Guest Blog: Trump’s Executive Orders Could Jeopardize Immigrants’ Health Coverage

By Mekdes Agezew, NCL Health Policy Spring Intern

As President Donald Trump begins his second term in office, he has signed a series of executive orders (EOs) aimed at reversing policies implemented by the Biden administration. In his first week alone, Trump revoked 78 of Biden’s executive orders and actions, impacting areas such as immigration, climate change, oil exploration, gender equality, federal diversity programs, and health care coverage.

Trump’s Immigration Policies and Their Impact on Health Care Access

One of President Trump’s executive orders expanded the power of Immigration and Customs Enforcement (ICE), to increase arrests and deportations of undocumented immigrants. As of February 3rd, DHS reports 5,693 deportations via X. and on February 6th the White House confirmed that 461 individuals arrested by ICE were released. Included in this is the removal of Colombian nationals via military planes on January 26, 2025. Colombian President Gustavo Petro initially resisted but ultimately conceded after threats of economic tariffs, and sent an aircraft of their own to pick up around 200 individuals being deported.

Although these deportation efforts primarily target undocumented immigrants, their effects extend to broader immigrant communities, including millions of U.S.-born children in mixed-status families. During Trump’s first term, restrictive immigration policies and increased enforcement created widespread fear, discouraging immigrant families from enrolling in healthcare programs such as Medicaid. The expanded “public charge” rule, later reversed, exacerbated these concerns by making immigrants fear that using public benefits could jeopardize their residency or citizenship applications. As of 2023, nearly three-quarters of immigrant adults, including nine in ten who are likely undocumented, reported uncertainty about using non-cash assistance due to fears of jeopardizing their immigration status.

During Trump’s first administration, which also increased immigration enforcement, KFF found that there was a decrease in health care use and participation in Medicaid and CHIP because of immigration-related fears. Now, with the Administration’s doubling down on a more forceful immigration agenda, fears are intensifying. His rollback of policies expanding Medicaid and ACA coverage, combined with rising enforcement actions, is expected to increase the number of uninsured immigrants and reduce participation in vital healthcare assistance programs.

Proposed Medicaid Funding Cuts and their Impact

Medicaid provides high-quality, affordable health care to Americans, including children, pregnant women, veterans, seniors, and low-income individuals. It covers essential services such as primary care, hospital stays, prescription drugs, and preventive care. While undocumented immigrants are ineligible for any federally funded coverage, lawfully present immigrants are often eligible, with a five-year waiting period. However, some states have expanded coverage by eliminating the waiting period.

Currently, the Trump administration is exploring ways to reduce federal spending and cut taxes, including cuts to Medicaid’s budget. On January 28, 2025, the White House issued a memo freezing federal loans and grants to review whether federally funded programs align with the Trump administration’s goals. This caused widespread confusion about Medicaid’s future, which was only exacerbated by reports from states that they were unable to access the systems used to draw down federal health dollars. Later, officials clarified that Medicaid—since it provides direct payments—was not included in the freeze. However, the program remains a target for Republican officials. House Republicans released a draft budget resolution on February 13 as part of their budget reconciliation strategy. With Medicaid being the largest program

overseen by the Energy and Commerce Committee; it is the primary plausible source for the minimum $880 billion cuts the Committee needs to find. Additionally, a bill was introduced within both chambers that would prohibit states from using Medicaid funding to provide healthcare benefits for illegal immigrants. If federal Medicaid funding is cut, states will be forced to either cover the costs themselves or scale back the program. States that choose to continue Medicaid may tighten eligibility requirements, reduce benefits, or limit enrollment, making healthcare access even more challenging for low-income and immigrant families. For instance, Idaho state Rep. Lori McCann states that if the state repeals its Medicaid expansion, more than 89,000 Idahoans could lose their coverage. Ultimately, this could increase the number of uninsured individuals and aggravate health disparities.

The Potential Impact of RFK Jr.’s Health Policies

On February 13, 2025, the Senate confirmed Robert F. Kennedy Jr. as Secretary of Human Health Services (HHS). As an anti-vaccine zealot, Sec. Kennedy. continues to voice his opposition to childhood vaccine mandates and question the safety of all vaccines. Secretary Kennedy also staunchly opposes pharmaceutical companies and their influence. As Secretary, RFK Jr can influence Medicaid’s vaccine coverage policies, potentially limiting access to childhood immunizations and other preventative vaccines for millions of low-income and immigrant families.

We are already seeing the consequences of declining vaccination rates. For example, Texas is experiencing an outbreak of measles amongst youth, totaling 58 cases at the time of writing, with 13 people hospitalized. Measles spreads easily and quickly in unvaccinated children and adults. This outbreak is the worst seen in the US in 30 years. The US is also facing the worst flu season in 15 years with nearly 400,000 hospitalizations and 16,000 deaths from the flu as of February 8. Further restrictions to vaccine access would pose serious public health risks,

particularly for children who rely on Medicaid for immunizations against diseases such as measles and polio.

The Impact of Halting Lower Drug Prices and Expanded Health Coverage Former President Biden prioritized lowering prescription drug costs and expanding health coverage under ACA and Medicaid, which NCL supports. In January 2021, Biden’s Executive Order 14009 strengthened these programs, extending enrollment periods and allowing more individuals and families to access health care. And in October 2022, Biden further issued Executive Order 14087 to reduce prescription drug prices, addressing the skyrocketing costs that burden low-income families. Over a quarter of adults have difficulty affording their prescription medications, and over half of adults worry about being able to afford them. When looking at race/ethnicity, 61% of Black adults and nearly 70% of Hispanic adults report worrying about their ability to afford their medications. By revoking these initiatives, the Trump Administration puts the health of low-income and vulnerable immigrant families and the communities they reside in, at greater risk.

While Mr. Trump has yet to announce a comprehensive health care plan, his actions suggest a shift away from affordability and accessibility, leaving whole communities across the US at risk, and it won’t be only immigrant communities, though they suffer more than most.

Conclusion

By rescinding executive orders that expanded Medicaid, ACA coverage, and lowered drug prices, Trump is engaging in a reckless experiment that runs the risk of spreading illness and disease; in doing so, he and his HHS Secretary put all Americans at risk. While the consequences of this experiment will be felt by all, immigrant families and communities are expected to be hit even harder.