El gobierno federal no lleva un registro de cuántos niños han ingresado a este sistema como consecuencia de operativos de control migratorio, lo que dificulta saber con qué frecuencia ocurre.

En Oregon, hasta febrero, dos niños habían sido ubicados en hogares temporales luego de ser separados de sus padres en casos de detención migratoria, según Jake Sunderland, vocero del Departamento de Servicios Humanos del estado.

“Antes del otoño de 2025, esto nunca había ocurrido”, aseguró.

Hasta mediados de febrero, casi por el Servicio de Inmigración y Control de Aduanas (ICE, por sus siglas en inglés).

El récord de 73.000 personas detenidas en enero representó un comparado con el año anterior. Según una , hasta agosto de 2025, padres de 11.000 niños con ciudadanía estadounidense habían sido detenidos desde el inicio del mandato de Trump.

El medio NOTUS que por lo menos 32 niños de padres detenidos o deportados habían sido colocados en hogares temporales en siete estados.

Sandy Santana, director ejecutivo de Children’s Rights, una organización de defensa legal, dijo que sospechan que el número real es mucho mayor.

“Ese número nos parece realmente muy bajo”, dijo.

La separación de sus padres es profundamente traumática para los niños y suele provocar , incluido el trastorno de estrés postraumático. El estrés prolongado e intenso también puede causar infecciones más frecuentes en los niños y problemas en el desarrollo. Ese “estrés tóxico” también se asocia con daños en áreas del cerebro responsables del aprendizaje y la memoria, , una organización sin fines de lucro dedicada a la información en salud que incluye a ºÚÁϳԹÏÍø News.

Durante el primer mandato de Trump, . y modificaron algunas leyes para permitir que tutores recibieran derechos parentales temporales en casos relacionados con migración. Ahora, tras el regreso de Trump al poder el año pasado, el aumento en los controles migratorios está impulsando una nueva ola de respuestas estatales.

En Nueva Jersey, legisladores están considerando un proyecto para modificar estatal que permite que los padres designen tutores temporales para casos de muerte o incapacidad. La nueva versión agregaría como otra razón válida la separación por control migratorio federal.

El año pasado, Nevada y California aprobaron leyes para proteger a las familias separadas por acciones de control migratorio. La ley de California, llamada Ley del Plan de Preparación Familiar (), permite que los padres designen tutores y compartan derechos de custodia, en lugar de que sus derechos se suspendan mientras están detenidos. Si son liberados y pueden reunirse con sus hijos, recuperan sus derechos parentales completos.

Existen importantes obstáculos legales para la reunificación familiar una vez que un niño entra bajo custodia estatal, explicó Juan Guzman, director del tribunal de menores y tutela en Alliance for Children’s Rights, una organización de defensa legal en Los Ángeles.

Si el niño es colocado en cuidado temporal y ni el padre ni la madre pueden participar en los procesos judiciales requeridos porque están detenidos o han sido deportados, es menos probable que puedan volver a reunirse con su hijo, afirmó Guzman.

Se estima que que son ciudadanos estadounidenses viven con un padre u otro familiar que no tiene estatus migratorio legal, según investigaciones de Brookings Institution, un centro de estudios en Washington, D.C. Dentro de ese grupo, 2,6 millones de niños tienen a ambos padres sin estatus legal.

Santana dijo que es probable que el número de casos de separación familiar aumente a medida que el gobierno de Trump avance con su campaña migratoria. Por lo tanto, más niños corren el riesgo de terminar en el sistema de cuidado temporal.

Las exigen que la agencia se esfuerce en facilitar la participación de los padres detenidos en los procedimientos de los tribunales de familia, de bienestar infantil o de tutela, pero Santana indicó que no está claro que el ICE esté cumpliendo con estas normas.

Los funcionarios de ICE no respondieron a las solicitudes de comentarios para este artículo.

Antes de que cambiara la ley de California, la única razón por la que un padre podía compartir derechos de custodia con otro tutor era si tenía una enfermedad terminal, contó Guzman.

Ahora, si los padres preparan un plan con anticipación y designan a alguien de confianza que pueda hacerse cargo de sus hijos si llegara a ser necesario, la agencia estatal de bienestar infantil puede iniciar el proceso para entregar a los niños a esa persona sin tener que abrir un caso formal de cuidado temporal, agregó.

Aunque los legisladores de Nevada el año pasado ampliaron una ley de tutela ya existente para incluir el control migratorio, la medida exige que los padres presenten documentación notarial ante la oficina del secretario de estado, un trámite administrativo que puede resultar costoso, dijo Cristian González-Pérez, abogado en Make the Road Nevada, una organización sin fines de lucro que ofrece recursos a comunidades inmigrantes.

González-Pérez señaló que algunos inmigrantes dudan en completar formularios gubernamentales por temor a que el ICE pueda acceder a esa información y los persiga. Él les asegura a los miembros de la comunidad que los formularios estatales son confidenciales y solo pueden ser consultados por hospitales y tribunales.

El gobierno de Trump ha tomado para acceder a información sensible a través de los Centros de Servicios de Medicare y Medicaid, el Servicio de Impuestos Internos (IRS), el Programa de Asistencia Nutricional Suplementaria (SNAP), el Departamento de Vivienda y Desarrollo Urbano y otras entidades.

González-Pérez y Guzmán consideran que muchos padres inmigrantes no conocen sus derechos. Designar un tutor temporal y crear un plan familiar es una forma de no sentirse impotentes, afirmó González-Pérez.

“La gente no quiere hablar de esa cuestión”, reflexionó Guzman. “Que un padre tenga que hablar con un niño sobre la posibilidad de separarse da miedo. No es algo que nadie quiera hacer”, concluyó.

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The federal government doesn’t track how many children have entered foster care because of immigration enforcement actions, leaving it unclear how often it happens. In Oregon, as of February two children had been placed in foster care after being separated from their parents in immigration detention cases, according to Jake Sunderland, a spokesperson for the Oregon Department of Human Services.

“Before fall 2025, this simply had never happened before,” Sunderland said.

As of mid-February, nearly by Immigration and Customs Enforcement. The record 73,000 people in detention in January represented an compared with one year before. According to , parents of 11,000 children who are U.S. citizens were detained from the beginning of Trump’s term through August.

The news outlet NOTUS that at least 32 children of detained or deported parents had been placed in foster care in seven states.

Sandy Santana, executive director of Children’s Rights, a legal advocacy organization, said he thinks the actual number is much higher.

“That, to us, seems really, really low,” he said.

Separation from a parent is deeply traumatic for children and can lead to , including post-traumatic stress disorder. Prolonged, intense stress can lead to more-frequent infections in children and developmental issues. That “toxic stress” is also associated with responsible for learning and memory, according to KFF.

, and amended existing laws during Trump’s first term to allow guardians to be granted temporary parental rights for immigration enforcement reasons. Now the enforcement surge that began after Trump returned to office last year has prompted a new wave of state responses.

In New Jersey, lawmakers are considering to amend a state law that allows parents to nominate standby, or temporary, guardians in the cases of death, incapacity, or debilitation. The bill would add separation due to federal immigration enforcement as another allowable reason.

Nevada and California passed laws last year to protect families separated by immigration enforcement actions. California’s law, called the , allows parents to nominate guardians and share custodial rights, instead of having them suspended, while they’re detained. They regain their full parental rights if they are released and are able to reunite with their children.

There are significant legal barriers to reunification once a child is placed in state custody, said Juan Guzman, director of children’s court and guardianship at the Alliance for Children’s Rights, a legal advocacy organization in Los Angeles.

If a parent’s child is placed in foster care and the parent cannot participate in required court proceedings because they are in detention or have been deported, it’s less likely they will be able to reunite with their child, Guzman said.

are U.S. citizens who live with a parent or family member who does not have legal immigration status, according to research from the Brookings Institution, a Washington, D.C.-based think tank. Within that group, 2.6 million children have two parents lacking legal status.

