Vermont Faces Health Care Crisis for Noncitizens

New Federal Policies Threaten Access Amidst Growing Concerns

Vermont is bracing for significant disruptions in health insurance access for noncitizens in 2025 and 2026. New federal legislation, dubbed the “Big Beautiful Bill Act,” is poised to restrict coverage, leaving many immigrants vulnerable and creating widespread confusion.

Impact of Federal Mandates

State officials predict that as many as 100 legal noncitizens residing in the U.S. for less than five years will lose health insurance premium assistance starting January 1. Additionally, an estimated 400 to 500 refugees, asylum seekers, and individuals without legal status are also slated to see their assistance reduced. By October 2026, another 500 to 600 Medicaid enrollees in these categories may lose eligibility.

“There’s a lot of Vermonters with a whole range of different immigration statuses, and they are the people who are putting on our roofs and helping milk our cows,” said Mike Fisher, Vermont’s health care advocate. He expressed dismay, stating, “It’s so disheartening to see an attack on their access to health care.”

Navigating Complexities and Fear

Advocates are already observing a chilling effect, with patients delaying or avoiding care. The bureaucratic hurdles associated with navigating health insurance, coupled with heightened fears of federal immigration enforcement, are major deterrents. This situation is expected to place a greater administrative burden on the healthcare system.

Jenney Samuelson, secretary of the Vermont Agency of Human Services, shared these projections during a recent legislative hearing. She emphasized that the precise ramifications of the federal cuts are still unfolding.

Programs and Barriers

Existing programs, like Vermont’s Immigrant Health Insurance Plan, offer coverage for pregnant individuals and young people not otherwise eligible for Medicaid. However, many immigrants remain uninsured, facing barriers such as fluctuating incomes, which make it difficult to accurately estimate earnings for eligibility purposes. Industries like agriculture and construction are particularly susceptible to weather and market volatility.

Naomi Wolcott-MacCausland, program coordinator for the Bridges to Health program, highlighted the compounding effect of the federal changes. “Health insurance can be really complicated for anybody, regardless of whether you speak English or don’t have access to the internet,” she noted, underscoring how the new legislation will exacerbate these challenges.

The shrinking or elimination of health insurance subsidies will disproportionately affect immigrants and those with unstable incomes. Wolcott-MacCausland stated that she has seen individuals on temporary visas eligible for insurance opt out due to concerns about fluctuating incomes potentially leading to unexpected financial obligations.

Increased Immigration Enforcement Fuels Fear

Beyond the legislative changes, increased federal immigration enforcement is contributing to a climate of fear, discouraging individuals from seeking medical attention. “People are delaying care that can in turn result in them being at a really costly emergency department visit,” Wolcott-MacCausland warned.

At the Open Doors Clinic, a free clinic serving uninsured and underinsured residents, including migrant workers, clinical and program director Julia Doucet reports a decrease in new patient visits. Some patients are reportedly returning to their home countries for care.

The full impact of these federal policies remains uncertain. “We’re trying like everybody else to understand impacts as the changes are coming down,” Wolcott-MacCausland commented. “There’s a lot of unknowns.”

In a related development, projections suggest that nearly 45,000 Vermonters could lose health insurance coverage due to recent federal tax legislation (Government Accountability Office, 2024).