The costs of barring undocumented immigrants from health and social supports

The Trump administration’s recent reinterpretation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) restricts undocumented immigrants and some legally present individuals, such as those with Temporary Protected Status, from accessing community health centers. 

The policy violates medical ethics, erodes humanitarian values, and threatens the Nevada health care system by limiting access to care in vulnerable communities. 

Medical professionals must provide care to all, regardless of their status.  A mandate to verify immigration status forces Nevada clinics, like those in Clark and Washoe Counties serving more than 200,000 low-income and uninsured residents annually, to prioritize bureaucracy over patient care. No one is currently being denied services, according to the Southern Nevada Health District, but ongoing lawsuits create uncertainty, threatening care for thousands across Nevada. 

PRWORA, designed to reduce federal spending, now restricts essential Nevada services, aligning with the One Big Beautiful Bill Act (OBBA), which attempts to ban Medicaid payments to nonprofits like Planned Parenthood. Although a federal court blocked this, for now, Planned Parenthood Mar Monte, serving 320,000 Nevadans, is reducing family medicine, prenatal care, and behavioral health services due to the anticipated loss of approximately $100 million in Medicaid reimbursements. 

Medicaid covers approximately 800,000 Nevadans, including 312,000 through expansion authorized under the Affordable Care Act. Curtailing Medicaid eligibility, the OBBA requires 80 hours of monthly work for adults under 65, with exemptions for parents of children under 14. The health research organization KFF estimates as many as 112,000 Nevadans, particularly in rural counties, could lose coverage due to administrative barriers.

The Supplemental Nutrition Assistance Program (SNAP), providing $170 million annually to Nevadans, requires work for adults under 65, with exemptions for those with children under 10. These rules, scheduled to take effect next year, risk removing benefits from 20,000 Nevadans, threatening food security and worsening health outcomes like diabetes due to poor nutrition. 

Immigration policies further intensify barriers for Nevada communities. The One Big Beautiful Bill Act allocates $46.5 billion to Customs and Border Patrol and $29.9 billion to ICE, fueling mass detention and deportation. Nevada Gov. Joe Lombardo’s 2025 expansion of 287(g) programs enables local police ICE collaboration in counties like Washoe, which deters people from seeking care. When workers avoid clinics for fear of deportation, it increases risks of untreated conditions which burdens Nevada public health systems.

Verifying immigration status and enforcing work requirements increase administrative costs. Reduced preventive care drives emergency room visits, straining rural hospitals where facilities face closure risks due to Medicaid cuts. An Urban Institute study estimates a $1.5 billion national health care cost increase from coverage losses, with Nevada facing disproportionate impacts. 

Clinic restrictions, Medicaid and SNAP cuts, and immigration enforcement deny care, increase fear, and worsen public health risks like untreated diseases in Nevada. These policies destabilize health care and burden local employers with $30 million in annual absenteeism costs due to preventable illnesses. This is not efficiency but deliberate exclusion, causing real harm to Nevada communities when policies rooted in care and dignity are most needed.