The federal government shutdown has boiled down to one issue: whether taxpayers should continue footing the medical bills for illegal immigrants.
Democrats are demanding renewed funding for “emergency Medicaid,” a program that reimburses hospitals for treating non-citizens, including those in the country illegally. Republicans have refused, calling the spending “out of control” and insisting that the money should go to American citizens instead.
According to federal data, emergency Medicaid payments for undocumented immigrants nearly doubled from $4 billion in 2023 to more than $9 billion in 2024, with California alone accounting for 70 percent of that cost. Republicans say hospitals and health networks have turned the program into a profit center, while emergency rooms have become overcrowded and inaccessible for law-abiding Americans.
“The healthcare lobby is one of the most powerful in Washington,” one GOP strategist said. “They’re making millions off taxpayer money for illegals while American citizens can’t even get into an ER.”
Democrats argue that the provision isn’t about illegal immigrants, but rather asylum seekers and individuals with temporary protected status. They say repealing the funding would represent “the largest cut to Medicaid ever.” But Republicans note that the changes under President Trump’s Big Beautiful Bill actually increases Medicaid spending for American citizens by removing fraudulent and non-eligible claims.
In states like New York and California—both sanctuary states—the number of emergency Medicaid cases involving undocumented patients has skyrocketed by as much as 1,400 percent in recent years. Republicans say that surge is draining local hospitals and worsening the healthcare crisis for working families.
“This is a hill we’re willing to fight on and we’re not going to give up,” said one House Republican. “American citizens must come first. If the Democrats want to shut down the government to fund illegal immigrant healthcare, that’s on them.”