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Immigrants in the US illegally are not eligible for free health care under the ACA

October 21, 2020 GMT

CLAIM: Democrats voted to fine American citizens for not buying health insurance and conspired to give it to “illegal aliens” for free.

AP’S ASSESSMENT: Partly false. The Affordable Care Act did make U.S. citizens who did not buy insurance pay a penalty, but that is no longer in effect. The law excludes immigrants living in the country without legal permission from receiving tax credits or purchasing insurance on the ACA marketplace, and Democrats are not united in providing free coverage to them. Democratic presidential candidate Joe Biden has not supported that proposal.


THE FACTS: Widely shared posts on social media claim: “The Democrats voted to fine American citizens for not buying insurance, and then conspired to give it to illegal aliens for free.” A similar post asserts, “Democrats voted to fine Americans for not buying health insurance, but want to give it to illegal immigrants for free.”

It is true the Affordable Care Act, the health care overhaul signed into law by former President Barack Obama in 2010, originally fined American citizens who did not buy insurance. But the penalty has since been set to $0, after Congress passed a reform that took effect last year. 

A key part of the ACA is the marketplace where Americans and certain legal immigrants can purchase health insurance. Under the law, some people qualify for tax credits to offset the cost of buying a plan.

Important context missing from the social media posts is that the ACA excludes immigrants living in the country illegally from receiving tax credits or even buying insurance on the marketplace at full price. 

“Under current rules, undocumented immigrants are not eligible to purchase coverage through the ACA marketplace,” said Samantha Artiga, vice president and director of the Racial Equity and Health Policy Program at Kaiser Family Foundation, a non-partisan organization that does health policy analysis. 

Biden has proposed creating a public option for insurance that Americans and immigrants in the country illegally could buy into, but free healthcare would not be available to immigrants living in the country without authorization. 


“Biden’s proposal would allow undocumented immigrants to buy health insurance, including the proposed public option, in the ACA marketplaces without federal subsidies,” Gerald Kominski, a professor at the UCLA Center for Health Policy Research, wrote to the AP in an email. “That isn’t free care.”

“Democrats are not unified in providing care to undocumented immigrants,” Kominski wrote, adding, “so the second part of both statements is false.”

Several candidates who were vying to become the Democratic party’s presidential nominee supported more progressive health policies, including “Medicare for All.” That proposed program would replace job-based and private insurance with a government-run plan that would provide universal coverage. 

Proposed legislation from Vermont Sen. Bernie Sanders said all U.S. “residents” would qualify, but left it up to the secretary of Health and Human Services to define who would be eligible, and whether that would include immigrants without legal status.

Sanders has said he supports including all immigrants regardless of their legal status in Medicare for All. 

Ahead of the Democratic National Convention this summer, a unity task force formed to reach common ground between Sanders and Biden recommended “extending Affordable Care Act coverage to DACA recipients” and “allowing undocumented immigrants to purchase unsubsidized coverage in the ACA marketplaces.”

Immigrants in the country without legal permission are far more likely to be uninsured than American citizens. An analysis of 2018 data of non-elderly adults by the Kaiser Family Foundation found 45% of “undocumented immigrants” lack health insurance, compared to 23% of legal immigrants and 9% of American citizens.


This is part of The Associated Press’ ongoing effort to fact-check misinformation that is shared widely online, including work with Facebook to identify and reduce the circulation of false stories on the platform.

Here’s more information on Facebook’s fact-checking program: