?

[Ann Marie Baldonado]

So since the program's been fully expanded, 1.6 million immigrants without legal status are currently enrolled in Medi Cal. And throughout the end of this year, people without legal status can still sign but under Newsom's budget proposal, enrollment would freeze for adult immigrants in January of next year if it's adopted. And experts, lawmakers, and even Newsom acknowledge that people without insurance coverage will end up seeking care in the state's emergency rooms. So in some ways, taxpayers pay for this care either way on the front end or the back end.

[Miles Parks]

Wow. Yeah. I can imagine advocates are probably running around California then, trying to get as many people signed up this year as absolutely possible. Are we seeing that at all?

[Ann Marie Baldonado]

Yeah, absolutely. And I think, you know, because this isn't set in stone yet, there's still a lot of, you know, I think a lot of the work's being done in the legislature right now to see if there's a way to avoid this enrollment freeze. So I think that's really where the focus is right now. But certainly, I mean, there. There could be really big changes to people's access to care if this proposal is adopted.

[Miles Parks]

Do we have any sense on how the public feels about this idea about providing healthcare for people who are in this country without legal status?

[Ann Marie Baldonado]

Californians support Medi Cal coverage for children without legal status, but the public's a little more divided when it comes to the 18 to 49 age group, and that's the age group that would really be impacted by this enrollment freeze. Like we said earlier, children would still be allowed to enroll in the Medi Cal program.

[Dana Ferguson]

Yeah. And to Laura's point, I don't know that we have the same level of recent polling in Minnesota, but what we've heard at the Capitol is there is public blowback to this effort to roll back coverage. Religious groups, immigrant advocates, and hospitals have been here in the last week or so saying, please don't do this, because, number one, folks care about individuals in their communities who might not be able to access health care anymore. And also there is that financial impact to hospitals if folks are uninsured and are coming to the emergency room for care rather than getting treatment earlier and detecting things that could be serious.

[Miles Parks]

I do feel like the other elephant in the room politically is that two of the main characters that we're talking about here, Governor Tim Walls and Governor Gavin Newsom, are in the conversation to run for President Potentially in 2028. Do you guys see that playing a role at all in this story?

[Dana Ferguson]

Yeah. It's hard not to look at a former vice presidential candidate in Governor Walz and think that he might not be thinking about the future. He's not committed to running for re election for governor yet, but says he'll do that potentially soon make an announcement. He's still circulating in other states doing town halls and political functions. And I think in the past, he's presented himself as someone who can work across the political aisle and said that's a positive for him as a candidate. So I imagine if he's got his sights set on 2028 or another, another office, some other time, he is going to look at this decision and be able to come back to it and say, maybe I didn't love this, but it's something that I was able to do as an act of compromise.

[Ann Marie Baldonado]

Yeah. And out in California, I mean, Newsom is widely seen as somebody who's evaluating a move for a presidential bid in 2028. You know, and when he's asked about this, he doesn't say one way or the other. You know, he, he's really, when it comes to this policy, in this proposal, he's really framed it in the sense that medical is way over budget in California and that we just need to make up for a $12 billion budget deficit. But I think the thing that you can't ignore here is that Newsom has been changing his tune on lots of different polic in the past few years, homelessness, spending, and he issued an executive order last summer on encampment removals things, things like that. And so I think that that is really important context in this backdrop of, you know, a potential reason why he's making this policy shift to the middle. I think, I think a lot of people see it that way out here in California.

[Miles Parks]

Okay, Cap Radio's Laura Fitzgerald and Minnesota Public Radio's Dana Ferguson, thank you both for walking me through this.

[Dana Ferguson]

You're welcome, Miles.

[Ann Marie Baldonado]

Thanks so much, Miles.

[Miles Parks]

And I'm Miles Parks. I cover voting. Thank you for listening to the NPR Politics podcast.

[Dana Ferguson]

On the Indicator from Planet Money podcast, we're here to help you make sense.

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[Gavin Newsom]

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