republican administration

New restrictions have stripped Medicaid coverage from certain legal immigrants, including refugees and victims of human trafficking, as part of broader federal changes to the health insurance program that are expected to force millions off their coverage.

The change effective Oct. 1 cut from Medicaid what is estimated to be hundreds of thousands of people who legally immigrated to the United States, many of whom work and pay taxes, in the latest Trump administration policy to target foreigners.

The move is part of sweeping changes to Medicaid under President Donald Trump’s 2025 tax cut and policy law, with many set to take effect early next year. The Medicaid changes are projected to result in 7.5 million fewer people with health insurance, according to the Congressional Budget Office’s 2025 estimate.

Advocates say that without Medicaid, people will not be able to afford private insurance and will either delay care or end up in emergency rooms, adding pressure to a strained health system. For immigrants, the cuts could be felt more acutely, compounding the effects of other administration efforts to restrict their access to public assistance as part of a broader immigration crackdown.

“This is about telling every immigrant in the United States that they are not welcome here and that they should leave,” said Ben D’Avanzo, a senior strategist at the National Immigration Law Center, which has pursued litigation against the Republican administration over its immigration agenda.

Refugees, asylum seekers, victims of human trafficking and domestic violence are among those who have lost coverage. Green-card holders were not impacted.

Lauren Bis, a White House spokesperson, said in a statement that “immigrants must be able to support themselves without taking from overburdened benefits programs paid for by hard-working American taxpayers.”

D’Avanzo said many people who have lost coverage will likely only realize when they need medical care. But for some, the change has been felt immediately.

Dwindling supplies of lifesaving medication

In Tucson, Arizona, María Chacon has been caring for her son Jesus for almost five years since a car accident at 17 left him unable to breathe on his own. He requires a ventilator, a feeding tube and daily medication, and must be turned once every two hours to stop sores from forming. Chacon said he sometimes opens his eyes.

The family is originally from Mexico and entered the U.S. on a T visa, offered to victims of human trafficking, in 2018.

Chacon said Medicaid has helped cover almost $25,000 per month of care for her son, which includes a small stipend for her and her husband as compensation for being long-term caregivers. She said doctors have explained that even if they both worked 24 hours a day, they would not be able to cover the cost of his care.

“Since that day I haven’t been able to sleep. We haven’t been able to eat or anything. We’re wondering what we’re going to do?” Chacon said.

Jesus takes medication that Chacon estimates costs $7,000 a month. The supply runs out in mid-October. Without coverage, she does not know how her son is going to survive.

Chacon found out just days before the cuts that she was losing care. She called the state’s Medicaid offices to appeal. Although she is in the process of obtaining a green card, Medicaid coverage would only kick in five years after she is approved.

Steven Camarota, research director for the Center for Immigration Studies, a right-leaning think tank that seeks less immigration, said the administration “is trying to nibble around the edges” with the Oct. 1 cuts, finding piecemeal ways to curb immigration into the U.S.

Camarota believes the government should screen legal immigrants for income potential and education, reducing the number who might rely on public benefits once they cross the border.

“You need immigrants who are unlikely to need welfare,” he said, or those with high educational attainment.

The administration recently revived a federal rule that could deny green cards to immigrants who use public benefits that could include food stamps, Medicaid, housing vouchers and others.

Chacon believes the cuts to Medicaid coverage are part of the administration’s clampdown on immigrants. She said her son is in no condition to travel.

“I know that’s what he’s doing, but, as my son is, I couldn’t go to Mexico,” Chacon said.

Millions more will be dropped from Medicaid

Medicaid, jointly funded by states and the federal government, has become a political focal point during Trump’s second term. The president has pushed to root out what he describes as fraud in the program. In July, the administration deferred over $1 billion in Medicaid payments to California and Minnesota, claiming there was suspected fraud; critics argued the move targeted Democratic-led states.

As more people are cut from Medicaid, the federal government is predicted to reduce program spending by $911 billion, according to healthcare research nonprofit KFF.

In Arizona, officials said 29,000 legal immigrants were cut from Medicaid rolls on Oct. 1. In Florida, estimates are closer to 177,000. Overall, more than 281,000 immigrants from nine states and the District of Columbia are estimated to lose Medicaid coverage, according to KFF.

As more states implement various restrictions to coverage, 7.5 million people are expected to lose coverage by 2034, according to analysis by the Congressional Budget Office.

Without coverage, people will turn to emergency rooms for care. When people delay seeing a doctor, conditions can worsen and become even more expensive to treat.

“At the end of the day, it does raise the cost for the states because once you get these people in for something that could have been prevented, they could not go to the doctor because they were uninsured; they most likely will end up at a hospital in an emergency room,” said Carmen Feliciano, the vice president of policy and advocacy at UnidosUS, a Latino civil rights organization.

UnidosUS partners with community organizations to help provide medical care, but Feliciano said they already are overwhelmed and would not be able to support the number of people who are going to lose medical coverage in the coming months.

“We are not going to have the capacity to serve all the people who need it,” Feliciano said.

Schuettler and Hussein write for the Associated Press.

The White House has spent days fiercely defending three taxpayer-funded advertisements that glorify President Trump — approaching at least $1.5 million in public spending — calling them public service announcements.

“Don’t let the Fake News get away with their lies about our epic Public Service Announcements that have been running on tv,” White House communications director Steven Cheung posted on X on Sunday.

