Despite being born with malformed limbs and later giving birth to four children, Francisca avoided going to the doctor as much as possible for about two decades.
The 58-year-old Southwest Side resident lacked health insurance, so when she got sick or was in pain she often relied on home remedies. When she had a toothache, she wouldn’t go to the dentist.
Nearly two years ago, though, Francisca’s situation changed dramatically. She obtained health coverage through a state program that provides taxpayer-funded insurance to immigrants like her who are in the country without legal permission as well as green card holders who haven’t been in the U.S. long enough to qualify for Medicaid, the traditional health care program for the poor.
When she had her first dental cleaning after getting the state-funded coverage, “it felt like a blessing,” said Francisca, who asked to be identified by only her first name because of her immigration status.
But in just a few months, Francisca and more than 30,000 other immigrants in Illinois may be uninsured once again as Gov. JB Pritzker has proposed eliminating funding for the program that began in 2022 for noncitizen immigrants ages 42 to 64.
While coverage would continue for noncitizen immigrants 65 and older, cutting the program for the 42-to-64 age group is a significant piece of Pritzker’s plan to balance a $55.2 billion state budget proposal. The governor estimates it will save $330 million as costs are rising and growth in income and sales taxes is slowing, developments that continue to strain the state’s finances and force difficult decisions to ensure the state lives within its means, Pritzker has said.
The effort to provide state-funded insurance, which began with coverage for those 65 and older during the depths of the COVID-19 pandemic in late 2020, has become a lightning rod in Springfield as costs far outstripped projections. Although many immigrants living in Illinois without authorization pay state and federal taxes that support the program and other services for which they are ineligible because of their citizenship status, a recent state audit found that over three years the insurance program for older immigrants cost nearly double what was expected and the program for the younger group cost nearly four times more than anticipated.
Pritzker’s proposal, which blindsided many of the programs’ supporters in the state legislature, has created some political dissonance for Democrats, particularly for the governor himself as he angles for national attention as a leading opponent of President Donald Trump’s immigration crackdown and Republican proposals to cut federal Medicaid funding.
A potential 2028 contender for the Democratic presidential nomination, Pritzker wrote in a recent Tribune op-ed opposing Medicaid cuts: “For Illinois families of all backgrounds and across the state, health care isn’t an afterthought — it’s a lifeline.” He also promised: “Illinois is doing all we can to preserve health care coverage.”
As some Democratic lawmakers scramble to find ways to preserve the program, patients and the providers who care for them are bracing for an abrupt end to their health insurance coverage.
“I actually have a bad toothache right now, and I will make sure I go to the dentist soon, before my (coverage) is taken away,” Francisca said. “Otherwise it will cost me like $300, and I don’t have that much money.”
The worry goes beyond her health. Francisca has a rare congenital disorder that has left her limbs either missing or disfigured. She uses a wheelchair and has never been able to work because of her disability. After she separated from her husband five years ago, she became fully reliant on her children.
“She is everything to us,” said her daughter Sara, 20, hugging her mother.
Getting insurance coverage from the state “felt like a relief,” Francisca said.
“We could go to the doctor knowing that if they found something wrong, we would be able to follow up. We no longer had to choose between going to the doctor, paying for the visit, the medication, or paying for rent and food,” Francisca said.
If the program goes away, the responsibility of paying her medical bills will fall back to her children, on top of paying for her other expenses. She has no savings and doesn’t qualify for Social Security disability benefits or Medicaid due to her immigration status.
“Sometimes I feel like a burden for them because they have to pay for everything,” she said.
Cases like Francisca’s illustrate what experts say are the broader consequences of leaving immigrants who are in the country without authorization uninsured.
Immigrants who don’t have coverage are less likely to have a steady source of health care outside the emergency room or to have a provider they trust in the U.S., said Drishti Pillai, director of immigrant health policy at KFF, a nonprofit, nonpartisan health policy organization.
In a survey KFF conducted in 2023, 1 in 5 uninsured immigrant adults said their health got worse as a result of skipping or postponing care, she said.
