immigrant healthcare – In California’s race for governor, Democrat Xavier Becerra and Republican Steve Hilton are turning immigrant access to state-funded health coverage into a stark economic referendum—just as budgets tighten, federal support shifts, and public support for the saf
On the morning of the June 2 primary, Steve Hilton framed immigrant healthcare like a personal affront—recorded in a Facebook video aimed at voters who say they’re already stretched thin.
“Stop taking money from California taxpayers who can barely afford their healthcare to give free healthcare to citizens of other countries who shouldn’t even be here,” Hilton said in the video.
For weeks, the dispute has hovered behind the broader California campaign. Now it’s moving front and center: who gets covered, how much it costs, and what happens to the state’s healthcare system when the numbers don’t add up.
Democrat Xavier Becerra and Republican Steve Hilton offer voters a choice that feels less like policy detail and more like a fork in the road. Both campaigns pitch the issue as economic. But the economic argument they make points in opposite directions.
Becerra. a former secretary of Health and Human Services under President Biden. said it would be “foolish” to exclude the poorest immigrants from routine care and push them into expensive emergency rooms on the taxpayer’s dime. Hilton. a conservative commentator backed by President Trump. has promised to eliminate coverage for immigrants without legal status and has echoed national Republicans who have attacked California’s Medicaid expansion by arguing fraud and abuse drive the costs.
The campaign is playing out as Californians—once broadly supportive of the state’s generous safety net—show signs of tightening their expectations. With voters nationwide focused on inflation and the rising cost of living. the political appetite for paying for coverage outside the narrowest boundaries appears to be shifting.
California lawmakers have long used state dollars to expand Medi-Cal. Over the past decade, they expanded the program so that low-income residents receive comprehensive coverage regardless of immigration status. But enrollment and costs rose faster than lawmakers expected. Medi-Cal coverage of immigrants without legal status costs the state roughly $10 billion a year. according to California’s nonpartisan Legislative Analyst’s Office—more than double initial estimates.
Budget pressure has followed. California lawmakers and Democratic Gov. Gavin Newsom, who championed the program, have approved major rollbacks for residents without legal status. They argue the state can’t afford ballooning healthcare costs while facing massive federal cuts from the GOP tax-and-spending law known as the One Big Beautiful Bill Act.
The California Health and Human Services Agency projected that up to 3.4 million Medi-Cal enrollees could lose coverage, and that the state could lose more than $30 billion a year in federal funding under the law—cuts officials say would cause major disruptions in the safety net health program.
Medi-Cal’s budget for fiscal year 2026-27 is $217 billion, and the program serves more than 14 million Californians.
At the same time, many legal U.S. residents and citizens have seen their health premium payments skyrocket this year after Congress let enhanced federal Affordable Care Act subsidies expire at the end of December. For voters, the debate doesn’t land in a vacuum; it lands in kitchens already grappling with bills.
A new poll captured the shift in mood. As California dealt with a deficit last year, a majority of likely voters in the state opposed providing health insurance to immigrants without legal status for the first time in nearly a decade, according to a poll by the Public Policy Institute of California.
Mark Baldassare, the institute’s survey director, said, “The state faces major challenges, and healthcare is one of the major expenditures,” adding, “People have become more selective about how they want to see those limited healthcare dollars spent.”
Hilton’s message has leaned into that anxiety. Running on affordability and lowering taxes, he cast coverage for immigrants without legal status as deeply unfair and as a direct threat to the state’s ability to help citizens.
In campaign stump speeches, Hilton promised to use savings to lower healthcare costs for other Californians without detailing how. Hilton did not respond to requests for comment.
The way both campaigns talk about the issue can be summed up by what a Democratic political consultant described as a dividing line voters are being asked to cross.
“Their messaging is very, very simple: It’s an us vs. them. ” said Roger Salazar. a Democratic political consultant who represents a coalition of healthcare advocates arguing that providing coverage to people who can’t afford it strengthens the workforce and. in turn. the economy. “It’s just a question of convincing the average voter that it’s much better economically.”.
