SPRINGFIELD, Ill. (AP) — Gov. JB Pritzker's positioning of Illinois as a sanctuary state, a welcoming port for immigrants from across the globe, hit the hard reality of state budgeting this spring.
The Democrat is a leading critic of President Donald Trump's administration, especially its immigration policies. But facing a budget shortfall for the upcoming fiscal year, Pritzker's proposed $55.2 billion fiscal plan would cut part of a four-year-old program providing health coverage to some adults regardless of immigration status. Illinois is one of seven states and the District of Columbia to offer such a program.
California, which last year one-upped Illinois by offering health care to all adult immigrants, has run into a similar revenue problem and plans to halt enrollment in its program.
Rep. Barbara Hernandez, a suburban Chicago Democrat, said the program helps many families.
“There's a huge need in the undocumented community that cannot get health care otherwise,” she said.
If Democrats, who control the Illinois General Assembly, can’t find money to continue the plan — estimated to cost $404 million this year — tens of thousands of migrants will be left without Medicaid-style health coverage.
It might not be just a question of revenue, but of will, given threats by congressional Republicans. As the GOP attempts to cut spending, including Medicaid, to make Trump's hoped-for tax cuts affordable, states' immigrant health programs will be in the crosshairs.
What is the program?
In 2020, Illinois became the first state to offer needs-based health insurance to all older adults, including low-income migrants who entered the country illegally, when it introduced Health Benefits for Immigrant Seniors, covering those 65 and older. In 2021, it introduced a second program which became Health Benefits for Immigrant Adults, for immigrants aged 42 to 64.
Enrollment in both programs has been halted, but the seniors' program will continue for current enrollees after June 30, while the program for those younger than 65 will end.
What's happening elsewhere?
California, Minnesota, Oregon and Washington, D.C. also provide public health insurance to adults, regardless of immigration status, according to the Los Angeles-based National Immigration Law Center. Colorado and Washington provide insurance obtained via the private market with state financial support. Like Illinois, New York covers older migrants with a public program.
California Democratic Gov. Gavin Newsom, who like Pritzker has presidential ambitions, last week announced a freeze on enrollment in that state’s immigrant health care program. Costs ran $2.7 billion over forecast for 1.6 million participants.
How big — and costly — is the Illinois program?
There are about 31,500 program participants in the under-65 crowd and the cost to cover them this year is estimated at $404 million. The two programs together enroll over 43,300 at an estimated cost of $538 million this year. With an estimated 400,000 immigrants without legal permission to live in Illinois, supporters point out that participation is likely far below eligibility.
Why is free health care available to migrants?
Supporters say the programs ensure a healthier state. People are more able to work. They're more likely to visit doctors and catch small problems before they become catastrophes. They can manage chronic illnesses such as diabetes and stave off new health concerns.
And they're not exactly getting it for free, proponents maintain. Immigrant-led households in Illinois pay $8.6 billion a year in state and local taxes, according to a 2024 University of Illinois at Chicago study.
"This argument of immigrants leeching or taking resources — they’re actually more likely to be working and additionally are absolutely paying taxes for which they are not receiving benefits in return,” said Tovia Siegel of The Resurrection Project, a Chicago-based immigrant justice advocacy group.
Illinois Republicans aren't on board. Rep. Ryan Spain, a deputy House minority leader from Peoria, points out that Congressional Republicans are wondering why states complaining about federal cuts to Medicaid somehow have enough in state coffers to cover the immigrant programs.
“The high cost of the program outweighs some of the arguments proponents make,” Spain said. “It's an unaffordable beacon to attract additional illegal immigrants to the state of Illinois.”
Are there tangible cost savings?
The programs have saved Illinois hospitals considerable sums, according to a study released this month.
People without insurance often treat the emergency room, where costs can by sky-high, as their doctor's office. Hospitals often eat those bills.
A study by the Embodying Racism Lab at the University of Chicago found that since the Health Benefits for Immigrants programs started, hospitals' bad debt — payment owed for services which administrators consider "unlikely or unattainable" — fell by 15%, the equivalent of $1.5 million per year per hospital.
“Our findings suggest these programs have the potential to both improve equity in healthcare access and ease the financial burden on hospitals that serve all residents of Illinois,” the study reported.
What are lawmakers doing?
Talks about putting together a state budget are just warming up, even though the Legislature’s spring session ends May 31. Sen. Elgie Sims of Chicago, the Senate Democrats' appropriations leader, said the health program is one of many worthy endeavors vying for a place in the spending column.
Matthew Lopas, director of state advocacy for the National Immigration Law Center, issued a challenge to Pritzker and the General Assembly to “hold the line and remain committed” during “a time of extremist politicians who are out there scapegoating immigrants.”
John O'connor, The Associated Press
