Midterm Election Update: Immigrant Health Policy  

Immigration restrictions and enforcement are central to the Trump administration’s domestic agenda and a focus of debate in the 2026 midterm elections. These policies have ripple effects on health care: immigration-related fears are leading some immigrant families to avoid medical care and drop coverage, including for U.S. citizen children, and visa restrictions could strain a health care workforce that relies on immigrants. Federal law has also narrowed eligibility for health coverage among lawfully present immigrants, and states are responding in different ways.

Overview  

The Trump administration’s immigration policies have several implications for health care. About 50 million immigrants lived in the U.S. in 2024, though that number has since been declining. One in 4 (26%) children has an immigrant parent, and immigrants make up 17% of the health care workforce, including significant shares of physicians and long-term care workers.

Noncitizen immigrants have more limited access to health coverage than citizens. Undocumented immigrants have long been ineligible for federally funded coverage, and the 2025 reconciliation law narrows eligibility for many lawfully present immigrants.

Key Developments  

Immigration Enforcement and Access to Care

The administration has expanded immigration enforcement in communities across the country, not just at the border. In 2025, it rolled back longstanding limits on enforcement in “sensitive locations” like hospitals, schools, and churches. It also began sharing Medicaid data on noncitizen enrollees with the Department of Homeland Security (DHS) for enforcement purposes, a departure from prior policy.

A KFF/New York Times Survey of Immigrants last year found that immigration-related fears are widespread and are affecting immigrants’ health and use of health care, especially among those who are likely undocumented. Fourteen percent of immigrant adults, including nearly half (48%) of likely undocumented adults, say they have avoided seeking medical care since January 2025 because of immigration concerns. About 4 in 10 immigrant adults (41%) say they worry that they or a family member could be detained or deported, up from 26% in 2023. Four in 10 immigrant adults, and nearly 8 in 10 likely undocumented adults, say immigration-related worries have had negative effects on their health.

Public Charge Policy

A new public charge rule, which took effect September 18, 2026, gives immigration officials broad discretion to deny a green card to people they deem likely at any time to depend on income-based government assistance programs, and allows them to consider use of programs previously excluded, including Medicaid and CHIP. The rule will likely increase fears about participating in programs among immigrant families (beyond those directly affected, including U.S. citizen children). KFF estimates that if 10% to 30% of Medicaid and CHIP enrollees in households with a noncitizen disenroll, 1.4 to 4.1 million people could drop coverage, including up to 1.7 million U.S. citizen children.

Immigration Policy and the Health Care Workforce

Visa restrictions could also affect the health care workforce. In September 2025, President Trump raised the H-1B visa fee, which allows workers with specialized skills to work temporarily in the U.S., to $100,000. After a federal court blocked the increase in June 2026, DHS proposed a $103,265 fee per petition, with some exceptions. KFF analysis found new H-1B approvals in health care and social assistance rose about 18% between FY2022 and FY2025. The fee could curb that trend and worsen health care worker shortages.

Health Coverage Restrictions

The 2025 reconciliation law limits Medicaid, CHIP, subsidized ACA Marketplace coverage, and Medicare to a narrower group of lawfully present immigrants, making many others, including refugees and asylees, ineligible. The Medicaid and CHIP restrictions fully took effect on October 1, 2026, and the Marketplace and Medicare restrictions take effect in January 2027. The Congressional Budget Office estimates 1.4 million lawfully present immigrants will become uninsured by 2034 as a result. Some states, including California, New Mexico, New York, and Oregon, are using state funds to cover lawfully present immigrants losing federal eligibility. At the same time, some states, including California, Colorado, DC, Illinois, Minnesota, and Washington, have scaled back or eliminated broader state-funded coverage for immigrants regardless of status due to budget pressures.

Recent Issues and Looking Ahead  

The midterm election outcome could impact immigration policy and the future of the 2025 reconciliation law’s Medicaid and ACA changes; many Democrats have campaigned on reversing those restrictions and reductions more broadly.

Several developments with health care implications are unfolding:

• Enforcement funding: The 2025 reconciliation law provided $170 billion in additional funding for immigration enforcement, including new detention facilities for immigrant children and families.
• Coverage and enrollment: The public charge rule and new Medicaid and CHIP restrictions are likely to lead to drops in coverage among immigrant families because of fear, confusion, or difficulty completing verification requirements.
• Health care workforce: DHS’s proposed $103,265 H-1B fee has not yet been finalized, but its outcome could have ramifications for the health care workforce.

• Census: The administration has proposed excluding many noncitizen immigrants from the 2030 Census count, which could reduce federal funding and shift political representation for states with large immigrant populations.

The Public’s Views  

As voters make their final assessments before they cast their ballots in the midterm election, KFF asked them what issues they want 2026 midterm candidates to prioritize. About a third (35%) of voters said immigration was “extremely important” for candidates to talk about, behind issues like cost of living (62%), health care costs (47%), and fraud in government programs (44%). Voters are divided on which party they think would do a better job on immigration (38% Republicans, 34% Democrats). One in 5 voters overall, including about 3 in 10 independent voters (32%), say they trust neither party to handle immigration.

Meanwhile, a majority of the public (56%) say they are concerned about the Trump administration’s tactics and immigration enforcement activities in or around health care settings. There are stark divides by partisanship on this tactic. Nearly 9 in 10 (86%) Democrats and about 6 in 10 (59%) independents say immigration enforcement activity should not be allowed in or around health care facilities, whereas 6 in 10 Republicans say it should be allowed. Among Republicans on this question, MAGA supporters are much more likely than non-MAGA supporters to say this tactic should be allowed (71% vs. 32%), and 4 in 10 (41%) non-MAGA Republicans say it should not be allowed.

The KFF/AP Rural Voters Survey found that immigration may play a larger role for voters living in rural areas, with nearly half (45%) of rural voters, including 56% of rural Republicans, saying it’s an “extremely important” issue for candidates to discuss. Rural voters largely view legal immigrants and seasonal agricultural workers as important to their local economies, a finding that echoes concerns about rural areas’ reliance on immigrant health care workers, but voters divided in their views of the Trump administration’s immigration policies, with about one-third each saying these policies have had a negative (36%) or a positive (35%) impact on their area, with an additional 3 in 10 (29%) saying it had no impact on their area.