But the Republican administration’s ads attracted mounting criticism on Monday, including from members of Trump’s own party.

“It shouldn’t be paid for with taxpayer dollars,” Senate Majority Leader John Thune, R-S.D., told reporters.

“It would not have been something that I would have done. And I know that the White House is not covered by the same guidance that we are, but it’s not something that I would have done,” said Sen. Mike Rounds, another South Dakota Republican.

Multiple legal experts consulted by the Associated Press said the ads appear to run afoul of federal statutes, including a law against congressionally appropriated funds being used for “publicity or propaganda” and a law that limits the partisan political activities of government employees.

They said the new ads, which are airing on network and cable TV and streaming, differ from other administrations’ PSAs because they aren’t designed to help Americans access any specific program.

“You watch all three ads, they’re sheer propaganda,” said Richard Painter, a former White House ethics czar under Republican President George W. Bush. “This is increasingly looking like what authoritarian governments do to promote their leaders.”

The heightened scrutiny comes as the Trump administration has increased spending on the ads and bought time on popular TV shows, including college football and National Football League programming. It remains unclear which part of the government is supplying the funds.

With both chambers of Congress led by Republicans, any oversight would likely have to come from Trump’s allies, decreasing the likelihood of hearings or other accountability efforts before November’s midterm elections.

Three ads have aired in less than a week, totaling well over $1M

The first ad in the campaign, which began airing last Wednesday, features clips of Trump talking about defeating communism interspersed with onscreen text promoting the “largest tax cuts in history,” “reigniting American manufacturing” and a call to “defend law and order and police.”

Later in the week, a second ad began running, showing scenic videos of Mount Rushmore at night with quotes and clips from Trump’s Fourth of July weekend speech there honoring the country’s 250th anniversary.

The latest of the ads, a spot first aired over the weekend, is virtually identical to an ad for Trump’s Republican reelection campaign in 2024. It shows him walking down a hallway as his voice can be heard warning of a “final battle” against “globalists” and “warmongers.”

All three ads end with a message that says: “Paid for by the U.S. Government.” The White House hasn’t responded to inquiries about which part of the government is paying.

According to AdImpact, which tracks media spending, the spots have so far cost more than $1.4 million and run across a wide range of TV networks around the country. The actual amount spent could be significantly more, depending on whether networks classified the ad as a political ad.

The ads are different from past PSAs, experts say

In defending the campaign, the White House published a list of PSAs from recent Democratic and Republican administrations.

Among the examples it cited were Bush’s Republican administration touting a Medicare law, Barack Obama’s Democratic administration promoting Affordable Care Act subsidies and Joe Biden’s Democratic administration running ads promoting COVID-19 vaccinations.

“The announcements are very clearly not campaign ads; President Trump is not on the ballot and there is no call to action,” the White House wrote. “Instead, the announcements are a reminder for Americans to love their country and know why it’s worth defending — at home, at the border, and abroad.”

Kathleen Clark, a legal ethics professor at Washington University in St. Louis, said in her view the new ads differ from the examples the White House provided because they aren’t aimed at helping members of the public benefit from specific government programs.

“These ads are nothing more than government propaganda, aimed at helping Trump,” she said.

Painter, who joined the Bush administration after the Medicare PSAs went out, said that ad campaign toed the line on appropriateness because it included misleading information about Medicare Part D. But he said Trump’s campaign is a far more egregious violation of the statute that blocks congressionally appropriated money from being spent on publicity or propaganda.

“There’s nothing in here about a particular policy that’s at all focused,” Painter said of Trump’s ads. “One of them is just about the evils of the deep state. Another one of them is about communists and Marxists.”

In its support for the ads, the White House also referenced the administrations of President Woodrow Wilson and President Franklin D. Roosevelt, both of whom used posters, radio and film to rally the country during World Wars I and II.

James Kimble, a communication professor at Seton Hall University who studies domestic propaganda, said it’s true that Wilson’s Democratic administration used propaganda to rally Americans. But he said most Americans no longer view its actions in a positive light.

“By almost any objective measure, looking back, we find what they did pretty repulsive,” he said.

Skepticism of the campaign grows on the Hill

Top Democrats on the Senate and House appropriations committees last week wrote to the White House demanding the ads be taken down and requesting more information on how much money was spent to create and air them.

In the days since, more than a dozen Democrats and a handful of Republicans have spoken up to further criticize the ads. Senate Minority Leader Chuck Schumer called the latest ad “an absolute violation of what a democracy is supposed to look like.”

“Americans sat down to watch football, not to be force-fed Trump’s propaganda on their own dime,” he said in a Senate floor speech Monday.

Sen. John Kennedy, a Republican from Louisiana, said on CBS’s “Face the Nation” on Sunday that no public official should spend public money on private ads for themselves.

And Rep. Thomas Massie, a Kentucky Republican who lost his primary to a Trump-backed challenger, had his own harsh words for the administration on Monday.

“Don’t worry, using taxpayer dollars to run ominous campaign ads of the President has been done before and is completely legal… in banana republics,” he wrote in an X post.

The Republican chairs of the Senate and House appropriation committees didn’t respond to requests for comment.

Swenson writes for the Associated Press. AP writers Mary Clare Jalonick and Steven Sloan contributed to this report.