'Free' Healthcare Is Anything But Free
Free healthcare doesn't come cheap.
That's one lesson Gov. Gavin Newsom, D-Calif., is learning the hard way.
Since Newsom officially extended the state's Medicaid program, Medi-Cal, to all undocumented immigrants last year, the entitlement's costs have ballooned.
Earlier this month, he announced that he'd need a $3.4 billion loan to keep Medi-Cal afloat.
Then last week, he requested another $2.8 billion loan from the state's general fund for Medi-Cal.
These pleas for more money were all too predictable.
Expanding Medi-Cal to cover all undocumented immigrants was bound to create more demand than the state could afford to meet.
As more and more people in the country illegally sign up for the program, the quality of care available to genuinely vulnerable U.S. citizens will almost certainly decline.
California has been gradually rolling out Medi-Cal to undocumented immigrants for years. Back in 2015, then-Gov. Jerry Brown made undocumented immigrants under the age of 19 eligible.
The Newsom administration extended this privilege to undocumented people up to the age of 25 starting in 2020.
Those over the age of 50 became eligible in 2022.
And since the beginning of last year, California has covered all undocumented residents who meet Medi-Cal's eligibility requirements — making it the first state in the nation to do so.
Not surprisingly, Medi-Cal's rolls have swelled, as has the cost to the state.
The program covers almost 15 million people.
About 1.6 million undocumented immigrants are enrolled in Medi-Cal.
Federal law prohibits federal money from paying for Medicaid for illegal immigrants.
So, California has to shoulder the cost on its own.
The state initially projected that Newsom's Medicaid expansion would cost about $5.8 billion during 2024 and 2025; it has since revised that figure up to $8.4 billion.
The result is that Newsom is spending money his state doesn't have to cover patients who aren't legally permitted to live in the United States.
Reporters asked him this month if he had plans to roll back his expansion of Medi-Cal. "Not on my docket," he replied.
California State Senate Minority Leader Brian Jones, R-Dist. 40, expressed the absurdity of this situation quite well, "If we weren't spending eight-and-a-half billion dollars on illegal immigrants, we wouldn't need to borrow $3.4 billion to cover the difference."
Remarkably, California isn't the only state whose finances are under strain because of public benefits for undocumented immigrants.
Seven states and the District of Columbia now provide state health coverage to at least some undocumented adults.
It's been less than three months since Colorado implemented its Medicaid expansion for undocumented people who would otherwise be eligible if they were citizens.
The initial cost estimate for the program in 2022 was $2 million.
But Colorado has seen 42,000 immigrants arrive in the state since then.
This fiscal year, the state projects that it could spend $16 million.
Next fiscal year, which begins July 1, the cost could double to $32 million.
These new enrollees compete with Medicaid's legacy beneficiaries, as well as able-bodied adults who qualify for coverage under Obamacare's expansion of the program, for scarce appointments and medical care.
That's made it difficult for the truly needy to access high-quality, timely care.
Moreover, extending Medicaid coverage to undocumented immigrants provides a strong incentive for people to come to the United States illegally — and to settle in states with permissive Medicaid programs.
In effect, Democrats in places like California and Colorado are putting the interests of unauthorized residents before those of their least-well-off citizens. They're doing so in ways that put their states' finances at risk.
States need to refocus their efforts on reining in Medicaid's out-of-control costs, while improving the quality of care available to the poor and disabled.
Expanding the program to undocumented immigrants does precisely the opposite — and it shows just how confused the left's healthcare priorities have become.
Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The World's Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It (Encounter 2025). Follow her on X @sallypipes. Read Sally Pipes' Reports — More Here.
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