The Trump administration’s bid to force states like Oregon to eliminate coverage for undocumented immigrants could cut billions from the state's health care system. But if Oregon cuts its program, costs of care for undocumented people would be shifted to hospitals, businesses and other commercial insurance ratepayers.
Advocates said eliminating the Healthier Oregon program would not only hurt the more than 100,000 people it covers; it would simply transfer the costs of their care from state government to other parts of the health care system — and potentially increase some of those costs.
“People will still get sick and we’ll get back to where we were before,” said Olivia Quiroz, executive director of the Oregon Latino Health Coalition, an advocate and supporter of the state’s health care program for immigrants. “They’ll end up in the hospital system. The costs will still be there — and will be even more. ”
The Medicaid-funded Oregon Health Plan provides free health care coverage to 1.4 million low-income Oregonians. That includes about 105,000 immigrants who lack documentation covered through Healthier Oregon, approved by lawmakers in 2021.
Oregon is one of seven states, along with the District of Columbia, that provides a level of health care services to both children and adults who are undocumented immigrants. Seven other states provide health care only to undocumented children.
Oregon uses only state funds to cover the costs of Healthier Oregon, which are projected to run about $750 million a year. But the federal government pays for the bulk of the costs for the other 1.3 million people in the Oregon Health Plan.
On May 22, the U.S. House of Representatives narrowly passed the budget bill that would cut federal funds for the Oregon Health Plan by more than $500 million a year, or more than $7 billion over 10 years, if the state does not eliminate coverage for undocumented immigrants.
Some states that have provided coverage for undocumented immigrants have already started to pare back that coverage, or are considering doing so. Minnesota has scaled back some health care coverage for immigrants, as has Illinois. Meanwhile, California Gov. Gavin Newsom has proposed a freeze on enrolling undocumented immigrants in its health care program, along with a $100 per month charge for current enrollees.
But Oregon Gov. Tina Kotek said early last week -- before the House passed the bill -- that it would be a mistake to make any changes in Oregon’s program — even in the face of possible repercussions from the budget bill.
Supporters of Healthier Oregon say the state should hold its ground. Quiroz said her group’s message to state leaders is: “Don’t make any preemptive cuts. Hold your values. We know this is a program that you’ve championed. It’s working. Let’s protect it.”
If the Kotek administration and lawmakers choose to retain the program, the Legislature will be tasked with making cuts elsewhere in the budget to account for reduced federal funding.
If, however, Oregon cuts the program, the costs of care for the 105,000 people currently enrolled in the program will likely be passed on to others in the system — specifically to hospitals, many of which are already struggling. Hospitals, in turn, pass their costs on to commercial health insurers through higher billings, which in turn lead to higher rates for individuals and businesses who pay for that coverage.
Care will shift to hospital emergency departments
If the federal legislation is approved and Oregon does decide to eliminate the Healthier Oregon program, many people who were part of the program will stop accessing most health care services.
But many will still need and receive some health care services, health care experts say — most likely in hospital emergency departments across the state. That will likely mean two things: people arriving at the emergency department will be sicker; and those costs will be passed on to others.
A federal law passed in 1986 requires all Medicare-participating hospitals to assess and stabilize anyone — citizen or non-citizen — who shows up at an emergency department and may need life-saving care. For many immigrants, the costs of that emergency treatment are covered, or partially covered, by Medicaid.
The budget bill would not change the 1986 law or the Medicaid provision covering emergency care for people who are undocumented. And, in Oregon, hospitals would be on the hook for any increased costs not paid for by Medicaid.
If people lose their coverage through the Healthier Oregon program, the costs of care for them in hospitals and health systems would likely show up as what’s known as “charity care.”
The Oregon Health Authority and other organizations told The Lund Report they have no current estimates on potential increased costs to hospitals resulting from the elimination of Healthier Oregon.
But a health authority spokesperson said in a statement, “Without Healthier Oregon, individuals who are currently covered by the program would likely receive emergency care that is not reimbursed. Increasing hospital expenses can raise health care costs for all patients.”
