On a recent episode of CNN’s State of the Union, Louisiana Republican U.S. House Speaker Mike Johnson made a bold and necessary statement: more than 1.4 million people illegally in the country are enrolled in Medicaid, a program designed primarily to support low-income American citizens.
Far from advocating cuts to this vital safety net, Johnson emphasized that his push to address this issue is about eliminating fraud and preserving resources for those the program was intended to serve.
Johnson’s comments brought needed attention to the staggering financial burden of illegal immigration on U.S. taxpayers and the strain it places on social services like Medicaid. The Trump administration’s efforts to curb this misuse are not about denying care to Americans, but ensuring the sustainability of safety net programs that have been stressed to the breaking point by an unprecedented influx of people illegally accessing the country under the Biden administration.
Critics will argue that people illegally in the country contribute to the economy through taxes. However, these contributions pale in comparison to the costs. A 2023 analysis by the Federation for American Immigration Reform showed that even after accounting for tax contributions, illegal migration results in a net fiscal deficit of at least $150.7 billion annually. The idea that migrants use fewer health care services than citizens ignores the broader strain on systems like Medicaid when millions access benefits without legal status.
The Congressional Budget Office has further confirmed that billions of dollars in Medicaid spending are directed toward people illegally in the country, often through loopholes or state-level programs that exploit federal funds. The House Homeland Security Committee has estimated that taxpayers could face costs as high as $451 billion to care for them and those who evade border apprehension, known as “gotaways.” These numbers are not abstract; they represent resources diverted from American citizens who rely on programs like Medicaid for basic health care needs.
Medicaid was created to serve vulnerable Americans, including low-income families, the elderly, and the disabled. Yet, when 1.4 million people illegally in the country access this program, as Johnson highlighted, it stretches finite resources thin.
The Trump administration’s efforts to remove people illegally in the country from programs like Medicaid are not punitive, but pragmatic. By tightening eligibility and closing loopholes, such as those allowing states to enroll noncitizens in federally funded programs, these policies aim to protect American taxpayers and prioritize citizens.
A recent proposal by the Centers for Medicare & Medicaid Services to shut down such loopholes further seeks to ensure that taxpayer dollars support those legally entitled to benefits. Far from denying services to Americans, these measures are designed to keep Medicaid solvent, preventing cuts that could harm citizens who rely on it for life-saving care.
We are in this predicament as a direct consequence of the Biden administration’s immigration policies, which allowed an unprecedented surge of illegal border crossings. Under Biden, border encounters soared, with U.S. Customs and Border Protection reporting over 2.5 million apprehensions of migrants at the southern border in 2023 alone. This does not account for the estimated 600,000 gotaways who evaded detection, many of whom access public benefits.
The Biden administration’s reversal of Trump-era policies, such as the “Remain in Mexico” program and Title 42 expulsions, created a lawless environment that encouraged illegal immigration. The result was yet more incentives to illegally enter the country as well as a strain on social services, as cities and states scramble to accommodate millions of new arrivals.
Speaker Johnson’s remarks are a call to action, not a call to limiting benefits to citizens. This is not about denying care to those in need but about ensuring that American citizens – the elderly, the disabled, and struggling families – are not shortchanged by a system overwhelmed by unchecked mass migration. The Biden administration’s lax policies left taxpayers to foot the bill for a problem that could have been mitigated through stronger border enforcement and stricter eligibility rules.
As the nation grapples with these challenges, Johnson’s stance and Trump’s policies offer a path forward: prioritize Americans, protect public resources, and address the root causes of the crisis. The Trump administration’s reforms, from border security to Medicaid eligibility, are not about exclusion but about accountability. By curbing fraud and misuse, we can ensure that programs like Medicaid remain a lifeline for citizens, not an endless buffet of social services for those who broke our laws by entering the country illegally. The time to support these reform efforts is now – before the costs, both financial and social, become even more unsustainable.