Santana said he expects the number of family separation cases to grow as the Trump administration continues its immigration enforcement campaign, putting more children at risk of being placed in foster care.

the agency to make efforts to facilitate detained parents’ participation in family court, child welfare, or guardianship proceedings, but Santana said it’s uncertain whether ICE is complying with those rules.

ICE officials did not respond to requests for comment for this report.

Before the change in California’s law, the only way a parent could share custodial rights with another guardian was if the parent was terminally ill, Guzman said.

If parents create a preparedness plan and identify an individual to assume guardianship of their children, the state child welfare agency can begin the process of placing the children with that individual without opening a formal foster care case, he added.

While Nevada lawmakers expanded an existing guardianship law last year to include immigration enforcement, the measure requires the parents to file notarized paperwork with the secretary of state’s office, an administrative step that may be burdensome, said Cristian Gonzalez-Perez, an attorney at Make the Road Nevada, a nonprofit that provides resources to immigrant communities.

Gonzalez-Perez said some immigrants are still hesitant to fill out government forms, out of fear that ICE might access their information and target them. He reassures community members that the state forms are secure and can be accessed only by hospitals and courts.

The Trump administration has taken through the Centers for Medicare & Medicaid Services, the IRS, the Supplemental Nutrition Assistance Program, the Department of Housing and Urban Development, and other entities.

Gonzalez-Perez and Guzman said that not enough immigrant parents know their rights. Nominating a temporary guardian and creating a plan for their families is one way they can prevent feelings of helplessness, Gonzalez-Perez said.

“Folks don’t want to talk about it, right?” Guzman said. “The parent having to speak to a child about the possibility of separation, it’s scary. It’s not something anybody wants to do.”

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An elementary school teacher chose a low-price health insurance plan but soon realized she wasn’t clear about what it would mean for her family’s finances.

“Once I got the insurance card, I compared our old plan to our new plan, and that’s when I really got worried, because I didn’t really understand what a deductible was. It got me thinking, how do I use this insurance?”

— Madison Burgess, 31, of San Diego

When enhanced federal subsidies expired at the end of 2025, a lot of people buying their own health insurance on the state and federal exchanges saw their expected monthly rates jump. To keep costs down, many switched to a high-deductible health plan. These plans offer lower monthly payments, but in exchange patients can face steep out-of-pocket costs when they need care.

The plans are pretty common. In 2023, 30% of people who got insurance through their employer had a high-deductible plan, up from only 4% in 2006.

Madison Burgess, a teacher in San Diego, gets health insurance through her teaching job. But when she investigated adding her husband to her plan, it was just too expensive, so she started shopping on the exchange for a cheaper option for him.

The longer she scrolled through the plan options, the more overwhelming it felt. Insurance jargon made it hard to tell what her family would owe if her husband got sick.

“I didn’t know what a deductible was, so I just went with what was cheap, and now I have regret,” she said.

In exchange for that lower monthly premium payment, her husband’s coverage won’t kick in for most care until they’ve paid $5,800 in medical bills. Burgess didn’t know that the deductible must be met before insurance picks up part of the tab.

Deductible:

The amount you as the patient have to pay before insurance picks up part of the tab

Premium:

The monthly bill for your policy, paid to the insurance company

How do you prepare for thousands of dollars in upfront costs? One option is a health savings account, or HSA, which lets you save pretax money and is now available to people enrolled in lower-tier state and federal exchange plans, including bronze and catastrophic coverage. These plans generally have the lowest premiums on the exchange but the highest out-of-pocket costs when you need care.

Burgess had chosen a bronze plan and didn’t know HSAs were an option.

“I’ve never thought about having to put money away for a deductible,” she said.

Burgess and others are often more worried about socking away money for unexpected car and house repairs or vet bills.

If, like Burgess, you chose cheaper health coverage for this year only to discover you’re on the hook for meeting a high deductible, these tips can help you prepare.

1. You might qualify for an HSA and not know it.

If you’re enrolled in a bronze or catastrophic plan, you qualify to open a health savings account. Think of it as a medical piggy bank with tax perks. You put in pretax money, which lowers your taxable income. The money grows tax-free, and when you spend it on , those transactions are also tax-free. That’s what people call a “triple tax advantage.”

These accounts build a cushion for future health costs, such as doctor visits, prescriptions, and even products like over-the-counter medicine, tampons, and sunscreen.

The money typically can’t be used for monthly premiums, but the account is yours to use for qualified medical expenses for yourself, your spouse, or your dependents anytime in the future. The money in the account is yours, even if you change jobs or health plans.

An HSA is not the same as a flexible spending account, or FSA. FSAs are tax-advantaged too but are offered only through employers. The money expires annually and you lose any remaining money when you leave that job.

2. HSA-curious? Here’s how to open one.

You open a health savings account through a bank or other financial institution. The institution will issue you a debit card so you can make purchases from the HSA.

You can at any point during the year as long as you’re covered by an eligible plan. You can choose where to open the account, but be sure to check for any fees financial institutions charge and shop around.

If you get insurance through your job, your employer may require you to use a specific IRS-approved company.

Many people decide they can’t afford to contribute to an HSA. For some households, the desire to set aside money for medical expenses competes with the need to pay rent and buy groceries.

But there’s a detail that can make it feel more manageable. Contributions don’t have to be large. Just a few dollars a month can get you started.

There is, however, a limit. The IRS sets an annual cap on how much you’re allowed to contribute to an HSA. In 2026, an individual is limited to $4,400, or $8,750 for a family plan. Under that ceiling, the amount is up to you.

3. Preventive services should be covered at no cost to you.

All plans sold on marketplaces must cover at no cost to the patient as long as the care is provided in-network. Those services include routine immunizations and cancer screenings.

Beyond preventive care, understanding what different services cost can help you decide which type of medical appointment works best for your health needs and your wallet. For example, some plans charge less for a telehealth visit than to see your primary care doctor in person.

Check out your for more details.

4. Seek care early in the year.

Most deductibles reset on Jan. 1. Scheduling appointments or surgeries early in the year can be strategic if you discover a condition that requires ongoing care. If you can afford it, meeting your deductible sooner can make the rest of the year significantly cheaper, said Caitlin Donovan, a senior director at the Patient Advocate Foundation.

5. Consider paying cash instead of spending down your deductible.

Some hospitals, clinics, or other providers offer cheaper prices if you pay cash. You have the and explanation of how much a health service would cost if you paid out-of-pocket. Ask for the estimate before you get care. Then, compare that price with what your insurance company tells you it would cost if you used your insurance. If you decide to go with a cash payment, you’ll need to pay while you’re still at the doctor’s office, before charges get submitted to your insurance company.

Paying cash may save you money, but the amount you pay generally won’t count toward your deductible or out-of-pocket maximum.

“If you don’t think you’re ever going to hit your deductible — you’re that young invincible, and your deductible is $10,000 — negotiate the cash price,” Donovan said.

6. On an ACA plan? Update your income and use an HSA to avoid a tax surprise.

If you’re on an ACA plan and you’re eligible for subsidies, be aware: If your and you don’t update your marketplace application, you could owe thousands of dollars at tax time. The . Report raises, new jobs, or side gigs as they happen. If your income goes up, stashing money in an HSA can help because the money you put in the account doesn’t count toward your taxable income.

As soon as you report an increase in your income, that could mean higher premiums (if you no longer qualify for the same subsidy), but experts say it’s better to pay now than owe a big bill that you have to pay all at once.

“One of the biggest problems I see is someone is newly unemployed and they sign up for coverage, they say that they’re not making any money, and then eventually they get a job and don’t report it, and then they have this huge tax bill at the end,” Donovan said.

