California governor race puts immigrant healthcare at center of debate

For many years, Californians have generally viewed immigrants as a benefit to the state and its economy. That sentiment now sits alongside growing anxiety about budgets, inflation, and rising public costs. Those pressures have pushed a once-familiar policy into the middle of the race for governor: whether low-income immigrants without legal status should continue to receive state-funded health coverage.

Democrat Xavier Becerra and Republican Steve Hilton are offering voters sharply different answers. Becerra, the former health and human services secretary under President Joe Biden, says it would be shortsighted to keep the poorest immigrants out of routine care and send them instead to costly emergency rooms that taxpayers must pay for. Hilton, a conservative commentator backed by President Donald Trump, says he would eliminate that coverage. He has echoed national Republican claims that California’s Medicaid expansions invite fraud and abuse.

The debate comes at a time when support for California’s broad safety net appears to be weakening. Some voters, facing their own cost-of-living pressures, may be less willing to support full healthcare coverage for people who do not have legal status. The policy choices California makes now could affect both its healthcare system and its wider economy.

Over the past decade, state lawmakers used state money to expand Medi-Cal so that all low-income residents could receive comprehensive coverage, regardless of immigration status. But enrollment and spending climbed beyond initial projections. According to California’s nonpartisan Legislative Analyst’s Office, Medi-Cal coverage for immigrants without legal status now costs the state about $10 billion a year, more than twice the original estimate.

California’s Democratic leaders, including Gov. Gavin Newsom, who had championed the expansion, have since approved major reductions in benefits for those residents. They say the state can no longer absorb rising healthcare costs while facing major federal cuts tied to the GOP tax-and-spending law known as the One Big Beautiful Bill Act. The California Health and Human Services Agency projected that as many as 3.4 million Medi-Cal enrollees could lose coverage and that the state could lose more than $30 billion a year in federal funding under the law, creating significant disruption in the safety net program.

Medi-Cal remains enormous. Its budget for the 2026-27 fiscal year is $217 billion, and it serves more than 14 million Californians. At the same time, many legal U.S. residents and citizens have seen their health premium payments rise sharply this year after Congress allowed enhanced Affordable Care Act subsidies to expire at the end of December.

As California dealt with a budget deficit last year, a majority of likely voters said for the first time in nearly a decade that they opposed providing health insurance to immigrants without legal status, according to a Public Policy Institute of California poll. Mark Baldassare, the group’s survey director, said the state is confronting major challenges and that healthcare is one of its largest expenses. He said people have become more selective about how they want to see limited healthcare dollars spent.

Hilton, running on an affordability platform and calling for lower taxes, has used that mood to his advantage. He portrays health coverage for immigrants without legal status as unfair and as a direct drain on what California can provide for citizens. In a Facebook video posted the morning of the June 2 primary, he said, “Stop taking money from California taxpayers who can barely afford their healthcare to give free healthcare to citizens of other countries who shouldn’t even be here.”

During campaign speeches, Hilton has promised to use the savings to lower healthcare costs for other Californians, though he has not explained how he would do that. He did not respond to requests for comment from KFF Health News.

Roger Salazar, a Democratic political consultant who works with a coalition of healthcare advocates, said Hilton’s message is built around a simple divide. The advocates argue that providing coverage to people who cannot afford it helps keep the workforce healthy and supports the economy. Salazar said the question is whether voters can be convinced that the broader economic case is stronger.

Becerra, whose parents were immigrants, has spent decades in Congress pushing to expand safety net benefits and has made a similar argument in his gubernatorial campaign. He also did not respond to requests for comment. During a debate in May, he said immigrants, whether documented or not, work hard, pay taxes, and sometimes get hurt on the job or have children who become sick. He said it would be foolish to tell a family that they cannot see a pediatrician or family doctor.

Becerra could become California’s first elected Latino governor. Last year he criticized Newsom and legislative leaders when they decided to freeze Medi-Cal enrollment for adults without legal status, cut benefits, and impose monthly premiums. In response to an Orange County Register candidate questionnaire in May, he wrote, “Stop treating coverage as a budget variable that expands in good years and contracts when revenue dips.” He has said he would seek steady new revenue for basic services, including higher taxes on corporations and wealthy Californians.

California had about 2.3 million people without legal status in 2023, according to the Pew Research Center. That group represented roughly 8% of the state’s labor force. The California Department of Education says one in five children in the state lives in a family that includes at least one member without legal status.

Healthcare economists say preventive care can save money over time by keeping workers healthy and reducing pressure on a strained system. Baldassare said that was an easier argument to make during the covid pandemic, when immigrants were widely seen as essential workers and the connection between individual health and public health was clearer.

Still, the financial burden has grown. State estimates show Medi-Cal costs for roughly 1.4 million immigrants have increased sharply. Because only some lawfully present immigrants qualify for federal Medicaid benefits, states that cover other groups must rely entirely on state funds. California budget experts have warned that continuing full coverage without new revenue could weaken the state’s long-term fiscal outlook.

During a legislative hearing last year, Republican Assembly member Carl DeMaio questioned whether taxpayers would put immigrant healthcare first, saying he doubted that “illegal immigrant healthcare in the general fund would be at the top of their list.” After lawmakers approved spending reductions, support for immigrant health coverage fell, Baldassare said.

Democratic lawmakers and Newsom agreed to delay several Medi-Cal cuts until July 2027, leaving the next governor to make key decisions. That means the election could shape whether the state continues to expand, trim, or reframe coverage for immigrants without legal status.

David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at UCLA, said people without legal status often have higher labor force participation and tend to work in jobs that do not offer employer-based health insurance. As a result, many turn to Medi-Cal, shifting the costs to the state rather than employers. He said California’s economy is tied to Latino workers, many of whom lack legal status. He noted that the state’s economy ranks fourth in the world with those contributions and would fall to eighth, about the size of Italy’s economy, without them.

Immigrant advocates are hoping Becerra will be a stronger champion if he becomes governor in a state where Democrats outnumber Republicans nearly two to one. State Sen. María Elena Durazo, a former labor leader who has backed the expansions, said he will fight and push back as much as he can. “That’s the most we could expect,” she said.