Metro creative

A government shutdown has arrived, and Medicaid spending is once again at the center of the fight. Vice President JD Vance claimed Democrats would shut the government down to “demand healthcare for illegal aliens”– his words to describe limited state-funded programs that provide narrow services to undocumented immigrants.

Michigan does not fund these programs, rather only seven states and Washington, D.C. strategically allocate their own state dollars this way.

Earlier this year, Republicans passed the One Big Beautiful Bill Act using the same rhetoric, politicizing health care policy with immigration talking points. Now, the newest round of Medicaid cuts, which Democrats have opposed, threatens to destabilize health care for Michiganders and increase costs nationwide. The fact is that non-citizens are already excluded from Medicaid enrollment, and the state programs under scrutiny are designed to recover otherwise unpaid expenses for essential and emergency care that hospitals are obligated to provide.

The political focus may be on immigrants, but the reality is that lawmakers are holding health care for millions of Americans hostage–with no savings for Michigan, only deeper cuts to its health care infrastructure.

As clinicians, we see firsthand the benefits of Medicaid, as the largest health insurance program in the U.S., covering low-income Americans, families, pregnant people, and those with disabilities. Federal law (EMTALA) requires hospitals to provide emergency care to anyone in need, regardless of their ability to pay. Emergency Medicaid funding, which helps hospitals meet this mandate, accounts for just 0.4% of federal Medicaid spending for all recipients, not just undocumented immigrants.

Yet in the current shutdown debate, these state-funded programs are cited as justification for reducing billions in federal health care funding, even though they receive no federal support. The result is a dangerous mismatch between rhetoric and reality, as political negotiations threaten to dismantle the financial framework that sustains EMTALA, potentially leaving hospitals uncompensated for legally mandated care and shifting those costs onto American families through higher premiums.

In addition, Medicaid cuts enacted by Republicans risk terminating state programs that have been shown to save state dollars. While lawmakers claim cutting access for undocumented patients would save Medicaid funds, Colorado demonstrates that limited coverage for low-income individuals, regardless of residency status, reduces overall health care expenditures in certain circumstances. Before expanding access to dialysis, Colorado spent nearly $20 million between 2017 and 2018 on costly emergency-only treatments delivered in the ER. After shifting away from emergency-only treatments and allowing scheduled dialysis, it nearly doubled access while cutting costs per patient in half.

This change reduced the burden on hospitals, meaning fewer costs were distributed to those with private insurance. These state funded programs show how strategic investments lower overall health care costs, protecting hospitals and insured patients alike. That’s not wasteful spending, it’s fiscal discipline. In cases like Colorado’s, whether or not programs exist, patients with kidney failure will still end up in our hospitals.

Funding cuts do not eliminate the need for care.

Instead of fiscal discipline, today’s shutdown fight advances a false narrative that scapegoats immigrants while undermining the very system it claims to protect. Restricting Medicaid under the guise of cutting costs does not erase expenses–it shifts them onto hospitals, insured patients, and communities. As with the One Big Beautiful Bill Act before it, framing Medicaid spending around undocumented immigrants misleads the public and distracts from the real consequences: destabilizing hospitals, raising premiums, and weakening care for millions of ordinary Americans.

In Michigan, where such programs do not exist, patients will still come to our hospitals whether they are citizens or not, and with less funding, our ability to support communities will be further undermined.