She advises updating your marketplace profile as soon as your income changes, which could newly qualify you for Medicaid or a plan that contributes more toward your medical bills.

Taylor Cook contributed to this report.

Health Care Helpline helps you navigate the health system hurdles between you and good care. Send us your tricky question and we may tap a policy sleuth to puzzle it out. Share your story. The crowdsourced project is a joint production of NPR and ºÚÁϳԹÏÍø News.

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Vestida con ropa de senderismo y collares de cuentas, Carranza, de 67 años, se movía entre árboles y niños en una mañana soleada de diciembre. “Agárrate de esa rama”, dijo en español. “¡Tú puedes, mi amor!”.

Carranza, profesional especializada en desarrollo infantil que creció columpiándose entre árboles y nadando en ríos en El Salvador, dijo que se siente como en casa en el bosque del preescolar al aire libre que cofundó. Ha trabajado con niños y adolescentes como cuidadora y educadora durante más de tres décadas, el tiempo suficiente para saber cuándo intervenir y cuándo dar un paso atrás para que sus estudiantes encuentren su propio equilibrio.

Cuando pasó a trabajar medio tiempo el año pasado, Carranza contaba con recibir Medicare y cheques del Seguro Social, beneficios otorgados a trabajadores estadounidenses e inmigrantes con presencia legal cuando se retiran, si de historial laboral y edad, o si tienen alguna discapacidad.

Carranza ha aportado decenas de miles de dólares a Medicare y al Seguro Social durante 24 años, según su registro de ingresos de la Administración del Seguro Social, revisado por El Tímpano y ºÚÁϳԹÏÍø News. Pero Carranza es una de un estimado de 100.000 inmigrantes con papeles que pronto quedarán excluidos de Medicare.

La ley One Big Beautiful Bill Act del Partido Republicano, firmada en julio pasado por el presidente Donald Trump, prohíbe que ciertas categorías de inmigrantes con presencia legal — incluidos beneficiarios del estatus de protección temporal (TPS), refugiados, solicitantes de asilo, sobrevivientes de violencia doméstica, víctimas de trata y personas con visas de trabajo — accedan a Medicare.

Quienes ya están en el programa, como Carranza, serán dados de baja antes del 4 de enero, una medida de legisladores republicanos para reducir el gasto de Medicare, ya que, junto con Trump, han argumentado que el dinero de los contribuyentes no debe usarse para pagar la atención médica de inmigrantes sin autorización.

“Los demócratas quieren que los inmigrantes ilegales, muchos de ellos CRIMINALES VIOLENTOS, reciban atención médica GRATIS”, dos meses después de firmar la ley. “¡No podemos permitir que esto suceda!”

Sin embargo, las categorías de inmigrantes que ahora perderán cobertura sí tienen estatus legal. Ni la Casa Blanca ni el Departamento de Salud y Servicios Humanos (HHS) respondieron a una pregunta sobre si era justo sacar de Medicare a residentes legales.

Los inmigrantes sin estatus legal ya no eran elegibles para Medicare ni para la mayoría de los beneficios públicos financiados por el gobierno federal.

Carranza teme que también pueda perder el permiso legal para vivir en Estados Unidos si la administración Trump pone fin al TPS para salvadoreños, como intentó hacer durante .

Si eso ocurre, Carranza perdería su residencia legal y podría estar en riesgo de pasar tiempo en un centro de detención migratorio o ser deportada.

“Esto es como una película de terror, una pesadilla completa”, dijo Carranza. “No es así como imaginé envejecer”.

“Bajo ataque constante”

Carranza dejó El Salvador en 1991 durante una guerra civil brutal, dejando atrás a tres hijos pequeños, para ganar dinero y enviarlo a su familia. Permaneció en el país después de que venciera su visa hasta 2001, cuando calificó para el TPS, luego de dos terremotos que azotaron El Salvador, y desplazando a 1,3 millones.

El TPS fue aprobado por el Congreso y promulgado en 1990 por el presidente republicano George H.W. Bush.

Este estatus permite que personas como Carranza, provenientes de ciertos países afectados por conflictos armados, guerras civiles o desastres climáticos, vivan y trabajen en Estados Unidos, si regresar a su país representa un riesgo.

Carranza se perdió la graduación de jardín de infantes de su hija menor y su primera medalla en atletismo. Trabajó turnos nocturnos cuidando recién nacidos y luego como maestra sustituta en escuelas públicas del Área de la Bahía de San Francisco para pagar la educación de sus hijos en El Salvador, así como sus propios estudios en el City College of San Francisco, donde obtuvo un título en desarrollo infantil.

También cuidó a decenas de niños de 3, 4 y 5 años que miraban con asombro mientras descubrían pequeños tesoros en el bosque de secuoyas del parque de Oakland donde cofundó Escuelita del Bosque, un preescolar de inmersión en español que enseña al aire libre.

Se suponía que la recompensa sería una jubilación tranquila. Pero el Congreso limitó la elegibilidad de Medicare a ciudadanos, residentes permanentes legales, nacionales cubanos y haitianos, y personas amparadas por los Compacts of Free Association, acuerdos entre Estados Unidos y naciones insulares del Pacífico.

La medida siguió a los intentos de Trump de excluir a algunos inmigrantes con presencia legal de Medicaid, de los subsidios en el mercado de seguros de salud y de servicios de apoyo social, como asistencia alimentaria, ayuda para vivienda y visitas médicas en centros de salud financiados por el gobierno federal. En total, se proyectaba que 1,4 millones de inmigrantes con presencia legal perderían el seguro de salud, según KFF, una organización sin fines de lucro de información de salud que incluye a ºÚÁϳԹÏÍø News.

Taylor Haulsee, vocero del presidente de la Cámara de Representantes, Mike Johnson, no respondió a solicitudes de comentarios.

Michael Cannon, director de estudios de política de salud en el Cato Institute, un centro de tendencia libertaria, dijo que los republicanos querían implementar recortes de impuestos y eliminar el seguro de salud para inmigrantes porque no afectaría a su base.

“No quieren convertir a Estados Unidos en un imán de asistencia social”, opinó. “Y les molesta que el gobierno les haga pagar por un estado de bienestar”.

Aunque no hay datos sobre inmigrantes con presencia legal, los inmigrantes sin papeles aportaron y $25,7 mil millones al Seguro Social en 2022, según el Institute on Taxation and Economic Policy.

La Oficina de Presupuesto del Congreso estimó que solo las restricciones a Medicare reducirían el gasto federal en para 2034.

Expertos en salud dicen que eliminar la cobertura para inmigrantes con estatus legal .

“En realidad, esta es la primera vez que el Congreso le quita Medicare a algún grupo”, dijo Drishti Pillai, directora de políticas de salud para inmigrantes en KFF. “Este cambio está afectando a inmigrantes con presencia legal en Estados Unidos, muchos de los cuales ya han trabajado y contribuido al sistema durante décadas”.

A medida que adultos mayores como Carranza pierdan su cobertura de Medicare, los médicos anticipan que retrasarán su atención, lo que llevará a un aumento de pacientes gravemente enfermos, especialmente en salas de emergencia.

Los adultos mayores pueden enfermarse de forma repentina y rápida, y son más vulnerables a enfermedades cardiovasculares como afecciones del corazón y presión arterial alta, especialmente si posponen la atención de rutina, dijo Theresa Cheng, médica de emergencias en Zuckerberg San Francisco General Hospital y profesora clínica adjunta de medicina de emergencias en la Universidad de California-San Francisco.

“Es bastante fácil que sufran un deterioro crítico de su salud”, dijo Cheng.

Carranza hace senderismo y se considera saludable, pero reconoce que está envejeciendo y comenzando a tener dificultades para seguir el ritmo de los niños en el bosque.