“When an individual doesn’t have health insurance coverage, since they’re more likely to forgo primary and preventive health care, it’s possible that health conditions that are fairly easy to treat can go undetected for a long time and ultimately become more complex and expensive to treat, which can raise the costs of uncompensated care,” Pillai said. “It can also lead to worse economic outcomes due to productivity losses, with immigrants playing a key role, especially in certain professions such as health care, agriculture, transportation.”
That’s similar to the argument Pritzker made nearly two years ago when he signed a state budget deal that preserved the program.
“We save money when we invest in health care for undocumented immigrants,” Pritzker said in June 2023, just a few weeks before his administration closed enrollment for immigrants under 65 to help control the programs’ costs. “Because you know what happens if they don’t get health care, basic health care: They end up in an emergency room. We all end up paying for that at a much higher cost than if we have preventative care.”
In response to the recent audit, Pritzker’s Department of Healthcare and Family Services, which administers the programs, also pointed to the prevalence of untreated chronic conditions and high rates of hospitalization among participants as key factors in driving the cost overruns.
If the program for those under 65 ends, many patients who seek treatment likely will do so through community health centers, which are obligated to continue providing care regardless of insurance coverage or immigration status, Pillai said. And whether or not the state is paying the bill, the community centers will treat those patients and have to absorb the cost, said Ollie Idowu, president and CEO of the Illinois Primary Health Care Association, which represents more than 50 health centers across the state.
While Idowu said he understands the state budget pressures, “for my health centers, it’s going to have a severe impact.”
About one-third of participants in the program for those under 65 are patients of community health centers, according to the association, and the loss of funding for their care could force centers to lay off employees, reduce or eliminate some services, or close sites.
The governor’s proposal also comes as health centers are facing pressure from what they see as inadequate Medicaid reimbursements from the state, possible cuts to federal Medicaid funding, and moves by the pharmaceutical industry to place restrictions on their ability to get drugs through a federal program at steeply discounted rates, which provides another major source of funding.
“At the federal level, there is a nightmare of a storm that is brewing that has potential to wreak havoc on our health care safety net, and so it’s critically important that our lawmakers and policymakers make the strongest possible investments that they can into people and providers to keep our communities healthy and to drive down costs to the health care system,” said Cyrus Winnett, the association’s chief public affairs officer.
Cook County Health is another provider for many immigrant patients who receive coverage through the program and also could face a major hit if the state stops compensating the county-run system. In 2024, the county health system received $111 million in reimbursements for care provided to about 8,000 patients through the program Pritzker has proposed eliminating, officials said, adding that regardless of the outcome in Springfield, “Cook County Health will be here to serve all patients in need.”
Rush University System for Health also could face a hit if the program ends.
Over four years starting in 2019, the hospital saw its financial assistance and charity care spending cut nearly in half, with “a substantial portion” attributable to payments from the state immigrant health care programs, said Padraic Stanley, Rush’s program manager of community integration, health promotion and disease prevention.
Illinois has long been at the forefront of providing health insurance coverage without regard for immigration status. In 2006, Illinois became the first state to cover children regardless of citizenship, and in 2020 became the first to do so for those 65 and older.
Others followed suit, with 13 other states and Washington, D.C., providing coverage for children and six other states and the nation’s capital providing state-funded coverage for some income-eligible adults as of January, according to KFF.
When expanding Illinois’ program for the second time in 2022 to extend coverage to those as young as 42, Pritzker declared in a news release that “everyone, regardless of documentation status, deserves access to holistic health care coverage.”
Despite backtracking on that issue, Pritzker is unlikely to face significant political consequences either in a bid for a third term next year or in a potential 2028 White House run, said E.J. Fagan, a political science professor at the University of Illinois Chicago.
“Any governor who’s served for a long period of time in their home state is going to run into issues that don’t look great nationally,” Fagan said.
In the more immediate term, it remains unclear whether there will be enough pushback from the Democratic-controlled legislature to change Pritzker’s mind on funding the program. Republicans, whose votes aren’t needed to pass a budget that takes effect July 1, uniformly oppose providing the state-funded coverage, arguing the resources would be better spent on legal residents of Illinois.
