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The Illegal-Immigrant Burden on Medicaid and Tax-Subsidized Care Is Growing

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Gary Alexander
Director Medicaid and Health Safety Net Reform Initiative at Paragon Health Institute

A nationally recognized health services expert and government reformer, Gary D. Alexander was head of the Medicaid and Health Safety Net Initiative at the Paragon Health Institute from October 2021 to October 2025.

The Medicaid program, originally designed as a safety net for the most vulnerable Americans, has ballooned into the largest public-welfare program in the United States, costing American taxpayers more than $825 billion annually. Alarmingly, its improper payment rate exceeds 15 percent, representing approximately $100 billion in misspending each year. With 80 million people on Medicaid and CHIP — approximately one in four Americans — the program is already strained to its breaking point. Nationally, the U.S. has fewer than two American taxpayers supporting each Medicaid recipient, a precarious ratio that highlights how unsustainable this system has become.

The Biden-Harris administration’s leniency toward illegal immigrants gaining access to Medicaid and public assistance will only make this worse. A recent Fox News op-ed by Hayden Dublois of the Foundation for Government Accountability (FGA) reveals that millions of illegal immigrants have been given an on-ramp to Medicaid through a series of administrative loopholes, and weakened eligibility verification.

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