Bulwark Takes - The Republican’s BIG LIE Regarding Healthcare

Episode Date: October 1, 2025

Republicans are pushing a false talking point during the government shutdown: that Democrats want to fund “free healthcare for illegal immigrants.” Jonathan Cohn explains why that’s simply not true, and why Republicans are scared of having a real conversation about healthcare policy.

Hey, it's Jonathan Cohn here at The Bullwork. Our government is shut down. And if you've been paying attention, if you've been watching TV on social media, listening to speeches, reading, writing, you know the Republicans have a favorite talking point they are taking into this battle. That talking point is that Democrats want to fund free health care for illegal aliens. Is that true? No, it's not. I'm here to break it down for you. It's the subject of my newest newsletter. And it's a subject I'm sure you're going to be hearing about in the coming days and weeks. because it doesn't look like the shutdown is going to end any time soon. You're probably going to want to know what to think about it. You might even want to know what to tell your friend who's arguing with you about it. Now, I call this a big lie, and there's a reason I use that word. I don't use the word lie a lot. To me, a lie has to be something that is fundamentally untrue. It's got to be built on facts that you can falsify.

And the people telling the lie have to know it or be in a position where they should know it. And to walk you through this, I'm going to show you the words of J.D. Vance, the vice president. Because while there are lots of Republican leaders out there telling this lie from the president on down, there is nobody who tells it with the enthusiasm, the tenacity, and the sheer shamelessness of our vice president. Before we get to all that, though, let's set the scene. Just as a reminder, federal government ran out of money on Tuesday night, September 30th. Republicans control the White House. They control the Congress, but they don't have enough votes to get a new spending bill through Congress. They need support from Democrats.

Democrats have said, hey, you want our votes. We need a few things. Two of their demands are closely tied to health care. One demand is that the Republicans undo the cuts to Medicaid, that were in the one big, beautiful bill that they passed over the summer. And the second demand is that Republicans agree to extend a temporary Biden-era program that's been lowering the cost of health insurance for more than 20 millions of Americans who buy their insurance through the affordable Care Act. This is not a debate that the Republicans really want to be having because polls have shown consistently that the voters trust Democrats more on health care. They don't like the cuts to Medicaid, which are going to take health care away from about 9 million people. And they're probably not going to feel too good if come December, January, they go to check the prices of their health insurance and they discover it's jumped by hundreds or even in some cases thousands of

dollars. That is not a conversation Republicans want to have. It's not a debate that Republicans want to have. The problem is Republicans also don't want to undo the Medicaid cuts and they don't want to spend new money on those subsidies that are part of Obamacare. It runs against their instincts as conservatives. They don't believe in spending more money on health care. And they especially don't believe in spending more money on Obamacare. Now, they could go out and sort of make that case, they could make the case that, hey, spending money on Medicaid is bad, spending money on Obamacare is bad, it's better off as tax cuts. That's not what they're doing. Instead, they've trotted out this new argument about illegal aliens. So that brings us to the vice president. I want to start

with an interview he gave about a week ago with Laura Ingraham on Fox News. Here's the video. The Democrats, their whole argument is we are going to shut down the government unless you give a trillion dollars for medical benefits for illegal aliens. So I want you to focus on two things that the vice president said there. First, he says a trillion dollars in spending. That's a really important number because when the vice president said this, the White House didn't put out material saying here's what the Democrats want to do. But you can tell by that figure that what he's referring to are the Medicaid cuts because

that's about how much they cost. It's a trillion dollars over 10 years. So he's referring to the Medicaid cuts. And then the second thing he said was this trillion dollars to fund health care for illegal aliens. So that is just simply not true. The reason I know it's not true is that it's against the law. The programs that we have, that government programs that provide people with health care, Medicare, Medicaid, the Affordable Care Act, or Obamacare. If you are an undocumented immigrant, you cannot get that program.

They are prohibited from enrolling anybody who is not here lawfully. Even if you're a legal immigrant, even if you have permission to be in this country, but you're an immigrant, there's a good chance you can't get onto those programs. And we're going to talk about that a little bit more in a second. So there are no undocumented immigrants on these programs. I mean, are there a few out there somewhere who have kind of slipped the cracks? I'm sure there is. It's a big country. These systems aren't perfect.

But for the most part, the trillion dollars in cuts that Democrats want to undo is a trillion dollars in cuts to Medicaid that are going to affect mostly U.S. citizens, people who are here legally, and the debate is whether or not to give them Medicaid or not. Now, a few days after that, you started to see some pushback on this, because as Vance was out there saying it, President Trump was out there saying it, congressional leaders were out there saying it, people started calling them on it and saying, hey, you guys are lying. This clearly isn't true. That brings us to this morning when J.D. Vance went back on Fox News to give an interview, and they asked him, hey, Democrats say, you're lying about this. What's the reality? Well, now J.D.

