Rosa María Carranza, 67, crouched to steady a 3‑year‑old scrambling up a boulder in the oak‑strewn hills of northeast Oakland, where she helped start an outdoor Spanish‑immersion preschool. A Salvadoran immigrant who has worked with children and teenagers for more than three decades, Carranza paid tens of thousands into Social Security and Medicare during 24 years of documented employment and had planned to go part‑time and rely on retirement benefits and Medicare.
Instead, Carranza is among an estimated 100,000 lawfully present immigrants who will be removed from Medicare after President Trump signed the One Big Beautiful Bill Act in July. The law bars several categories of lawfully present immigrants from the program — including holders of temporary protected status (TPS), refugees and asylum‑seekers, survivors of domestic abuse, trafficking victims and some people on work visas — and federal officials say people already enrolled in Medicare will be disenrolled by Jan. 4.
Supporters of the law frame it as a way to cut federal spending and prevent taxpayer funds from covering noncitizens; Mr. Trump has criticized Democratic positions on immigrant access to health care. But advocates and some experts say it is unprecedented to strip Medicare from people who have paid into the system and who hold lawful immigration status.
Carranza fled El Salvador’s civil war in 1991 and initially overstayed a visa. She later obtained TPS after deadly earthquakes in 2001 — a status Congress created in 1990 to let people from countries affected by conflict or disaster live and work in the U.S. when returning home would be unsafe. She earned a child development degree at City College of San Francisco, supported her family working overnight babysitting shifts and substitute teaching, and built a decades‑long career in the Bay Area.
Health professionals warn that removing Medicare from older immigrants who have worked and contributed to the system will push many to postpone care, leading to worse chronic disease control and more emergency hospital visits. Theresa Cheng, an emergency physician at Zuckerberg San Francisco General Hospital, said older patients can decline quickly when routine care stops. Carranza herself has high blood pressure and arthritis; she recently paid $10 for an urgent care visit and $5 for a primary care appointment — costs she expects to rise without Medicare.
Drishti Pillai, director of immigrant health policy at KFF, described the change as historic, saying it is the first time Congress has taken Medicare away from a defined group. KFF projects that broader federal policy changes related to Medicaid, marketplace subsidies and other services could leave about 1.4 million lawfully present immigrants without health insurance. The Congressional Budget Office estimated the Medicare restriction would lower federal spending by roughly $5.1 billion through 2034. Independent analyses also note immigrants have contributed billions to Medicare and Social Security; one 2022 estimate put undocumented workers’ Medicare contributions at about $6.4 billion and Social Security payments at $25.7 billion.
Carranza knows the financial and emotional strain firsthand. In April, the Social Security Administration mistakenly informed her she was no longer “lawfully present,” and Medicare payments to her plan stopped, temporarily disenrolling her. Without her benefit check she missed a month’s rent and worked off the cost by babysitting. With help from Rep. Lateefah Simon’s office she regained her benefits, but the incident left her shaken.
Beyond losing benefits, Carranza worries the administration could try to rescind TPS designations — an effort attempted during President Trump’s earlier term — which would jeopardize her legal status and raise the risk of detention or deportation. Her daughter, a green‑card holder in Texas working toward naturalization, could petition for Carranza, but that process can take years.
State options offer limited relief. California, which has the nation’s largest population of older immigrants, froze enrollment this year for certain adult groups including TPS holders, people lacking authorization and some asylum‑seekers. Gov. Gavin Newsom’s proposed budget does not fully backfill the projected federal health‑care cuts affecting roughly 200,000 lawfully present immigrants, citing an estimated $1.1 billion annual price tag and tight state finances. A California Department of Finance spokesperson said the state “cannot backfill for this change in federal policy,” though some legislators are exploring ways to extend Medi‑Cal coverage to those affected.
Clinicians and advocates say the public‑health impact could be wide: people skipping medications, preventive visits and chronic‑disease care will likely have more advanced illness and rely more on emergency rooms, increasing strain on hospitals. The uncertainty has also taken a mental toll on Carranza; she has sought therapy and acupuncture for insomnia and anxiety, saying she feels “under constant attack.” She keeps a box of identification and work‑authorization documents as proof of her long work history and lawful authorization to live and work in the U.S.
Political reactions have been mixed. Officials in some Republican circles argue the policy is meant to prevent the country from becoming a “welfare magnet.” Requests for comment from House leadership and federal health agencies went unanswered for this report.
Carranza had imagined a modest, secure retirement after decades of caregiving and community work. Now she faces the loss of Medicare and the possibility of losing Social Security and long‑earned stability. “This is like a horror movie, a complete nightmare,” she said. “This is not how I imagined getting old.”
This piece was produced in collaboration with El Tímpano and KFF Health News.