California Gov. Gavin Newsom, who is eyeing a presidential bid, has incensed both Democrats and Republicans over immigrant health care in his home state, underscoring the delicate political path ahead. <\/p>\n
For a second year, the Democrat has asked state lawmakers to roll back coverage for some immigrants in the face of federal Medicaid spending cuts and a roughly $3 billion budget deficit<\/a> that analysts warn could worsen<\/a> if the artificial intelligence bubble bursts. Newsom has proposed that the state not step in when, starting in October, the federal government stops providing health coverage to an estimated 200,000 legal residents \u2014 comprising asylees, refugees, and others<\/a>.<\/p>\n Progressive legislators and activists said the cost-saving measures are a departure from Newsom\u2019s \u201chealth for all\u201d pledge<\/a>, while Republicans continue to skewer Newsom for using public funds to cover any noncitizens.<\/p>\n Newsom\u2019s latest move would save an estimated $786 million this fiscal year and $1.1 billion annually in future years in a proposed budget of $349 billion, according to the Department of Finance.<\/p>\n State Sen. Caroline Menjivar, one of two Senate Democrats who voted against Newsom\u2019s immigrant health cuts last year, said she worried the governor\u2019s political ambition could be getting in the way of doing what\u2019s best for Californians.<\/p>\n \u201cYou\u2019re clouded by what Arkansas is going to think, or Tennessee is going to think, when what California thinks is something completely different,\u201d said Menjivar, who said previous criticism got her temporarily removed<\/a> from a key budget subcommittee. \u201cThat\u2019s my perspective on what\u2019s happening here.\u201d<\/p>\n Meanwhile, Republican state Sen. Tony Strickland criticized Newsom for glossing over the state\u2019s structural deficit<\/a>, which state officials say could balloon to $27 billion the following year. And he slammed Newsom for continuing to cover California residents in the U.S. without authorization. \u201cHe just wants to reinvent himself,\u201d Strickland said.<\/p>\n It\u2019s a political tightrope that will continue to grow thinner as federal support shrinks amid ever-rising health care expenses, said Guian McKee, a co-chair of the Health Care Policy Project at the University of Virginia\u2019s Miller Center of Public Affairs.<\/p>\n \u201cIt\u2019s not just threading one needle but threading three or four of them right in a row,\u201d McKee said. Should Newsom run, McKee added, the priorities of Democratic primary voters \u2014 who largely mirror blue states like California \u2014 look very different from those in a far more divided general electorate.<\/p>\n Americans are deeply divided on whether the government should provide health coverage to immigrants without legal status. In a KFF poll<\/a> last year, a slim majority \u2014 54% \u2014 were against a provision that would have penalized states that use their own funds to pay for immigrant health care, with wide variation by party. The provision was left out of the final version of the bill passed by Congress and signed by President Donald Trump.<\/p>\n Even in California, support for the idea has waned amid ongoing budget problems. In a May survey<\/a> by the Public Policy Institute of California, 41% of adults in the state said they supported providing health coverage to immigrants who lack legal status, a sharp drop from the 55% who supported it in 2023<\/a>.<\/p>\n Trump<\/a>, Vice President JD Vance<\/a>, other administration officials<\/a>, and congressional Republicans have repeatedly accused California and other Democratic states of using taxpayer funds on immigrant health care, a red-meat issue for their GOP base. Centers for Medicare & Medicaid Services Administrator Mehmet Oz has accused California<\/a> of \u201cgaming the system<\/a>\u201d to receive more federal funds, freeing up state coffers for its Medicaid program, known as Medi-Cal, which has enrolled roughly 1.6 million immigrants without legal status.<\/p>\n \u201cIf you are a taxpayer in Texas or Florida, your tax dollars could\u2019ve been used to fund the care of illegal immigrants in California,\u201d he said in October.<\/p>\n California state officials have denied the charges, noting that only state funds are used to pay for general health services for those without legal status because the law prohibits using federal funds. Instead, Newsom has made it a \u201cpoint of pride<\/a>\u201d that California has opened up coverage to immigrants, which his administration has noted keeps people healthier<\/a> and helps them avoid costly emergency room care often covered at taxpayer expense.