Vance had a slightly different answer, and it kind of, you could tell, was sort of kind of walking this back a little bit. Here's the segment. Yeah, so this is a Democrat talking point. They say we're not actually trying to give health care benefits to illegal aliens, and here's why it's not true. There are two Biden-era programs that explicitly gave the taxpayer health care money to illegal aliens that we turned off when President Trump took over in January. Program number one is there's a lot of emergency health care at hospitals that are provided to illegal aliens. That was funded by the federal government. We turned off that funding because, of course, we want American citizens to benefit from those hospital services, not to be taxed, and then to have those hospital

services go to illegal aliens. The second of which is the Biden administration gave mass parole to millions upon millions of illegal aliens, and then they simultaneously made those parolees eligible for health care benefits funded by taxpayers. In the one big beautiful bill, President Trump and Congressional Republicans turned off that money to health care funding for illegal aliens, the Democrats want to turn it back on. Now, if you listened closely, the first thing you notice is that he's now defining illegal aliens a little differently. He's being very careful to say what he means by illegal aliens. He doesn't mean people who are necessarily here unlawfully. He doesn't mean undocumented immigrants. He means people who were here legally. People are on protected

status, people in some cases who are applying and on their way to getting permanent green cards. These are people who we've said can be in this country, and in some cases, depending on their circumstances, some of them are eligible for some programs. But what you need to know is this is a very small portion of the money in play here. Again, the vast majority of the money in play here, both for Obamacare and for Medicaid is going to U.S. citizens, legal U.S. citizens. Along the way, Republicans have said, yeah, but we don't know. And really, there's a lot of illegal immigrants coming on to these programs because there's all kinds of fraud. there's really no reason to believe that either. The reality is the systems for enrollment on the Affordable Care Act for Medicaid

check citizenship really carefully. And one thing we know is that if anything, immigrants are less likely to seek public benefits precisely because they're worried. It will put them on the radar screen of government. It will get them in trouble even if they're here legally. So that one doesn't really make sense. Then there's this other piece, this piece on emergency Medicaid that he talked about. Medicaid that's paying for emergency services. If you really squint hard, if you really want to give

them the benefit of the doubt, say, where do they have a sort of legitimate case that some of the money Democrats want to spend would go to care for undocumented immigrants? This is it. But there's a lot more to this story than he's letting on. The first thing to know is that, again, this is a tiny portion of the program. What it does is it reimburses hospitals for money they spend when people who are here as immigrants, they might be undocumented or they might be one of these legal immigrants who aren't yet eligible for Medicaid. If they show up at the emergency room, they need emergency care. Hospitals by law, by a whole separate law, have to care for them. If you're a hospital, you can't turn away someone who's got a heart attack or is delivering a baby. And I don't

think that's what most people want. But the hospital, that costs the hospital money. So this reimburses the hospital for that. It's 1% of Medicaid spending in total. And it's not money that goes to the recipients. It doesn't go to the person who got the medical care. It just goes to the hospital, in part to make sure the hospitals can stay open to serve everybody to keep the emergency services. So Vance there is suggesting, oh, this is, you know, we're doing this. We're making these cuts in order to protect American citizens. Well, no, emergency Medicaid actually does serve American citizens because it helps ERs stay open and provide services.

But there's one more tell there that's really. important. He referred to it as a Biden-era program. That is just not true. Emergency Medicaid was created in 1986 as part of a law that was signed by Ronald Reagan. Ten years later, when they did the big welfare reform act that imposed work requirements on welfare, which is something conservatives want and actually restricted benefit access to immigrants. Again, very much in line with what Trump and Vance say they want to do. That law preserved emergency Medicaid very specifically. And again, for the very same reason, there was a recognition that giving hospitals extra money to cover their cost when, you know, somebody shows up at their door with a heart attack with some need, some kind of life-saving treatment, they're going to give it. We're going to help the hospitals cover that cost because it's in everybody's interest. Ronald Reagan thought it was a good idea. You know, Gingrich thought it wasn't a good idea. I guess maybe J.D. Vance doesn't. And if, you know, look, if that's the case they want to make that this tiny, tiny piece of this bill is a bad idea because we,

You should tell an unoccupied immigrant with a heart attack or delivering a baby that, nope, we're not going to take care of you. Go ahead and make that case. But just remember that, number one, that's what they're arguing for. Number two, it's a tiny portion of the cut. And the reality is the vast majority of the money that we are talking about in this debate is money that will go to U.S. citizens to pay for their health care. And the debate today, the debate Republicans don't want to have, is whether we should spend

the money to take care of Americans who need health care or not spend that money.