A finales del año pasado le diagnosticaron hipertensión, y en enero despertó con una presión en el pecho y fue a un centro de urgencias porque su presión había subido a niveles peligrosos. Unas semanas después, tropezó mientras caminaba y se cayó. Al día siguiente despertó con el pie hinchado. En el hospital local, un médico le dijo que tenía artritis.

Dijo que fueron momentos preocupantes, pero estaba agradecida de pagar solo $10 por la visita a urgencias y $5 por ver a su médico de atención primaria. Sin embargo, eso cambiará cuando pierda Medicare a principios del próximo año.

El estrés de saber que perderá su seguro de salud y posiblemente su estatus legal, mientras agentes federales detienen a inmigrantes como ella en todo el país, ha afectado su salud mental, contó. Está buscando terapia y servicios de acupuntura para tratar su insomnio y ansiedad, y la sensación de estar “bajo un ataque constante”.

Sin un lugar a donde ir

En California, hogar del mayor número de , Carranza podría haberse inscrito en un seguro patrocinado por el estado, pero este año la inscripción para adultos de 19 años o más que tienen TPS, están en el país sin autorización o son solicitantes de asilo. Otros estados con gobernadores demócratas como también han reducido sus programas de salud para inmigrantes por presiones presupuestarias.

En enero, el gobernador de California, Gavin Newsom, propuso un presupuesto estatal que no compensaría los recortes federales de atención médica para unos 200.000 inmigrantes con presencia legal, señalando el costo anual de $1.1 mil millones y déficits presupuestarios estatales.

“Dadas estas presiones fiscales, la administración no puede compensar este cambio en la política federal”, dijo H.D. Palmer, vocero del Departamento de Finanzas de California.

Pero algunos legisladores demócratas y defensores de los consumidores dicen que el estado debería intervenir. La asambleísta Mia Bonta, quien preside el Comité de Salud de la Asamblea, dijo que está trabajando en una solución presupuestaria legislativa para incluir en Medi-Cal — la versión estatal de Medicaid — a los inmigrantes que perderán su cobertura, incluidos los adultos mayores.

La demócrata de East Bay está especialmente preocupada por personas como Carranza, “que han vivido aquí durante décadas y han contribuido a esta economía, que han aportado a nuestro tejido cultural y a nuestras comunidades, que han formado familias y vidas y que ahora quieren tener la posibilidad de retirarse con dignidad y vivir con dignidad y tener la atención médica que necesitan”.

Una señal del futuro

En abril pasado, Carranza vislumbró lo que podría significar perder su cobertura de salud y beneficios de jubilación, después de que la Administración del Seguro Social le enviara una carta informándole que ya no calificaba para beneficios de jubilación porque no tenía presencia legal en el país, aunque sí la tenía. Luego Medicare dejó de pagar a su plan de salud, que como resultado la dio de baja.

Como beneficiaria de TPS con permiso de trabajo, sabía que se trataba de un error. Aun así, sin su cheque, Carranza no tuvo dinero para pagar la renta durante un mes. Compensó ese pago cuidando a los hijos de sus arrendadores. En mayo pasado, la oficina de la representante federal Lateefah Simon (demócrata de Oakland) ayudó a Carranza a recuperar sus beneficios de jubilación, pero tomó meses recuperar su seguro de salud.

La experiencia la dejó afectada.

“Es como recibir una bofetada en la cara después de más de 30 años trabajando para el sistema aquí”, dijo Carranza. “Y a cambio, esto es lo que tenemos ahora”.

Por las noches permanece despierta imaginando el futuro: aquí, donde ha pasado la mitad de su vida, sin seguro de salud y posiblemente sin beneficios del Seguro Social; o en El Salvador, donde están dos de sus tres hijos. Su hija, residente permanente que vive en Texas, espera convertirse en ciudadana para poder solicitar la residencia permanente para Carranza, pero el proceso puede tardar años.

También está la posibilidad que más teme: la detención indefinida o la deportación.

En una mañana reciente en su estudio en el sótano en Oakland, Carranza sacó una caja del fondo de su clóset. Dentro había una pila alta de tarjetas de identificación que incluían licencias de conducir antiguas, su tarjeta del Seguro Social y decenas de permisos de trabajo emitidos por el gobierno federal.

“Mi vida está en esta caja”, dijo.

Este artículo fue producido en colaboración con , una organización cívico-mediática que sirve y cubre a las comunidades inmigrantes latinas y mayas del Área de la Bahía.

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Dressed in hiking gear and beaded necklaces, Carranza, 67, maneuvered between trees and children on a sunny morning in December. “Hold on to that branch,” she said in Spanish. “You can do it, my love!”

Carranza, a child development professional who grew up swinging through trees and swimming in rivers in El Salvador, said she feels at home in the forest at the outdoor preschool she co-founded. She has worked with children and teens as a caregiver and educator for more than three decades, long enough to know when to lean in and when to step back to let her students find their own footing.

When she transitioned to working part-time last year, Carranza counted on getting Medicare and Social Security checks — benefits given to American workers and lawfully present immigrants when they retire, work history and age or disability requirements. She’s contributed tens of thousands of dollars into Medicare and Social Security over 24 years, according to her Social Security Administration earnings record, reviewed by El Tímpano and ºÚÁϳԹÏÍø News. But Carranza and an estimated immigrants will soon be cut out of Medicare.

The GOP’s One Big Beautiful Bill Act, signed last July by President Donald Trump, barred certain categories of lawfully present immigrants — including temporary protected status holders, refugees, asylum-seekers, survivors of domestic violence, trafficking victims, and people with work visas — from Medicare.

Those already in the program, like Carranza, will be disenrolled by Jan. 4 — a move by Republican lawmakers to rein in Medicare spending, as they and Trump have argued that taxpayer dollars should not be used to pay for the health care of immigrants in the U.S. without authorization.

“The Democrats want Illegal Aliens, many of them VIOLENT CRIMINALS, to receive FREE Healthcare,” Trump two months after he signed the bill into law. “We cannot let this happen!”

However, the categories of immigrants now losing coverage do have legal status. Neither the White House nor the Department of Health and Human Services responded to a question about whether it was fair to disenroll legal residents from Medicare.

Immigrants without legal status were already ineligible for Medicare or most other federally funded public benefits.

Carranza is worried that she could also lose legal permission to live in the United States if the Trump administration ends temporary protected status for Salvadorans, as it sought to do during .

If that happened, Carranza would lose legal residency, risking time in an immigration detention center or deportation.

“This is like a horror movie, a complete nightmare,” Carranza said. “This is not how I imagined getting old.”

‘Under Constant Attack’

Carranza left El Salvador in 1991 during a brutal civil war, leaving behind three young children, to earn money to send home to her family. She overstayed her visa until 2001, when she qualified for temporary protected status, after two earthquakes struck El Salvador, and displacing 1.3 million.

Temporary protected status, or TPS, was passed by Congress and signed into law by Republican President George H.W. Bush in 1990.

It allows people such as Carranza, from select nations undergoing armed conflict, civil war, and climate disasters, to live and work in the United States if being in their home country poses a risk.

Carranza missed her youngest daughter’s graduation from kindergarten and first medal-winning performance in track. She worked overnight shifts babysitting newborns and later substitute-taught in public schools in the San Francisco Bay Area to pay for her children’s schooling in El Salvador, and for her own classes at City College of San Francisco, where she earned a degree in child development.

And she cared for dozens of 3-, 4-, and 5-year-olds who gazed in awe as they uncovered little treasures buried in the redwood forest of the Oakland park where she co-founded Escuelita del Bosque, a Spanish immersion preschool that teaches children outdoors.

The trade-off was supposed to be a peaceful retirement. But Congress narrowed Medicare eligibility to citizens, lawful permanent residents, Cuban and Haitian nationals, and people covered under the Compacts of Free Association, agreements between the United States and Pacific island nations.

