Immigrant Care Costs DOUBLE Police Budget!

Screenshot of the HealthCare.gov website with enrollment information

Oregon now spends over twice as much on health care for undocumented immigrants as it does on its entire state police force—a financial shift that signals a seismic change in who and what the state values most.

Story Snapshot

Oregon’s 2025–2027 budget commits $1.5 billion to cover health care for undocumented immigrants—over $700 million more than its state police budget.
Eligibility expansions and surging enrollment have driven costs far beyond initial projections, with a reported $260 million shortfall in 2024.
Advocates frame the policy as a moral imperative, while critics question the fiscal sustainability and public safety trade-offs.
Oregon’s approach sets it apart nationally, with ripple effects for immigration, health, and budget debates across the country.

Oregon’s Budget: A Window Into Changing Priorities

Oregon’s budget for the next two years tells a blunt story: $1.5 billion is earmarked for comprehensive health coverage for immigrants, regardless of legal status, compared to just $717 million for the entire Oregon State Police. That’s more than double the funding for law enforcement, and it’s a ratio practically unheard of outside the nation’s most progressive enclaves. The Healthier Oregon Program, born from the racial justice movement in 2020, began as a modest initiative but quickly ballooned. Its transformation from the limited “Cover All People” pilot to an all-ages, all-statuses program is a study in policy acceleration driven by political will, demographic change, and advocacy muscle.

Oregon’s status as a pioneer in immigrant health care is no accident. Federal law bars undocumented immigrants from Medicaid except in emergencies or for pregnancy. Oregon sidestepped these restrictions using state funds and inventive funding maneuvers—like leveraging hospital taxes to draw some federal matching dollars. The result: nearly 93,000 enrollees, almost double what officials projected, and a program deficit of $260 million as of October 2024. The Oregon Health Authority confirmed that roughly 25% of this spending is federally reimbursed via indirect mechanisms, but the lion’s share falls on state taxpayers, making the program’s fiscal trajectory a political lightning rod.

The Political Engine Behind Healthier Oregon

Democrats dominate Oregon’s legislature, and their grip has allowed progressive policies to flourish. The Healthier Oregon Program’s expansion was no backroom deal—it was the product of sustained advocacy from managed care organizations, medical societies, unions, and immigrant rights groups. These coalitions framed health equity as both a public health and a moral imperative. The governor’s office, which initiated the racial justice council that first proposed expanded coverage, has been unwavering in support. Meanwhile, critics, including some Republicans and law enforcement advocates, point to mounting costs and argue that prioritizing undocumented residents over public safety is a distortion of government’s basic responsibilities. Still, in Oregon’s current political climate, opposition has struggled to check the program’s growth.

National context adds fuel to the debate. Other states, including California, Illinois, and Minnesota, have considered or implemented similar programs, but most have either capped spending or faced rollbacks due to budget crunches. Oregon’s willingness to push forward—despite fiscal alarms—underscores its outlier status. The surge in undocumented immigration under the Biden administration has only intensified scrutiny, with some arguing that generous benefits may serve as a magnet for migration, while others view expanded access as a humane response to a broken federal system.

Winners, Losers, and Looming Questions

The immediate beneficiaries are clear: undocumented immigrants in Oregon now enjoy comprehensive health coverage, a rarity nationwide. Health care providers also benefit, as new enrollees bring increased reimbursements and less uncompensated care. But the budget math is less forgiving. State taxpayers foot the majority of the bill, and the allocation of $1.5 billion has prompted sharp questions about sustainability—especially as other needs, like law enforcement, are funded at much lower levels. Public safety advocates worry that reduced police funding will undermine crime prevention and response, though supporters of the health program argue that healthier communities are safer communities. The debate is as much about values as it is about spreadsheets, and both sides see existential stakes for Oregon’s future.

Looking ahead, lawmakers are monitoring enrollment and costs, with the possibility of further expansion or retrenchment depending on budget realities and political winds. While the Oregon Health Authority insists the program is vital for health equity, fiscal watchdogs warn that the current trajectory is unsustainable without either new revenue or cutbacks elsewhere. Other states are watching closely: Oregon’s willingness to push the envelope may embolden imitators or serve as a cautionary tale. The tug-of-war between compassion and fiscal prudence will only intensify as the next budget cycle approaches, especially if enrollment and costs continue to outpace expectations.