Immigration Smokescreen.

The GOP-led Senate has passed their version of the Big Beautiful Bill Act, which will undergo a name change when it goes back to the House for reconciliation. After all the debate, that’s the one victory the Democrats were able to claim: a name change. The bill guts Medicaid dramatically among other cuts to Biden-era programs and provisions from the prior administration’s landmark bills. And it extends generous tax cuts for the wealthy and creates additional loopholes to help wealthy people and corporations evade taxes.

But the focus today is how the Trump White House is using immigration as a smokescreen for all these cuts to Medicaid in particular.

Cruelty

Let’s begin with an excerpt from a June 30, 2025 interview with Treasury Secretary Scott Bessent on Bloomberg TV.

Bloomberg: “What do you tell the nearly 12 million people that are on the brink of losing access to Medicaid?”

 

Bessent: “Well, again, that’s not right. 1.4 million are illegal aliens. Then a huge percent of that are the able bodied working people who will need to go back to work. So we’re going to have a work requirement and we’ll go from there. We are just going back to the levels pre-COVID.”

It’s the ultimate misdirect—point at immigrants while you pick the pockets of working families who depend on Medicaid for their healthcare. It’s the oldest trick in the authoritarian playbook: blame the most vulnerable while enriching the most powerful.

The numbers don’t lie, and when you dig into what’s actually happening, the whole immigration argument falls apart. This isn’t about protecting taxpayers from fraud. This isn’t about stopping abuse of the system. This is about taking healthcare away from millions of Americans while the wealthy get another tax break they absolutely don’t need.

As the architect of Donald Trump’s immigration policy, Stephen Miller has led a war on immigration well beyond any reasonable enforcement policy. Reports indicate he has verbally dressed down top ICE officials, telling them to start terrorizing neighborhoods and picking up immigrants off the street at Home Depot and 7-Eleven parking lots. His reign of terror has gone well beyond chasing down immigrants who are in the criminal justice system—it’s become an all-out war on Hispanic people, and now Iranian Americans are being caught up in the deportation frenzy.

This isn’t law enforcement; this is systematic intimidation designed to create fear in entire communities. When you’re telling ICE agents to target people at places where day laborers gather to find work, you’re not going after criminals—you’re going after people trying to survive and feed their families.

When you expand beyond targeting actual criminals to conducting sweeps in neighborhoods, you’ve crossed the line from enforcement into persecution.

But here’s the thing about Miller’s approach: it’s not actually about immigration policy. It’s about creating a climate of fear and chaos that allows the administration to push through policies that would otherwise be politically impossible. While everyone’s focused on the dramatic raids and the human tragedy of family separations, a different tragedy is unfolding in the budget.

As has been said, cruelty is the point, but it’s also a distraction.

The expansion to include Iranian Americans shows this isn’t even about immigration status anymore—it’s about targeting anyone who doesn’t fit their narrow definition of who belongs in America. And, of course, protecting White South Africans from the imaginary white genocide occuring. This is authoritarianism 101: create an atmosphere of fear, target vulnerable populations, and use that chaos to consolidate power and enrich your allies.

Smokescreen

The White House talking points try to frame these Medicaid cuts as simply eliminating fraud and waste through work requirements and rule enforcement, while claiming they need to strip immigrants of their ability to access Medicaid “illegally.” It’s a neat little package that sounds reasonable on the surface—who doesn’t want to eliminate fraud and waste, right?

But let’s break down what “eliminating fraud and waste” actually means in this context. The bill includes requiring childless adults and parents of children older than 14 to work, volunteer, or attend school for 80 hours a month as a condition of enrollment, unless they qualify for an exception. This work requirement alone accounts for $317 billion in cuts over ten years—the largest single cut in the entire package.

Think about that for a moment. The biggest “waste” they’ve identified isn’t administrative bloat or actual fraud—it’s healthcare for people who can’t work enough hours. We’re talking about people who might be caring for elderly parents, dealing with disabilities that don’t qualify them for disability benefits, working unstable gig economy jobs, or simply unable to find consistent work in their communities.

The bill also requires states to check eligibility of people in Medicaid expansion every six months instead of once a year, cutting $58 billion. Another provision allows states to require more paperwork and more frequent eligibility checks, cutting $78 billion. These aren’t anti-fraud measures—they’re bureaucratic barriers designed to make it so difficult to maintain coverage that people give up.

When you add up all these “fraud prevention“ measures, you’re looking at over $450 billion in cuts. But the actual fraud rate in Medicaid is tiny compared to these numbers. This isn’t about waste—it’s about making healthcare inaccessible to working families while maintaining the fiction that it’s about fiscal responsibility.

Here’s where the administration’s immigration rhetoric completely falls apart: immigrants who came seeking asylum aren’t “illegal.” That’s actually the proper process to follow under U.S. law. Seeking asylum is an entirely legal way to seek residence in the United States, and those waiting for courts to determine their eligibility aren’t entitled to any welfare programs, especially Medicaid.

Let’s be crystal clear about what the law actually says. Under current federal law, undocumented immigrants are not eligible for federally funded Medicaid. They don’t get social security benefits, free housing, food stamps or SNAP. Federal law explicitly bars people living in the U.S. without legal status from enrolling in these programs, except for limited emergency medical services because one of the beautiful things about the Hippocratic Oath is that we still, at a minimum, believe in the obligation to treat people in emergency situations.

But even among lawfully present immigrants, most must wait five years after obtaining qualified status before they are eligible for Medicaid. Only refugees, asylees, and a few other specific groups are exempt from this waiting period.

“This isn’t about fiscal responsibility or stopping abuse—it’s about manufacturing outrage over pennies while stealing dollars.”