The move followed Trump’s efforts to bar some lawfully present immigrants from Medicaid, marketplace insurance subsidies, and social support services, such as food assistance, housing subsidies, and medical visits in federally funded health centers. Altogether, 1.4 million lawfully present immigrants were projected to lose health insurance, according to KFF, a health information nonprofit that includes ºÚÁϳԹÏÍø News.

A spokesperson for House Speaker Mike Johnson, Taylor Haulsee, did not respond to requests for comment.

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank, said Republicans wanted to enact tax cuts and eliminate health insurance for immigrants because it wouldn’t upset their base.

“They don’t want to turn the United States into a welfare magnet,” he said. “And they resent the government for making them pay for a welfare state.”

While data on lawfully present immigrants is not available, immigrants without legal status and $25.7 billion into Social Security in 2022, according to the Institute on Taxation and Economic Policy. The Congressional Budget Office estimated that the Medicare restrictions alone would reduce federal spending by 2034.

Health experts say eliminating coverage for immigrants with legal status .

“This is actually the first time that Congress has taken away Medicare from any group,” said Drishti Pillai, director of immigrant health policy at KFF. “This change is impacting immigrants who have lawful presence in the U.S., and many of whom have already worked and paid into the system for decades.”

As older adults like Carranza lose their Medicare coverage, clinicians anticipate that they will delay their care, leading to an increase in severely ill patients, especially in hospital emergency rooms.

Seniors can become sick suddenly and quickly, and they are more vulnerable to cardiovascular diseases such as heart disease and high blood pressure, especially if they put off routine care, said Theresa Cheng, an emergency physician at Zuckerberg San Francisco General Hospital and assistant clinical professor of emergency medicine at the University of California-San Francisco.

“It’s quite easy for them to fall off the cliff,” Cheng said.

Carranza hikes and considers herself healthy, but she acknowledges that she is aging and starting to struggle to keep up with the kids in the forest.

Late last year she was diagnosed with high blood pressure, and in January she woke up with a tight chest and went to urgent care because it had spiked to dangerous levels. A few weeks later, she tripped on a curb while walking and fell to the ground. She woke up the next day with a swollen foot. A doctor at the local hospital told her she had arthritis.

These were scary moments, she said, but she was grateful to have to pay only $10 for the urgent care visit and $5 to see her primary care doctor. However, that will change when she loses Medicare by early next year.

The stress of knowing she will lose health insurance coverage, and potentially her legal status, all while masked federal agents are detaining immigrants like her across the country, has taken a toll on her mental health, she said. She is searching for a therapist and acupuncture services to treat her insomnia and anxiety — and the feeling that she is “under constant attack.”

Nowhere To Turn

In California, home to the largest number of , Carranza could have enrolled in state-sponsored insurance, but this year the state for adults 19 and older who are a TPS holder, in the U.S. without authorization, or an asylum-seeker. Other states with Democratic governors such as have also scaled back their health programs for immigrants amid budget pressures.

In January, California Gov. Gavin Newsom proposed a state budget that would not backfill federal health care cuts to about 200,000 lawfully present immigrants, noting the $1.1 billion annual price tag and state budget shortfalls.

“Given these fiscal pressures, the administration cannot backfill for this change in federal policy,” California Department of Finance spokesperson H.D. Palmer said.

But some Democratic lawmakers and consumer advocates say the state should step in. State Assembly member Mia Bonta, who chairs the Assembly’s health committee, said she is working on a legislative budget solution to bring immigrants who will lose health coverage, including older adults, into Medi-Cal, the state’s version of Medicaid.

The East Bay Democrat is especially concerned for people like Carranza, “who have lived here for decades and contributed into this economy, who have given into our cultural fabric and into our communities and who built families and lives and who are now wanting to be able to retire with dignity and live with dignity and have the health care that they need.”

A Sign of the Future

Last April, Carranza got a glimpse of what losing her health coverage and retirement benefits could look like, after the Social Security Administration sent her a letter informing her that she no longer qualified for retirement benefits because she was not lawfully present in the U.S. — even though she was. Then Medicare stopped payments to her health plan, which disenrolled her as a result.

As a TPS holder with a work permit, she knew a mistake had been made. Yet, without her check, Carranza didn’t have money to pay her rent for a month. She worked off her rent by babysitting her landlords’ children. Last May, the office of U.S. Rep. Lateefah Simon, an Oakland Democrat, helped Carranza recover her retirement benefits, but it took months for her to get her health insurance back.

The experience left her reeling.

“It’s like getting slapped on the face after more than 30 years working for the system here,” Carranza said. “And in return, this is what we have now.”

She lies awake at night imagining the future: here, where she’s spent half her life, without health insurance and possibly Social Security benefits; or in El Salvador, where two of her three children remain. Her daughter, a green-card holder who lives in Texas, hopes to become a citizen so she can petition for permanent residency for Carranza, but the process can take years. Then there’s the possibility she fears most: indefinite detention or deportation.

On a recent morning in her basement studio in Oakland, Carranza pulled a box from the back of her closet. In it was a thick stack of identification cards that included old driver’s licenses, her Social Security card, and dozens of work IDs issued by the federal government.

“My life is in that box,” she said.

This article was produced in collaboration with , a civic media organization serving and covering the Bay Area’s Latino and Mayan immigrant communities.

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Ollie’s parents, who adopted her in 2020, tried to sign her up for a clinical trial using — which genetically reprograms a patient’s white blood cells to help them fight cancer — at UNC Health in Chapel Hill, North Carolina, an hour-and-a-half drive from their home in Eden.

Her mother, Britany Super, described it as Ollie’s “last option.”

But in early March, Super recalled, UNC Health’s financial office told them the bad news: The state’s new insurance for kids in foster care wasn’t going to pay for the treatment.

In December, Ollie became one of hundreds of thousands of kids nationwide enrolled in a special kind of public health insurance for people served by the foster care system. That insurance, known as a specialized managed care plan, is part of Medicaid, the federal-state program that covers health costs for people with low incomes or disabilities.

North Carolina is one of 14 states with such specialized foster care plans, according to the National Academy for State Health Policy. The plans differ by state, but each is meant to expand coverage for children in the foster care system — and for kids who were adopted out of it, such as Ollie and her siblings.

Yet, as in other states that have struggled when adding such plans, North Carolina families have faced hurdles obtaining care. Thousands of doctors whose services were covered under Medicaid were not included in the specialized plan — which is costing the state $3.1 billion over four years — when it rolled out on Dec. 1. That left guardians and parents of kids adopted out of the system scrambling to figure out whether they would have to find new health care providers or new insurance.

In North Carolina, the insurance plan’s stumbles have added another layer of complication around health care issues. The state — like many others — is already over expected Medicaid cuts in the wake of congressional Republicans’ One Big Beautiful Bill Act. A separate Medicaid funding shortfall also prompted a push to cut care providers’ reimbursement rates.

Texas, which established its plan 18 years ago, that its foster families also had a hard time finding doctors on the insurance. In Florida, researchers for the state reported as early as 2016 that there was .

Illinois’ plan by the Centers for Medicare & Medicaid Services over a lack of access to care. Research concluded that California’s plan children with adequate mental health services. Georgia’s access problems alarmed state officials enough to calling for children to be removed from the plan and put back on other Medicaid plans.

But such specialized plans for kids in foster care continue to gain traction. Four states have started their own plans in the past five years, said , the senior director of children and family health at the National Academy for State Health Policy, and she said it’s likely more will adopt them soon.

showing how these programs are faring, Medicaid policy analysts said. It’s therefore difficult to know why they’ve run into rollout problems or whether they’ve improved access to care. That makes the plans risky, said , a research professor at Georgetown University’s Center for Children and Families.