“This administration is committed to doing everything within our means to protect health care for the most vulnerable,” Pritzker spokesman Alex Gough wrote in response to questions about the governor’s proposal. “This difficult decision was one, among many, that reflect the reality of our situation and unfortunately needed to be made in order to maintain a balanced budget. In this case, we opted to preserve health care coverage for the most vulnerable through” the program for those 65 and older.
“We are happy to engage the General Assembly should they have creative solutions to maintain funding for the program but we have a responsibility to Illinois taxpayers to maintain a balanced budget,” Gough said.
While she appreciates the administration’s willingness to listen to other ideas, state Rep. Norma Hernandez, a Melrose Park Democrat who chairs the House Latino Caucus, said those discussions should have begun before Pritzker introduced his proposal last month.
“I’m curious to understand why this specific population is being targeted. Is it because they’re being seen as less human?” Hernandez said. “Before making this announcement, there should have been those bigger conversations. … How can we create a pathway to help fund this program, to not only just keep it but to expand it?”
Pritzker’s budget plan was based on revenue forecasts that painted a more optimistic picture than the $3.2 billion deficit his administration was projecting as recently as November. But the legislature’s bipartisan forecasting arm more recently produced its own estimate for the coming year, anticipating about $737 million less revenue than the governor’s plan, before accounting for tax changes that would require legislative approval.
Further clouding the outlook are stock market turmoil and growing recession fears stemming from Trump’s use of tariffs against some of the U.S.’s largest trading partners and expansive cuts to the federal workforce.
Nevertheless, Hernandez said she and other supporters of the program are looking for “progressive revenue” options to keep the program going, without offering examples. While funding the program has led to infighting among legislative Democrats in recent years, she said Latino members have worked hard on “educating folks on the reality of … why this program is so important, why this program saves the state money.”
Among those working alongside members of the Latino caucus and other supporters to preserve the program is Andrea Kovach, a senior attorney at the Shriver Center on Poverty Law and a member of the Healthy Illinois Campaign.
The campaign was a driving force behind creating the programs but also is among those Pritzker administration officials have blamed for providing inaccurate cost estimates that ended up ballooning in recent years.
“Cancer doesn’t care what someone’s immigration status is. Diabetes doesn’t go away because someone has a particular immigration status. So the cost will still be there,” Kovach said. “People still age, have accidents and need to treat and manage chronic conditions. The difference is they’ll not be diagnosed soon, but at a much later stage and it will be much more costly to the state.”
Illinois has “a legacy we should be really proud of, and now is not the time to go backwards,” she said.
It’s an open question whether supporters would be able to round up enough votes to pass any kind of tax proposal to fund the program, or whether Democratic leaders would allow such a plan to advance. House Speaker Emanuel “Chris” Welch, for example, said in a Sun-Times podcast interview earlier this year that “talking about tax increases … would be tone-deaf to what we heard in November” from voters.
While budget negotiations continue in Springfield ahead of the legislature’s May 31 budget deadline, the future of health care coverage for Francisca and tens of thousands of other immigrants living in Illinois hangs in the balance.
Also among that group are Maria Esther Morales, 57, and her husband, Adan Rodriguez, 60, of the Pilsen neighborhood.
They have been unable to legalize their status in the country after living in the U.S. for more than 32 years, even with four of their five children being citizens, because federal law would require them to leave the country for 10 years to be eligible.
For decades, they didn’t see a dentist. Though they both have diabetes, they avoided the doctor except for the handful of times they ended up in the emergency room.
Three years ago, when Morales and her husband found out they could finally get Medicaid-style coverage from the state, their lives completely changed, Morales said.
“We couldn’t believe it; it was the greatest blessing for the two of us and for many other people,” Morales said. “We immediately made appointments to get a dental clinic and follow-ups to treat my anemia.”
Since getting coverage, neither of them have had to go to the emergency room, she said. They only go to their checkups and follow-up appointments at Alivio Medical Center, a community health center. Morales, who volunteers with a group of cancer patients and survivors, said many people covered by the program are anxious and nervous.
She said she prays lawmakers find a way to keep it.