The administration keeps talking about cutting off “illegal” access to Medicaid, but that access doesn’t exist in the first place. It’s like claiming you’re going to stop unicorns from buying guns—you’re solving a problem that doesn’t exist.

Some states do use their own funds—not federal Medicaid dollars—to provide health coverage to certain undocumented immigrants, such as children or pregnant people. But these state-funded programs are not federally funded Medicaid, even if they’re sometimes described as “Medicaid-like” coverage. Recent GOP proposals have conflated these state-funded programs with Medicaid, claiming that millions of “illegal aliens” are on Medicaid when they’re actually referring to state-funded health coverage using state money.

The reality is that asylum seekers who are following the legal process are stuck in immigration limbo for years while courts process their cases, and during that time, they have access to essentially nothing. Again, no Medicaid, no Children’s Health Insurance Program (CHIP), no food stamps, no housing assistance. They’re expected to survive on their own while navigating a legal system that can take years to resolve their cases.

So when the administration talks about cracking down on immigrants accessing Medicaid illegally, they’re either ignorant of the law or deliberately lying. The law already prevents what they claim to be stopping.

Emergency

Here’s the truth about what undocumented immigrants receive from the federal government: if they show up at an emergency room, they can receive emergency medical care. That’s it. That’s the whole list.

This happens through Emergency Medicaid, which reimburses hospitals for emergency services provided to immigrants who would qualify for Medicaid except for their immigration status. The federal government currently pays 90% of costs in states that expanded Medicaid under the Affordable Care Act (ACA), and the state’s regular Federal Medical Assistance Percentage in non-expansion states. This program covers only true emergency conditions—labor and delivery, heart attacks, severe injuries—and accounts for less than 1% of total Medicaid spending.

The Senate bill cuts $28 billion from this program over ten years. Let’s do the math: that’s $2.8 billion per year. The federal budget is approximately $7 trillion annually, which means Emergency Medicaid for undocumented immigrants represents about 0.04% of the entire federal budget. Four one-hundredths of one percent.

To put that in perspective, that’s like arguing over 40¢ in a $1,000 budget. It’s a rounding error. It’s less than what we probably spend on office supplies for DOGE. But this microscopic portion of the budget has become one of the administration’s leading talking points for gutting the entire Medicaid system.

Outside of emergency medical care, the only other “benefit” undocumented immigrants receive is public schooling for their children, but that’s covered by local real estate taxes. Immigrants pay landlords who remit property taxes to school districts. So even if they’re renters, they’re paying property taxes through their rent. That leaves school lunches and emergency hospital visits as the only programs that are technically “free” to immigrants.

The absurdity of making this microscopic expense one of the leading talking points to justify massive Medicaid cuts reveals the true nature of this campaign. This isn’t about fiscal responsibility or stopping abuse—it’s about manufacturing outrage over pennies while stealing dollars.

When you’re cutting $28 billion over ten years from a program that serves people having heart attacks and women giving birth, you’re not the fiscal conservative hero of your own story. You’re the villain who steals medicine from sick people while claiming it’s for the greater good.

The truth becomes undeniable when you look at the full scope of what’s being cut versus what’s being preserved and expanded. This is a catastrophic gutting of Medicaid that reveals this administration’s real priority: waging war on the poor while enriching the wealthy.

The numbers tell the story. Beyond the $317 billion in work requirements we discussed, the bill includes $183 billion in cuts from provider taxes, $149 billion from limiting state-directed payments, $85 billion from canceling rules that help low-income Medicare beneficiaries pay premiums, $78 billion from new eligibility requirements, and $58 billion from more frequent eligibility checks.

Then there are the smaller but equally cruel cuts: $7.5 billion from requiring co-payments of up to $35 for medical services for Medicaid patients, and $6.2 billion from limiting immigrant Medicaid coverage by restricting eligibility after a 5-year waiting period to only green card holders and certain other immigrants, excluding many who are currently “lawfully present.”

Add it all up, and you’re looking at nearly $900 billion in Medicaid cuts over ten years. These aren’t tweaks around the margins—this is dismantling the healthcare safety net for America’s most vulnerable populations.

Theft

And what’s happening on the other side of the ledger? Generous tax cuts for the wealthy and additional loopholes to help wealthy people and corporations evade taxes. While working families lose their healthcare, billionaires get another tax break.

The co-payment requirement perfectly illustrates the cruelty of this approach. We’re talking about people so poor they qualify for Medicaid, and now they’ll have to pay up to $35 every time they see a doctor. For a family living paycheck to paycheck, that $35 co-pay might mean choosing between medication and groceries, between a doctor’s visit and keeping the lights on.

The work requirements reveal the fundamental misunderstanding—or deliberate misrepresentation—of poverty in America. Most Medicaid recipients who can work already do work. They’re working multiple part-time jobs without benefits, they’re caring for children or elderly relatives, they’re dealing with health issues that make consistent employment difficult but don’t qualify them for disability.

When you require 80 hours of work per month and create bureaucratic barriers to maintaining coverage, you’re not encouraging self-sufficiency—you’re creating a system designed to kick people off healthcare when they’re most vulnerable.

This isn’t about immigration. This isn’t about fraud and waste. This is about taking healthcare away from millions of Americans while the wealthy get richer. The immigration rhetoric is just the smokescreen, the distraction that allows them to pick the pockets of working families while everyone’s looking the other way.

The cruelty is the point, but the money is the goal. And while we’re arguing about $2.8 billion in emergency room visits for undocumented immigrants, they’re stealing $900 billion from the people who need healthcare the most.

That’s not fiscal conservatism. That’s not protecting taxpayers. That’s just theft with better PR.

Here endeth the lesson.

Image Source

• Barnes, Elvert “103.Rally.TrumpMustGoNow.WDC.4July2025” Flickr, 9 July 2025. CC BY-NC-SA 4.0. Changes were made.