“The states that are going in this direction, unless they have data to support it, are experimenting,” Schneider said. “They’re putting all their eggs in one basket, so they need to pay close attention.”

Rough Rollout

North Carolina’s specialized insurance plan for foster kids experienced problems the day it rolled out.

The state automatically enrolled Ollie and about 32,000 other people in , called . North Carolina officials had said the program would improve health care access for foster children, who often have medically complex needs and move frequently.

But foster families quickly began hearing that their health care providers were not taking the insurance, according to several families who recounted their experiences fighting to get their children’s procedures covered under the plan.

UNC Health, a state-run health system that is , with nearly 4,400 physicians, initially, which is why it told Super that Ollie’s CAR T-cell treatment wouldn’t be covered.

After more than two months of limbo for families, UNC Health ultimately in mid-March with Blue Cross Blue Shield of North Carolina, which runs the plan.

But some North Carolina doctors still don’t accept Healthy Blue insurance.

, interim deputy secretary for North Carolina’s Medicaid program, said her office to expand its network, even though it already has what she called an “adequate” number of providers. North Carolina’s health department and Blue Cross Blue Shield did not answer ºÚÁϳԹÏÍø News’ questions about how many providers are covered by the new insurance.

“We welcome qualified providers who want to join,” said Blue Cross Blue Shield of North Carolina spokesperson Sara Lang.

Other problems . As thousands of health care records move over to a statewide database managed by Healthy Blue, children’s doctors are struggling to track their patients’ medical histories, said foster care advocates and pediatricians. Parents reported problems seeing health records, finding themselves locked out of online portals. Others couldn’t access prescriptions. Surgeries got delayed. Appointments were canceled.

“Network management for any plan is an ongoing process,” Lang said.

All this meant added red tape and heartache for the caregivers of children like Ollie with complex medical needs — those the .

Gearing Up

Cancer has been part of Ollie’s life since she was 2. She was in the process of getting adopted out of foster care when she began chemotherapy and radiation treatments, then received two stem cell transplants, Super recalled.

Surgeons installed temporary tubes in a vein near her heart and a feeding tube in her abdomen. Her hair fell out as the treatment intensified, and a thin layer of skin peeled off, forcing her new family to wear surgical gowns and gloves when they wanted to be close.

“She doesn’t remember life outside of going to doctors and being in a hospital,” Super said.

Ollie still has a port in her chest ready for whenever she needs intravenous medicine, and her monthly doctor appointments are about to become weekly. During an emergency room visit in mid-March, doctors told Super her daughter’s cancer had spread. Ollie will need more chemotherapy before her body is ready for the more advanced treatment.

But the Supers, thrown into uncertainty for more than two months, still feel some relief. They’re preparing for back-and-forth drives for the CAR T-cell therapy treatments in Chapel Hill. And they’re grateful, even if it means Ollie will spend at least five more weeks in and out of a hospital.

Reliable health insurance will be vital for Ollie, and Healthy Blue leaders said they are talking with doctors, parents, and others to make sure the plan is working. Her procedures carry multimillion-dollar price tags, her mother said, but having her bills seamlessly covered allows the family to focus on Ollie’s treatment.

“The biggest challenges for her will be in the first few months of the study,” said Super, who knows the therapy’s side effects include fever, fatigue, and confusion. “But I’m hoping that after that, the CAR T-cells will do their job and fight the cancer and she can continue to have a playful, active life.”

That means, they hope, the girl could be at home more often with her five siblings and the three family dogs, including Remy, a border collie mix who is Ollie’s favorite.

Super relishes those precious moments for her daughter — “being a kid and doing kid things.”

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Estaba pensando en retrasar el estudio, contó, porque este año la prima mensual del seguro de Obamacare se le triplicó a $2.460, lo que es igual a cerca de un tercio de sus ingresos.

Con un deducible de $2.700, habría tenido que pagar de su propio bolsillo la mayor parte del examen diagnóstico, un golpe económico que aseguró no poder asumir.

Galvin vive en North Kingstown, Rhode Island, y se retiró recientemente como director de una empresa de equipos médicos. “La colonoscopía me iba a costar cerca de $3.000. Así que decidí postergarla”, explicó.

También Nancy, la esposa de Galvin, está retrasando una costosa tomografía computarizada por unos años, hasta que pueda aplicar a Medicare y que el programa federal de salud cubra el costo. Medicare ofrece cobertura para todos los estadounidenses de 65 años en adelante.

Las personas con planes de la Ley de Cuidado de Salud a Bajo Precio (ACA) que están cerca de la edad de jubilación fueron de las más afectadas por los aumentos de precios luego de la suspensión de los subsidios federales mejorados, a finales de diciembre.

Quienes tenían ingresos superiores al 400% del nivel federal de pobreza para una familia de dos miembros— habían estado recibiendo ayuda para pagar los planes desde que la administración Biden amplió los subsidios durante la pandemia de covid-19. Los adultos de 50 a 64 años representaban alrededor de en ACA.

Ahora, sin esa ayuda financiera, algunas personas en este grupo de edad dicen que están pensando si no les conviene retrasar la atención médica hasta que califiquen para Medicare.

Según defensores de pacientes, médicos y expertos en políticas de salud, esta decisión no solo puede poner en riesgo la salud, sino también generar mayores costos para el sistema. Al postergar la atención médica hasta alcanzar la elegibilidad para Medicare, muchas afecciones se pueden agravar, lo que termina trasladando el gasto a los contribuyentes.

“Habrá mucha demanda acumulada y necesidades no atendidas”, dijo , consultora de políticas de salud que trabajó en las administraciones de Barack Obama y Joe Biden. “Medicare va a tener que gastar mucho dinero cubriendo y manejando esos tratamientos”.

ACA ha sido una fuente clave de cobertura médica para personas de 50 a 64 años. El acceso a los planes del Obamacare ayudó a reducir a la mitad la tasa de personas sin seguro en este sector, un grupo de defensa que representa a adultos mayores.

Esto permitió que algunas personas se jubilaran antes manteniendo cobertura. También ha servido como red de seguridad para los dueños de pequeños negocios y para quienes tienen empleos que no ofrecen seguro médico.

El otoño pasado se produjo el cierre del gobierno más largo de la historia, en medio de un intento fallido de los demócratas por extender los subsidios mejorados. Los republicanos que se opusieron a la medida argumentaron que la ayuda beneficiaba a las aseguradoras e incentivaba el fraude y la oferta de cobertura innecesaria.

El tema seguirá siendo relevante en la política, especialmente ante las elecciones de medio término de este año, incluso entre los estadounidenses mayores, que votan de manera regular, dijo el estratega republicano , quien dirige Atlas Strategy Group.

“¿El costo de la atención médica va a ser un tema? Sin duda”, dijo. “¿Los precios de la atención médica influirán? Sí”.

Incluso antes de que expiraran los subsidios, los costos de la atención médica, los hogares de adultos mayores y los medicamentos recetados eran algunas de las principales preocupaciones de salud entre las personas mayores de 50 años, según .

Los adultos de mediana edad con planes del Obamacare sienten con más fuerza el impacto de la eliminación de estos subsidios, porque primas hasta tres veces mayores que a las de 20, ya que estas últimas, por lo general, usan menos servicios médicos.

Y muchos adultos de mediana edad ya estaban inscriptos en los planes de menor costo disponibles, lo que los deja sin opciones más baratas, señaló , analista de políticas en KFF, una organización sin fines de lucro de información en salud que incluye ºÚÁϳԹÏÍø News.

“Esto es muy grave para las personas mayores inscriptas en el mercado de seguros”, dijo.

Quienes ganan apenas unos dólares por encima del 400% del nivel federal de pobreza ahora quedan fuera de los subsidios, y en algunos estados las primas promedio para este grupo .