<\/p>\n \u201cNo administration has done more to expand full coverage under Medicaid than this administration for our diverse communities, documented and undocumented,\u201d Newsom told reporters in January. \u201cPeople have built careers out of criticizing my advocacy.\u201d<\/p>\n Newsom warns the federal government\u2019s \u201ccarnival of chaos\u201d passed Trump\u2019s One Big Beautiful Bill Act, which he said puts 1.8 million Californians at risk of losing their health coverage with the implementation of work requirements, other eligibility rules, and limits to federal funding to states.<\/p>\n Nationally, 10 million people could lose coverage by 2034, according to the Congressional Budget Office. Health economists have said<\/a> higher numbers of uninsured patients \u2014 particularly those who are relatively healthy \u2014 could concentrate coverage among sicker patients, potentially increasing premium costs and hospital prices overall.<\/p>\n Immigrant advocates say it\u2019s especially callous to leave residents who may have fled violence or survived trafficking or abuse without access to health care. Federal rules currently require state Medicaid programs to cover \u201cqualified noncitizens\u201d including asylees and refugees, according to Tanya Broder of the National Immigration Law Center. But the Republican tax-and-spending law ends the coverage, affecting an estimated 1.4 million<\/a> legal immigrants nationwide.<\/p>\n With many state governors yet to release budget proposals, it\u2019s unclear how they might handle the funding gaps, Broder said.<\/p>\n For instance, Colorado state officials estimate roughly 7,000 legal immigrants could lose coverage due to the law\u2019s changes. And Washington state officials estimate 3,000<\/a> refugees, asylees, and other lawfully present immigrants will lose Medicaid.<\/p>\n Both states, like California, expanded full coverage to all income-eligible residents regardless of immigration status. Their elected officials are now in the awkward position of explaining why some legal immigrants may lose their health care coverage while those without legal status could keep theirs.<\/p>\n Last year, spiraling health care costs and state budget constraints prompted the Democratic governors of Illinois and Minnesota<\/a>, potential presidential contenders JB Pritzker and Tim Walz, to pause or end coverage of immigrants without legal status.<\/p>\n California lawmakers last year voted to eliminate dental coverage and freeze new enrollment for immigrants without legal status and, starting next year, will charge monthly premiums to those who remain. Even so, the state is slated to spend $13.8 billion from its general fund on immigrants not covered by the federal government, according to Department of Finance spokesperson H.D. Palmer.<\/p>\n At a press conference in San Francisco in January, Newsom defended those moves, saying they were necessary for \u201cfiscal prudence.\u201d He sidestepped questions about coverage for asylees and refugees and downplayed the significance of his proposal, saying he could revise it when he gets a chance to update his budget in May.<\/p>\n Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, pointed out that California passed a law in the 1990s requiring the state to cover Medi-Cal for legal immigrants<\/a> when federal Medicaid dollars won\u2019t. This includes green-card holders who haven\u2019t yet met the five-year waiting period for enrolling in Medicaid.<\/p>\n Calling the governor\u2019s proposal \u201carbitrary and cruel,\u201d Savage-Sangwan criticized his choice to prioritize rainy day fund deposits over maintaining coverage and said blaming the federal government was misleading.<\/p>\n It\u2019s also a major departure from what she had hoped California could achieve on Newsom\u2019s first day in office seven years ago, when he declared his support for single-payer health care<\/a> and proposed extending health insurance subsidies to middle-class Californians<\/a>.<\/p>\n \u201cI absolutely did have hope, and we celebrated advances that the governor led,\u201d Savage-Sangwan said. \u201cWhich makes me all the more disappointed.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. 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