ILLINOIS — For nearly two decades, Francisca avoided seeking medical attention. Born with malformed limbs, the 58-year-old Southwest Side resident suffered in silence, relying on homemade remedies and skipping dental appointments due to high costs. Without health insurance, she couldn’t afford even basic medical care.
That changed two years ago, when she became eligible for Illinois’ taxpayer-funded health insurance program, which covers low-income noncitizens, including undocumented immigrants and green card holders who do not meet Medicaid’s residency requirement.
Francisca was able to see a doctor for the first time in years without being concerned about unmanageable bills.
That security is no longer guaranteed. Under Gov. JB Pritzker’s proposed budget for 2025, the program for noncitizen immigrants aged 42 to 64 could be eliminated. More than 30,000 people, including Francisca, face losing their insurance coverage as the state attempts to close a growing budget gap.
The proposed cuts are part of a larger effort to balance Illinois’ $55.2 billion budget, with Pritzker claiming that the state must reduce spending as tax revenue growth slows. The administration estimates that eliminating the program will save $330 million.
While coverage would continue for noncitizens aged 65 and up, the move has sparked outrage among immigrant advocates and Democratic lawmakers, many of whom were caught off guard by the proposal.
The program, which began in 2022, was intended to close the healthcare gap for vulnerable immigrant populations. However, a state audit revealed that costs had risen significantly beyond initial projections.
The program for older noncitizens cost nearly twice as much as expected, while the expenses for the younger age group were nearly four times as high.
Pritzker’s decision has sparked political divisions within his own party. The governor has established himself as a key Democratic voice opposing former President Donald Trump’s restrictive immigration policies and Medicaid cuts.
Just last month, he wrote an op-ed opposing Republican efforts to cut federal healthcare funding, stating, “For Illinois families of all backgrounds and across the state, health care isn’t an afterthought—it’s a lifeline.”
However, his budget proposal directly contradicts that position, leading some to question his commitment.
“A specific population is being targeted. Is it because they are perceived as less human? asked State Representative Norma Hernandez, Chair of the House Latino Caucus.
For those who rely on the program, the loss of coverage would be devastating.
Francisca, who has never been able to work because of her disability, relies solely on her children for financial support. Her state-funded insurance provided her with access to primary care, specialists, and medication—all of which will disappear if the program is cut.
“I actually have a bad toothache right now, and I will make sure I go to the dentist soon, before my [coverage] is taken away,” Francisca told me. “Otherwise, it will cost me like $300, and I don’t have that much money.”
Her daughter, Sara, 20, is concerned about the financial burden that will be placed on their family. “She is everything to us,” she explained.
Healthcare policy experts warn that dropping coverage for tens of thousands of noncitizens may have far-reaching economic and public health consequences.
“When an individual does not have health insurance coverage, they are more likely to forego primary and preventive health care, which means that health conditions that are relatively simple to treat may go undetected for a long time and eventually become more complex and expensive to treat,” said Drishti Pillai, director of immigrant health policy at KFF, a nonpartisan health research organization.
Uninsured people frequently seek treatment in emergency rooms, which raises uncompensated care costs and ultimately burdens taxpayers.
Pritzker defended the program in 2023, stating, “We save money when we invest in health care for undocumented immigrants…because you know what happens if they don’t get health care, basic health care: They end up in an emergency room.”
If the program is cut, many patients will turn to community health centers, which are legally required to provide care regardless of insurance or immigration status.
However, these centers are already experiencing financial difficulties. The Illinois Primary Health Care Association, which represents more than 50 community health centers across the state, warns that a loss of state funding could result in layoffs, reduced services, or even closures.
“My health centers will be severely impacted,” said Ollie Idowu, president and CEO of the association.
In addition to the potential loss of state funding, health centers face federal Medicaid reimbursement challenges and restrictions from pharmaceutical companies, which may limit their ability to obtain discounted medications.
“At the federal level, there is a nightmare of a storm brewing,” stated Cyrus Winnett, the association’s chief public affairs officer.
Illinois has long been a pioneer in improving healthcare access for immigrant populations. In 2006, it became the first state to offer health insurance to all children, regardless of immigration status. In 2020, it became the first to provide Medicaid-style benefits to seniors without legal status.
That legacy is now at risk.
Supporters of the program are scrambling for alternative funding options. Some legislators are considering tax increases or reallocating resources, but finding additional revenue in a tight budget environment will be difficult.