 Muchas personas están viendo aumentos anuales de miles de dólares, con primas que pueden representar hasta una cuarta parte de sus ingresos.

, médico de atención primaria e investigador de políticas de salud en la Universidad de Michigan, contó que con frecuencia sus pacientes mayores le hablan de sus esfuerzos para afrontar el pago de su atención médica. Algunos, de poco más de 60 años, probablemente abandonen la cobertura de ACA debido al aumento, dijo.

“Es una apuesta arriesgada”, opinó.

Marci Heinbaugh podría verse obligada a asumir ese riesgo. La trabajadora social de 63 años, que vive en una zona rural de Illinois, contó que su prima mensual superó el doble de su valor, pasando de unos $1.100 a $2.333, por un plan con gasto máximo de bolsillo de $10.150.

Sabía que tendría que pagar más, dijo, pero no imaginaba un aumento de esa magnitud. Después de unos meses, ya no está segura de poder mantener el plan durante el resto del año y dijo que incluso podría quedarse sin seguro. “Me da pánico siquiera pensarlo”, confesó Heinbaugh.

Las personas quieren comprar su propio seguro en el mercado y muchos adultos de mediana edad podrían pagarlo con un poco de ayuda financiera federal, dijo , vicepresidente senior de políticas públicas en AARP. Quienes abandonan la cobertura o retrasan la atención hasta cumplir 65 años pueden estar ahorrando dinero ahora, pero eso podría resultar más costoso para ellos —y para los contribuyentes— más adelante.

“Existe una probabilidad significativa de que los supuestos ahorros por reducir los subsidios a medida que las personas se acercan a la jubilación terminen convirtiéndose en mayores costos para Medicare”, señaló Weil.

Los afiliados a Medicare no están protegidos de los aumentos de costos. Por ejemplo, en enero, las primas estándar de la subieron de $185 al mes a casi $203.

Hasta que Galvin pueda inscribirse en Medicare, prevé gastar los $30.000 de su cuenta de jubilación para cubrir los pagos de primas y el deducible de su plan del mercado.

reveló que 1 de cada 5 adultos mayores de 50 años no tiene ahorros para la jubilación y que a 3 de cada 5 les preocupa no tener suficientes fondos para mantenerse.

La expiración de estos subsidios del Obamacare ejerce una presión financiera adicional sobre los estadounidenses a medida que se acercan a la jubilación, dijeron investigadores de políticas de salud.

“Están obligando a las personas a tomar decisiones imposibles”, dijo , directora de defensa federal en salud de la organización sin fines de lucro Justice in Aging.

¿Tienes dificultades para pagar tu seguro médico? ¿Has decidido prescindir de la cobertura? Haz clic aquí para contactar a ºÚÁϳԹÏÍø News y compartir tu historia.

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The , the public health insurance program that pairs state and federal money. Federal officials have announced unprecedented actions in Minnesota this year, declaring they could withhold over $2 billion in payments slated for the state and claw back nearly $260 million from last year.

The actions in Minnesota came as part of the administration’s declared crackdown on fraud, but critics have likened them to using a bludgeon instead of a scalpel, probably harming patients who rely on Medicaid for care but are not responsible for fraud in the program.

“It’s going to hurt a lot of people if they end up going through with this,” said Sumukha Terakanambi, a 27-year-old who has Duchenne muscular dystrophy and works as a public policy consultant with the Minnesota Council on Disability.

“Of course we support going after fraud,” Terakanambi said, but “this overly aggressive action is missing the point. It’s not punishing fraudsters. It’s punishing the people.”

Longtime Medicaid observers also doubt the federal actions will achieve their purported objective. , a senior managing director with the consulting firm Manatt, that actions of this magnitude by the federal government are unprecedented, partly because punitive measures against states have “really never been an effective way to address fraud.”

Meanwhile, fraud prosecutions as the U.S. attorney’s office there grapples with the exodus of nearly half its attorneys and a surge in cases from the Trump administration’s immigration crackdown.

Despite these concerns, Centers for Medicare & Medicaid Services head Mehmet Oz said the techniques the federal government is using in Minnesota could be applied to other states, and he has launched social media campaigns alleging high-dollar public benefit fraud in , , , and . And a February release of by the Trump administration’s Department of Government Efficiency appears to be part of a campaign to paint the program as riddled by fraud, Guyer said.

, a research professor at Georgetown University’s Center for Children and Families, said that campaign by the administration seems particularly focused on services designed to keep people with disabilities out of institutions, and he described withholding $2 billion from Minnesota’s Medicaid program as “.”

A ‘Political Football’

Scrutiny of Minnesota’s public benefit programs began early in the Biden administration, years before the most recent investigations. The spotlight on the state’s Medicaid system grew after FBI raids in December 2024.

The following May, an into Medicaid housing stabilization services in Minnesota prompted further scrutiny from federal prosecutors, and from Gov. Tim Walz.

Under the Democratic governor, the state launched investigations into 85 autism providers, ordered a third-party audit of 14 types of Medicaid services deemed to be “high-risk” for fraud, and delayed payments for those services for up to 90 days. Many of the services are ones people with disabilities receive at home, making them more difficult to monitor.  

Terakanambi worried the state’s “heavy-handed approach” would destabilize the entire home care system. While his own care was not disrupted — his parents provide the 10 hours of daily personal care he qualifies for through Medicaid — other Minnesotans with disabilities have said they experienced interruptions and .

In December, one man was after losing his in-home care services amid the crackdown.

“We’re losing sight of the people that have done nothing wrong, that rely on these supports and services to live in the community,” said Sue Schettle, chief executive of , a Minnesota nonprofit that represents organizations supporting people with disabilities. “It becomes a political football.”

Schettle said she took her concerns about the crackdown to state officials, who have since met routinely with her and other advocates. The subsequent federal actions, however, have left her “shell-shocked,” she said.

The ‘Nuclear Option’

In December, a , with help from state Republicans, supercharged the issue in Minnesota, alleging widespread fraud in child care centers owned by members of the Somali community. A follow-up state investigation of the child care centers that were featured in the video determined that all were “.”

On Jan. 6, CMS’ Oz sent Walz a letter alleging Minnesota’s Medicaid program was out of compliance with federal rules on fraud, waste, and abuse, setting the stage for the Trump administration’s move to withhold over $2 billion in federal Medicaid funds to Minnesota this year, about 18% of what the state received the year before.

Minnesota is appealing.

The Republican-aligned Paragon Health Institute, a think tank that recently published a calling for similar enforcement actions across the country, applauded the federal moves.

“That will spur states to take necessary action, thus ensuring that Medicaid funds go to those who are truly eligible,” said , a legal research analyst who co-authored the brief.

Georgetown’s Schneider questioned the necessity and effectiveness of withholding the money.

“I don’t see any relationship between that and actually reducing fraud against the Minnesota Medicaid program, given the state has already taken a lot of action,” he said.

In late February, Oz went further, announcing that on top of withholding $2 billion in future payments to Minnesota, the administration was in federal Medicaid payments to the state.

“We have notified the state that we will give them the money, but we are going to hold it and only release it after they propose and act on a comprehensive corrective action plan to solve the problem,” Oz said at with Vice President JD Vance.

Minnesota the deferment in court.

“We’re waiting for feedback from CMS on our corrective action plan, which is why we were surprised and confused when Dr. Oz said in a news conference with the vice president last week that we needed to provide one,” Minnesota Medicaid director John Connolly said at a March 3 news briefing.

‘Another Minnesota’

Oz and Vance both said during the February news conference that they are not specifically targeting Democratic-led states. Oz noted Florida has a “big fraud problem” and in mid-March sent a letter to state officials with a list of questions about their Medicaid program. Until then, the letters and most of Oz’s social media videos had been limited to California, Maine, and New York, all led by Democrats.