In 2023, Oregon hospitals reported $1.6 billion in unreimbursed care. Included in that total is charity care, shortfalls in Medicaid payments for care, and some other subsidized health services.
Since then, hospitals say they’ve been hit with unexpectedly high costs due to a new state law that increased their charity care responsibilities. So the prospect of cutting Healthier Oregon just adds to concerns over other proposals to cut coverage that would drive up the need for charity care.
“Our state is highly vulnerable to any Medicaid cuts, which will send shock waves through the health care system with devastating consequences for Oregonians,” the Hospital Association of Oregon said in a statement to The Lund Report. “Any version of the bill Congress passes is going to put the services hospitals provide and patients depend on at risk.”
Emergency care costs more
Before lawmakers approved Healthier Oregon, the Portland-based nonprofit Project Access NOW played a central role in the region for people who lack documentation, connecting people with health care needs to providers willing to help them, such as through hospital charity care.
Tracy Carver, president and chief executive officer of the group, said that the 2021 law expanding care has helped address health needs more efficiently. Without primary care and preventive health care services, untreated health problems can grow much worse, she said.
“We know in public health that if people don't have stable access to good preventative care, that they are going to be more likely to just show up downstream in our (health) system — and likely with more poorly controlled conditions,” she said. “Particularly if we're talking about chronic disease.”
That ultimately leads to more costly interventions, she said — more costly “not just for individuals but even for hospitals and health systems that provide care to them. And I think that impacts all of us ultimately.”
Recent health policy studies support that coverage has lowered costs.
An April 2025 study by a University of Chicago group found that hospitals in Illinois had a 15% reduction in hospital bad debt in the years after a state law was passed in 2020 that provided some health care coverage to undocumented immigrants. That was about $1.5 million reduction in bad debt per hospital. The savings were higher in Illinois counties with higher enrollment in the health care program, the study found.
Another 2022 study underlined how good primary care significantly decreased visits to emergency departments, and decreased the associated costs.
University of Notre Dame and Massachusetts Institute of Technology researchers found that undocumented immigrants who had free access to several primary care clinics in New York City showed significantly reduced use of emergency departments. During the 14-month project, visits from average-risk patients to emergency departments decreased by 21%, saving those departments about $200 per person. Higher-risk patients had a 42% decrease in the use of emergency departments. That led to savings of about $500 per patient, the study found.
“Access to health coverage helps keep more individuals and families healthy, which reduces health costs and risks for every community in our state,” according to a statement released by the health authority. “Uninsured people are less likely to receive preventive care due to cost and often wait until a condition worsens to the point that it requires more advanced, expensive care at an emergency department or hospital. Preventive care is more cost effective and reduces the physical and mental stresses associated with serious health issues.”
Some health care advocates also point to the prenatal care for mothers that programs like Healthier Oregon provide — care that Oregon lawmakers have been trying to beef up.
Losing that care will have a likely effect on the ongoing health of their children — who will be U.S. citizens and eligible for Medicaid coverage. Analysis by KFF.org, a health policy research organization, indicates that about one in eight children had at least one non-citizen parent in 2023.
Omar Al Rais, senior vice president of operations for Project Access NOW, said the need for donated care decreased substantially after Healthier Oregon began.
The group’s donated care program served 2,766 people in calendar year 2021 and 2,845 in 2022. That number fell to 406 by 2024 and to 193 in the first three months of 2025. Al Rais said eliminating Healthier Oregon would roll back “all this progress and this work that we are so proud we achieved in Oregon.”
What happens next
The U.S Senate will consider the House-passed budget bill — likely for the next several weeks. Senate Republicans are currently divided on various provisions in the bill.
If the bill were passed and signed by President Trump, states like Oregon would then need to decide how — or whether — to change their health care programs for immigrants.
“There’s a lot more hurdles in the federal landscape,” Quiroz said.
Referring to the name of the Trump administration budget bill — the “One Big Beautiful Bill Act,” she added, “I don’t know what’s beautiful about it. It’s a devastating bill.”
