Ronny Jackson wrong on unauthorized immigrant access to ballot, health care coverage

U.S. Rep. Ronny Jackson, R-Amarillo, who is running for reelection in Texas' 13th Congressional District, made a surprising claim regarding unauthorized immigrants on Twitter and garnered more than 6,000 replies.

Jackson tweeted on Jan. 16: "In 2022, illegal immigrants will have MORE FREEDOMS and easier access to healthcare and ballot boxes than most Americans... Just think about that."

Jackson's office did not respond to our calls and emails for Jackson's source. So we went ahead and took a look at the two aspects of his claim: unauthorized immigrants' access to the ballot and their access to health care.

Is it true immigrants living in the U.S. illegally have "more freedoms" and easier access to health care and the ballot box compared to most Americans?

Immigrants lacking legal authorization to live in the U.S. cannot vote in federal and state elections, said Matthew Weil, director of the Washington-based Bipartisan Policy Center's Elections Project. The project explores and analyzes voter legislation to ultimately inform policy makers.

Almost all localities in the U.S., and all in Texas, limit elections to citizens. Even in the small handful of localities where non-citizens can vote in local elections, those localities only allow lawfully present noncitizens to vote.

Weil noted New York City is one example of the few localities that allow noncitizens to vote in local elections. New York City allows Deferred Action for Childhood Arrivals holders but not all unauthorized immigrants to vote, as reported by the Associated Press in early January. There are no circumstances where noncitizens can vote in federal elections.

"I don't know of any jurisdiction that allows somebody who's here undocumented to access the ballot box," Weil said.

There are an estimated 1.7 million people lacking legal immigration status in Texas, according to 2019 estimates by the Migration Policy Institute, a nonpartisan policy research institution. More than 20% of them, according to the institute, have been in the U.S. for 20 or more years.

Unauthorized immigrants are barred from federal health care programs, said Anne Dunkelberg, associate director at Every Texan, an Austin-based nonpartisan policy institute. This includes Medicare, Medicaid, the Children's Health Insurance Program, and coverage through the Affordable Care Act marketplace.

Based on policy research, Every Texan advocates for Texas to expand Medicaid under the Affordable Care Act, which all but 12 states have done. That expansion would not include immigrants living in the U.S. illegally.

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Dunkelberg said there is an exception where providers can recoup the cost of treating an unauthorized immigrant in an emergency situation. Even that emergency funding for providers is subject to the same restrictions as for Medicaid in Texas for adult citizens.

"And so hospital emergency rooms can't turn away people with real emergencies, regardless of whether they're uninsured, regardless of what their immigration status is. They have to treat you in real emergencies," Dunkelberg said. "So that's why there is a provision back for emergency room visits by a very limited number of undocumented immigrants, not even all of them."

Unauthorized immigrants have access to some state and local health programs, which can be funded by federal grants. This patchwork of programs addresses some aspects of wellbeing like mental health, immunizations, and communicable disease.

However, these programs are not health care coverage, Dunkelberg said. That care isn't free, and in many cases program costs work on a sliding scale. Those programs are available to citizens, too.

Locally, counties can opt to serve uninsured immigrants living in the U.S. illegally through medical assistance programs. The uninsured people seeking care have to meet specific income requirements. Dunkelberg said most of Texas' major urban counties opt to provide care to uninsured unauthorized immigrants.

States also have the option of providing prenatal care to women regardless of immigration status through the Children's Health Insurance Program, said Ruth Wasem, professor of public policy practice at the LBJ School of Public Affairs at the University of Texas. Wasem said this option was created under former president George W. Bush.

Texas is one such state that opts for the CHIP perinatal program (prenatal, delivery, and postpartum care) for unauthorized immigrants.  

Even with limited emergency Medicaid, it's a stretch to say unauthorized immigrants have "easier access" compared to most Americans.

"There is no aspect of that that is in any way superior to the access for U.S. citizens," Dunkelberg said.

Though Jackson led the White House Medical Unit as Physician to the President in the Obama and Trump administrations, he seems off the mark about health care.

Rep. Ronny Jackson tweeted "In 2022, illegal immigrants will have MORE FREEDOMS and easier access to healthcare and ballot boxes than most Americans... Just think about that."

Unauthorized immigrants don't have access to the ballot for federal, state, and almost all local elections. Though immigrants can have access to some medical assistance programs depending on where they live, they also do not qualify for any health insurance coverage with any federal dollars. They do not qualify for Affordable Care Act marketplace coverage even if they pay costs without ACA subsidy.

We rate this claim as Pants on Fire.