Becerra, for his part, has tied the issue to lived reality. A son of immigrants, he has pushed for safety net benefits in Congress for decades and now makes a similar pitch in his bid to become governor.
At a debate last month, Becerra said, “Immigrants, whether documented or not, work hard. They pay taxes, and sometimes they get injured on the job or their children get sick,” adding, “It would be foolish to tell a family that they don’t have access to the pediatrician or the family doc.”
Becerra also criticized decisions that preceded his campaign pitch. Last year, when Newsom and legislative leaders decided to freeze Medi-Cal enrollment for adults without legal status, cut benefits, and impose monthly premiums, Becerra objected.
“Stop treating coverage as a budget variable that expands in good years and contracts when revenue dips. ” Becerra wrote last month in response to an Orange County Register candidate questionnaire. He vowed to pursue new, steady revenue to fund basic services, including upping taxes on corporations and the wealthiest Californians.
The underlying population at the center of the dispute is significant. In 2023. California was home to about 2.3 million people without legal status. representing roughly 8% of the state’s labor force. according to the Pew Research Center. The California Department of Education reported that 1 in 5 California children live in a family that includes at least one member without legal status.
Healthcare economists say preventive care can save money in the long run by keeping the workforce healthy and easing pressure on an overburdened system.
Baldassare said that wasn’t a hard argument to make during the COVID-19 pandemic, when immigrants were celebrated as essential workers and the link between individual well-being and public health was more obvious.
But the fiscal question has sharpened with rising Medi-Cal costs. Medi-Cal costs to cover roughly 1.4 million immigrants have ballooned. according to the latest estimates from the Department of Health Care Services. And because only some lawfully present immigrants are eligible for federal Medicaid benefits. states like California that cover other populations must fund those residents exclusively with state funding.
California’s budget experts have warned that maintaining full Medi-Cal coverage for immigrants without seeking additional revenue would destabilize the state’s long-term fiscal outlook.
In a legislative hearing last year, Republican Assemblymember Carl DeMaio questioned whether California taxpayers would prioritize the expansions. He said he doubted “illegal immigrant healthcare in the general fund would be at the top of their list.”
After lawmakers approved the spending reductions, support for immigrant health coverage dropped, Baldassare said. Now lawmakers and Newsom are negotiating further cuts.
David Hayes-Bautista. who has studied the economic contributions of Latinos and immigrants. described a different dynamic driving the budget strain: many immigrants without legal status have higher labor force participation but tend to work in industries and occupations that don’t offer employer-based health insurance. Many of them. he said. end up relying on Medi-Cal—putting the healthcare costs onto the state rather than onto employers.
“California. as a state. has the world’s fourth-largest GDP. which is true thanks to Latinos. ” Hayes-Bautista. director of the Center for the Study of Latino Health and Culture at UCLA. said. Without contributions from Latinos. many without legal status. he added. “it drops to eighth place. about the size of Italy’s economy.”.
Advocates say the political fight is also about who carries the message. They are looking for a louder champion in Becerra, the favorite to become governor in a state where Democrats outnumber Republicans nearly 2 to 1.
State Sen. María Elena Durazo, a former labor leader who has championed the immigrant healthcare expansions, said, “He will fight, he will push back, he will do all that he can,” adding, “That’s the most we could expect.”
In the end. the race is forcing voters to decide what they believe the state’s healthcare system should prioritize as it confronts budget instability and rising costs. For Becerra, the argument is that routine care keeps families healthy and prevents more expensive emergencies. For Hilton. the argument is that taxpayers can’t be asked to shoulder coverage for people he says should not be in the country. Both claims are wrapped in economics—and both are designed to land with voters who increasingly want to know where their healthcare dollars go.
California governor race Medi-Cal immigrant healthcare Xavier Becerra Steve Hilton One Big Beautiful Bill Act Medicaid Public Policy Institute of California Affordable Care Act subsidies safety net