As lawmakers debate cuts to Medicaid and restrictions on care for undocumented immigrants, the question isn’t just what America covers—it’s who.

Proposals like the No Medicaid for Illegal Immigrants Act of 2025, and related attempts to embed its provisions in the One Big Beautiful Bill Act, aim to block federal funding for Medicaid services to undocumented families. Some state plans go further, threatening to remove children from CHIP if their parents are undocumented. These aren’t just policy decisions, they’re declarations about who belongs.

Health care isn’t charity. It’s infrastructure. When we divide it, that infrastructure begins to crack. We just came out of Immigrant Heritage Month—a time meant to honor the people who helped build this country. And yet, as health care access is stripped away from immigrant families, we have to ask: What message are our policies sending?

As a physician from an immigrant family, I’ve experienced the impact of these policies through both ends of the stethoscope.

Growing up our backyards were lined with cracked concrete and bordered by chain-link fences, where old tires sat beside saints’ candles. Our neighborhoods had spray-painted murals of Aztec warriors, their bold colors defiant against gray cement and hard times. Our kitchens were filled with the scent of chile, tortillas warming on the comal, and stories that tied us to generations before. We were raised by parents who skipped meals in silence, making sure our plates were full before theirs ever were. But it was a place full of pride, where neighbors were like family and “mi casa es tu casa” wasn’t just a saying but a way of life. Despite the hard times, our families planted roots because they believed in the American dream—a dream built on determination, not documentation.

My father’s hands told that story, callused from years of labor, they built a life from nothing. My mother held it together with grace and grit. Their sacrifices were the price of our possibility. Now, when I walk into the hospital, their story walks in with me.

Immigrants come to this country dreaming big—of classrooms, clinics, and courtrooms, not just fields and kitchens. We don’t want handouts. We want fairness.

But fairness must be more than a sentiment. It must be policy.

That means expanding access, not narrowing it. Policies like the HEAL for Immigrant Families Act, which remove immigration status as a barrier to Medicaid and CHIP, are steps toward a system that reflects our values, not our fears.

Census Bureau data show that over half of Latino children rely on public insurance like Medicaid or CHIP. But coverage alone isn’t enough. It must be paired with access, safety, and dignity. A study published by Elsevier, a leading global research and educational publisher, found that perceptions of immigration laws and potential health care consequences were a significant predictor of underutilization of care and unmet medical needs. As a result, millions of children in mixed-status families may go without the care they qualify for.

The Center for Migration Studies estimates that 5.8 million U.S. citizen children live in such households. Misinformation and fear from past policies, including the now-reversed expansion of the “public charge” rule still linger. As a result, some immigrant families now worry that accessing public programs like Medicaid might harm their immigration status, even when their children are eligible and protected.

I’ve had patients skip follow-up care because they feared what showing up might cost them—not in dollars, but in consequences. One teenager I cared for had been rationing insulin because her undocumented mother was too afraid to pick up prescriptions. Fear doesn’t stay in waiting rooms. It follows kids into homes, affecting how they sleep, eat, and grow.

We treat what we can, but policies that make families feel safer hiding than being seen cause real harm. They lead to missed vaccines, untreated infections, and uncontrolled asthma. These are not isolated problems. They strain hospitals, destabilize health systems, and deepen mistrust in communities already on edge.

In immigrant households when hard work falls short, Medicaid and CHIP help fill the gaps. For many families, they are a quiet lifeline.

That lifeline is now under threat.

Fear has become more than a byproduct of immigration policy—it’s become the point. Tom Homan, Trump’s appointed “border czar,” has said, “If you’re here illegally, you better be looking over your shoulder,” and promised “shock and awe” deportations. When questioned about legal challenges, he doubled down: “We are not stopping. I don’t care what the judges think.” He has openly supported deporting undocumented parents “with or without their kids,” even when those children are U.S. citizens. These aren’t just enforcement statements. They are declarations of fear as policy.

This country needs leaders who will protect care, not politicize it. That means rejecting proposals like the No Medicaid for Illegal Immigrants Act and supporting laws that expand access, such as the HEAL Act. It means removing the fear baked into care by protecting health data privacy, fully funding safety-net clinics, and restoring trust after the damage of policies like public charge. Health systems must train providers to recognize immigration-related trauma and reassure families that their presence in a clinic is not a risk. Readers must demand a health care system that treats all people with dignity and humanity.

America calls itself the land of life, liberty, and the pursuit of happiness. But when it comes to health, we are forced to ask a question that should never need asking: Who gets to be well in America?

The answer isn’t complicated. Every child, every parent, every family—everyone deserves the chance to be well.

Joshua Vasquez is a pediatric resident at Oregon Health and Science University with interests in cardiology, immigrant health, and health equity. The son of Mexican immigrants and a first-generation American, he draws on his lived experience to advocate for children and families often overlooked by the health care system. He leads community-based education sessions for underserved youth and contributes regularly to national conversations on structural injustice in medicine. His writing has been featured in KevinMD and Doximity, and his essay “Who gets to be well in America: Immigrant health is on the line” explores how policy and identity shape access to care. He believes in the power of storytelling to bring both visibility and change.