OAKLAND, Calif. — Rosa María Carranza, 67, leaned forward to steady a 3‑year‑old climbing a rock in the forested hills of northeast Oakland, where she co‑founded an outdoor Spanish‑immersion preschool. A child development professional who grew up in El Salvador, Carranza has worked with children and teens for more than three decades. After 24 years of documented earnings — tens of thousands of dollars paid into Social Security and Medicare — she planned to transition to part‑time work and rely on retirement benefits and Medicare.
Instead, Carranza is among an estimated 100,000 lawfully present immigrants who will be disenrolled from Medicare after the GOP’s One Big Beautiful Bill Act, signed by President Trump in July, barred certain categories of lawfully present immigrants from the program. The law excludes groups including temporary protected status (TPS) holders, refugees, asylum‑seekers, survivors of domestic violence, trafficking victims and some people with work visas. Officials say those already in Medicare, like Carranza, will be removed from the program by Jan. 4.
Supporters of the lawframe it as a measure to rein in federal spending and prevent taxpayer funds being used for noncitizens; Trump posted on Truth Social that Democrats “want Illegal Aliens… to receive FREE Healthcare.” But the people losing coverage are legally present; advocates and some experts call it unprecedented to strip Medicare from a group that has paid into the system.
Carranza, who overstayed a visa after leaving El Salvador during its civil war in 1991 and later qualified for TPS following deadly earthquakes in 2001, says the move has left her frightened. TPS — created by Congress and signed into law in 1990 — lets people from certain nations facing conflict, disaster or other risks live and work in the U.S. when returning home would be dangerous. Carranza earned a child development degree at City College of San Francisco, worked overnight shifts babysitting and substitute taught to support her family, and built a life and career in the Bay Area.
Health experts warn that removing Medicare for older immigrants who have worked and paid into the system will lead many to delay care, increasing severe illness and emergency hospital visits. Theresa Cheng, an emergency physician at Zuckerberg San Francisco General Hospital, said older adults can deteriorate quickly if routine care is missed. Carranza herself has been diagnosed with high blood pressure and arthritis; she recently paid $10 for an urgent care visit and $5 for a primary care visit — costs that will rise without Medicare.
Drishti Pillai, director of immigrant health policy at KFF, called the change historic: “This is actually the first time that Congress has taken away Medicare from any group.” KFF projects that, more broadly, 1.4 million lawfully present immigrants could lose health insurance because of related federal changes affecting Medicaid, marketplace subsidies and other services. The Congressional Budget Office estimated the Medicare restrictions would reduce federal spending by about $5.1 billion by 2034. Data also show immigrants — including undocumented ones — have contributed billions into Medicare and Social Security; one estimate for 2022 put undocumented payments at $6.4 billion for Medicare and $25.7 billion for Social Security.
The policy shift has practical and emotional consequences for Carranza. Last April, the Social Security Administration mistakenly notified her that she no longer qualified for retirement benefits because she was “not lawfully present,” and Medicare payments to her plan stopped, temporarily disenrolling her. Without her check, she couldn’t pay rent for a month and worked off rent by babysitting. With help from Rep. Lateefah Simon’s office, she recovered benefits, but the experience left her shaken.
Beyond health coverage, Carranza fears the Trump administration could seek to end TPS designations — as it attempted during his first term — which would put her legal presence at risk and raise the specter of detention or deportation. Her daughter in Texas, a green‑card holder hoping to naturalize, could petition for Carranza, but that process can take years.
At the state level, options are limited. California — home to the nation’s largest number of immigrant seniors — froze enrollment this year for adults 19 and older who are TPS holders, in the U.S. without authorization, or asylum‑seekers, and Gov. Gavin Newsom proposed a budget that would not backfill federal health care cuts for about 200,000 lawfully present immigrants because of a $1.1 billion annual cost amid state budget pressures. A California Department of Finance spokesperson said the administration “cannot backfill for this change in federal policy.” Some state lawmakers, including Assembly member Mia Bonta, are exploring budget solutions to bring affected immigrants into Medi‑Cal, the state’s Medicaid program.
Advocates and clinicians warn the public health impact could be broad: older adults skipping medications, routine visits and preventive care can lead to more advanced disease and greater strain on emergency services. The stress and uncertainty have also taken a toll on Carranza’s mental health; she’s sought therapy and acupuncture for insomnia and anxiety amid what she describes as feeling “under constant attack.”
Political responses have been mixed. A spokesperson for House Speaker Mike Johnson did not respond to requests for comment. Michael Cannon of the Cato Institute said Republicans want to avoid turning the U.S. into “a welfare magnet” and resent paying for a welfare state. The White House and Department of Health and Human Services did not respond to questions about the fairness of disenrolling legally present residents from Medicare.
Carranza keeps a box of identification and work authorization cards as evidence of her long work history and legal authorization to live and work in the U.S. She says she imagined a peaceful retirement after decades of labor in the Bay Area. Now she worries about losing Medicare, Social Security and the life she has built: “This is like a horror movie, a complete nightmare… This is not how I imagined getting old.”
This article was produced in collaboration with El Tímpano and KFF Health News.