“We might have another Minnesota on our hands,” Oz said in posted the same day as sent to Maine Gov. Janet Mills, a Democrat, requesting information on how the state was addressing Medicaid fraud.

“And if we’re not satisfied with their progress, we reserve the right to cut off payments entirely,” Oz said in the video.

The video and letter were prompted by a in Maine that found the state had made at least $45.6 million in improper Medicaid payments. Similar audits in , , and had comparable findings.

In , Mills called Oz’s letter a “pretense to send ICE and other weaponized federal agents into states led by Democrats.”

CMS spokesperson Chris Krepich said the agency does not take funding actions lightly. “The focus is on strengthening oversight, improving accountability, and ensuring that vulnerable patients receive the services they are entitled to,” Krepich said.

But Terakanambi said it’s not difficult to see how federal actions like those in Minnesota could put services in jeopardy. The amount of money Minnesota could lose from the CMS actions announced this year is already equivalent to about two-thirds of the state’s rainy-day fund.

Many states are looking to reduce or even eliminate funding for home care services over much smaller budget shortfalls. And further cuts are anticipated, with congressional Republicans’ One Big Beautiful Bill Act, signed into law last year, expected to reduce federal Medicaid spending by more than $900 billion over the next decade.

“People will die,” Terakanambi said. “People will lose critical supports and will no longer be able to participate in their community the way they want to.”

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Still, 69% of those enrolled last year signed up again this year, often for less generous coverage. About 9% said they had to forgo insurance, according to the survey by KFF, a health information nonprofit that includes ºÚÁϳԹÏÍø News.

The KFF poll revisited the people who responded to of Affordable Care Act enrollees during open enrollment for ACA plans.

Steve Davis, a 64-year-old retired car salesman in Rogersville, Tennessee, who participated in both polls, said he was looking at an annual premium of about $14,000 to renew his ACA coverage this year. He didn’t qualify for enough of a tax credit to defray the cost, he said, after Congress gridlocked on an extension of more-generous subsidies put in place under President Joe Biden.

But things worked out for Davis. He landed a job at a convenience store that came with insurance, with his share costing about $100 more a month than the $300 he paid for an ACA plan last year, before the enhanced tax credits expired.

“As it happened, the Lord provided and my insurance kicked in through my employer,” he told ºÚÁϳԹÏÍø News.

In the November survey, many respondents were not sure what they would do for their health insurance in the coming year.

Some were waiting to see whether Congress would extend the enhanced premium subsidies, which had helped many people get lower-cost — or even zero-cost — health premiums.

Congress’ inaction left some consumers in a bind.

Now, the new poll found, affordability issues are hitting home as the midterm election approaches. And that might play a role in competitive districts, creating headwinds for Republicans.

Midterm Signals

Across all respondents who were registered to vote, the poll found more than half place “a lot” of blame for rising costs on Republicans in Congress (54%), with a similar share putting the same level of blame on President Donald Trump (53%). A smaller group placed a lot of the blame on congressional Democrats (34%). Among independents, a group expected to be a key factor in many districts, the percentages putting a lot of the blame on the GOP (56%) and Trump (58%) were higher.

Among Republicans, 60% placed a lot of the blame on Democrats in Congress.

“Those who have marketplace coverage, who remained on it, they’re really struggling with health care costs,” said Lunna Lopes, senior survey manager for KFF.

While more than half (55%) of returning ACA enrollees said they will have to pare back on other household expenses to cover health care costs, about 17% said they might not be able to continue paying insurance premiums throughout the year.

Overall, 80% of those who reenrolled for 2026 said their premiums, deductibles, or other costs are higher this year than last, with 51% saying they are “a lot higher.”

About three-quarters of ACA enrollees in the survey who were registered voters said the cost of health care will have an impact on their decision to vote — and on which party’s candidate they support.

Democrats were more than twice as likely as Republicans to say those costs will have a major impact on their decision.

“Democrats seem particularly more energized by health care costs than their Republican counterparts,” Lopes said.

Enrollment Tally Down

Data released Jan. 28 by federal officials showed that about 23 million people enrolled in Obamacare plans across the federal healthcare.gov marketplace and those run by states, about 1.2 million fewer than in 2025.

But it isn’t yet known how many are paying their monthly premiums on time, and many analysts expect overall enrollment numbers to fall as that data becomes available in the coming months.

For most people, having to pay more for premiums this year was mainly due to the expiration of the enhanced tax cuts, pollsters noted. Because the subsidies that remain are less generous, households have to pay more of their income toward coverage. Congressional inaction also meant the restoration of an income cap for subsidies at four times the poverty level, or $62,600 for an individual, sticking people like Davis with higher bills.

Not everyone saw increases.

Matthew Rutledge, a 32-year-old substitute teacher in Apple Valley, California, who participated in both KFF polls, said he qualified as low-income and his subsidies fully offset his monthly premium payment, just as they did last year. He does have copayments when he sees a doctor or accesses other medical care, but he told ºÚÁϳԹÏÍø News that “as long as the premium doesn’t go up, I’m fine with it.”

Rising premiums are fueled by a variety of factors, including hospital costs, doctors’ services, and the prices of drugs.

To lower premiums, insurers offer plans with higher deductibles or copayments. In the ACA, plans with lower premiums but higher deductibles are called “catastrophic” or “bronze” plans. “Silver” plans generally balance premiums and out-of-pocket spending, while the highest-premium plans with lower deductibles are “gold” or “platinum.”

About 28% of those who stayed in the ACA marketplaces switched plans, the pollsters noted.

One 56-year-old Texas man told pollsters that his family’s income exceeded the cap for subsidies, so they switched down from a gold plan to a bronze. “Even doing that, our premiums are three times what they were in 2025, with lower plan features and a higher deductible,” he said, according to a KFF poll news release.

For some, reenrolling was not a viable option.

In addition to the 9% who said they are now uninsured, about 5% said they switched to some type of non-ACA coverage.

Some people, like Davis, landed job-based coverage, while others found they qualified for Medicaid, the joint state-federal program for low-income residents.

Such churn in and out of ACA coverage is not unusual, Lopes noted. “People get a job. They get married. They age into Medicare,” the program for older or disabled people, she said.

The poll highlighted that many people dropping coverage were younger, between 18 and 29. About 14% of people in that range now say they are uninsured. 

That’s not surprising, given that younger people tend to use health coverage less. ACA insurers said one reason they raised premiums this year was because they expected more young or healthy people to drop out, leaving them with a higher share of older, more costly enrollees. Among those 50 or older, the poll found that only 7% are now uninsured.

GOP critics of the now-expired enhanced subsidies say they were always meant to be temporary. Extending them would have cost about $350 billion from 2026 to 2035, .

But not extending them means more people will become uninsured. The CBO said the extension would have meant 3.8 million more people having insurance coverage in 2035.

KFF pollsters, in February and early March, surveyed 1,117 U.S. adults, more than 80% of the ACA enrollees originally polled in November, online and by telephone. The margin of error is plus or minus four percentage points for the full sample.

Are you struggling to afford your health insurance? Have you decided to forgo coverage? Click here to contact ºÚÁϳԹÏÍø News and share your story.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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The legislation would prohibit state and local governments from requiring crisis pregnancy centers to perform abortions, provide referrals for abortion services, or inform patients about such services or contraception options. It also would allow crisis pregnancy centers to sue the violating government entity.

Wyoming lawmakers of the Center Autonomy and Rights of Expression Act, or , on March 4. Other versions have advanced in and this year. One was in 2025. The CARE Act is “model legislation” created by the , an anti-abortion, conservative Christian legal advocacy group.

A similar proposal, the , was introduced in Congress last year but hasn’t moved out of the House Energy and Commerce Committee.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).