Congress remains mired in a bitter debate over the fate of enhanced Obamacare subsidies that could subject some Americans to triple-digit premium hikes if allowed to expire at the end of this year.
But with open enrollment newly underway, there is little discussion about the one group set to feel the full brunt of the premium increases: hundreds of thousands of legal, taxpaying immigrants.
A provision in the One Big Beautiful Bill Act Republicans passed in July strips all Obamacare subsidies from low-income lawfully present immigrants — those authorized to work and live in the country but unable to qualify for Medicaid yet. This could result in 300,000 people losing coverage next year because they can’t afford it, according to the nonpartisan legislative scorekeepers at the Congressional Budget Office, with nearly 1 million immigrants losing their insurance by 2034.
Democrats, who are preoccupied with getting an extension of the enhanced subsidies, say it will be hard to undo measures in the megabill.
“Once we get the government open maybe we can get them to negotiate on that, but I am not optimistic,” said Sen. Mark Kelly (D-Ariz.) on Friday.
Immigration advocates worry that the impact of the loss is being underestimated and predict that entire families could lose access, including U.S. citizen spouses and children. The policy could also raise insurance prices for everyone, said Arturo Bustamante, a professor at the UCLA Fielding School of Public Health, since immigrants tend to be younger and use fewer health services than the general population.
“This could potentially trigger some local markets to go into death spirals,” said Bustamante, who focuses on the health impacts of immigration policy. “If you only keep unhealthy people insured, who are expected to have high utilization of services, that essentially makes insurance really expensive.”
The 2010 Affordable Care Act offered insurance subsidies in the form of tax credits to lawfully-present immigrants who earned less than 100 percent of the federal poverty level — roughly $15,000 a year. The policy made it easier for green card holders, asylum seekers and refugees to qualify — some of whom are barred by law from Medicaid coverage for at least 5 years after arriving in the U.S.
The Obamacare tax credits, meant to fill this gap in coverage, will disappear starting next year due to a provision in Republicans’ One Big, Beautiful Bill Act. And in 2027, lawfully-present immigrants who earn more than 100 percent of the poverty level will lose discounted Obamacare rates available to citizens, based on income.
While Republicans have repeatedly accused Democrats of using the government shutdown as leverage to ensure health care access for unauthorized immigrants, such immigrants were never eligible for Medicaid or ACA subsidies.
State action
States and advocacy groups are scrambling to warn immigrants about the impending change and get the word out about their options.
Connecticut’s state-run Obamacare exchange, for example, is among those that ramped up in-person outreach to immigrants, according to its CEO, James Michel.
Advocates are stressing immigrants need to pay attention to the fine print of this open enrollment, which kicked off on Saturday for most states.
“They need to make sure they accurately represent their income, particularly if their income might be higher than the poverty line this year [because] that would make them eligible for tax credits,” said Ben D’Avanzo, senior strategist for the National Immigration Law Center.
Some states have stepped in to provide Medicaid coverage for immigrants who don’t qualify yet for the program.
The 2009 Immigrant Children’s Health Improvement Act allows states to waive the five-year waiting period for children and pregnant women. As of April 2025, 37 states and the District of Columbia have taken up this option for children and another 31 for pregnant women, according to an analysis fromthe health policy research group KFF.
Fourteen states and the District of Columbia offer coverage for children regardless of their immigration status, including unauthorized immigrants, but these states have to use their own funds to pay for it. Unauthorized immigrants are not eligible for Medicaid or ACA subsidies.
Since September 2025 seven states — Illinois, Minnesota, New York, Colorado, Oregon, Washington and California — have offered Medicaid to anyone whose income qualifies regardless of immigration status. However, California, Minnesota and Illinois are scaling back their programs due to budget concerns, according to KFF.
Uncertain fate
Lawfully-present immigrants are bracing for an additional blow to their health care access: the expected revival of the so-called “public charge rule” from Trump’s first administration — which could penalize immigrants who take advantage of the health insurance programs they remain legally entitled to.
The Department of Homeland Security sent a draft proposal of the regulation to the White House on Monday — typically the final step before it is published for public comment.
The previous version of the policy, which the Biden administration stopped enforcing in 2021 and scrapped in 2022, empowered the government to deny immigrants’ applications for permanent resident status if they had received or were expected to receive food or housing assistance, Medicaid, or other public benefits. While the U.S. has long imposed restrictions on immigrants considered a burden on taxpayers, the Trump administration was the first to designate public health insurance as a form of welfare.
The scope of the new version of the rule is not yet known — which immigrants it will apply to and what kinds of benefits will be implicated — but data has emerged about the impact of the previous iteration that has alarmed advocates for immigrants.
“The public charge rule intensified a lot of people’s existing fears of accessing public benefits,” said Adriana Cadena, executive director of the advocacy group Protecting Immigrant Families. “Bringing it back now would only compound that effect, since there’s already a target on immigrants’ backs, and further erode their trust in government.”
A 2021 study found that the rule led many low-income immigrants to avoid using health services, including more than a quarter of legal permanent residents, who were not subject to the rule. The chilling effect began years before the policy took effect, fueled by rhetoric from federal government officials, the UCLA researchers found, and continued for more than a year after President Joe Biden got rid of the rule.
“When you take health care away from one person in a family, the rest of the family is less likely to get the care they need even if they still qualify,” said Cadena.
Bustamante predicted, based on this and other research, that both a revived public charge rule and the loss of ACA subsidies for legal immigrants will have spillover effects for the entire population. For instance, he said, the policies could burden already stressed hospitals if immigrants without health insurance skip preventive care and end up in the emergency room, and they could make it harder to control outbreaks of infectious diseases by deterring immigrants from seeking testing and treatment.
