Rosa Maria Carranza leans forward to support her three-year-old as she climbs a rock in the forested hills of northeast Auckland.
Wearing hiking gear and a beaded necklace, Carranza, 67, wandered among trees and children on a sunny December morning. “Grab that branch,” she said in Spanish. “You can do it, my love!”
Carranza, a child development expert who grew up swinging through the trees and swimming in rivers in El Salvador, said she feels at home in the woods at the outdoor preschool she co-founded. She has worked with children and teens as a child care provider and educator for over 30 years. For that long, I knew when to lean in and when to step back to help my students find their footing.
When Carranza transitioned to part-time work last year, she expected to receive Medicare and Social Security checks. This is a benefit given to American workers and immigrants upon legal retirement, provided they meet work history, age, and disability requirements. She has contributed tens of thousands of dollars to Medicare and Social Security over 24 years, according to Social Security Administration income records reviewed by El Tímpano and KFF Health News. But Carranza and an estimated 100,000 other legally present immigrants will soon be excluded from Medicare.
The Republican One Big Beautiful Bill Act, signed by President Donald Trump last July, prohibits certain categories of legally present immigrants from being excluded from Medicare, including temporary protected status holders, refugees, asylum seekers, domestic violence survivors, human trafficking victims and people on work visas.
Those already in the program, like Carranza, will have until January 4th to be deregistered. This is a move by Republican lawmakers to rein in Medicare spending, as they and Trump argue that tax dollars should not be used to pay for medical care for U.S. immigrants without their permission.
“Democrats want illegal aliens, many of them violent criminals, to have free health care,” Trump posted on Truth Social two months after signing the bill. “I can’t let this happen!”
But categories of immigrants currently losing insurance coverage have legal status. Neither the White House nor the Department of Health and Human Services responded to questions about whether it would be fair to exclude legal residents from Medicare.
Immigrants without legal status were already ineligible for Medicare and most other federally funded public benefits.
Carranza worries that if the Trump administration ends Temporary Protected Status for Salvadorans, which he sought during his first term, he could also lose legal permission to live in the United States.
Carranza would then lose legal residency and risk time in an immigration detention center or deportation.
“This is like a horror movie, a complete nightmare,” Carranza said. “He didn’t age as I had imagined.”
“We are under constant attack.”
Carranza left El Salvador in 1991 during the country’s brutal civil war, leaving behind her three young children to earn money to send to her family. She overstayed her visa until she received temporary protected status in 2001 after two earthquakes in El Salvador killed more than 1,100 people and displaced 1.3 million.
Temporary Protected Status (TPS) was passed by Congress in 1990 and signed by Republican President George HW Bush.
The program allows people like Carranza from selected countries affected by armed conflict, civil war, and climate disasters to live and work in the United States if staying in their home country poses a risk.
Carranza missed her youngest daughter’s kindergarten graduation and her first track and field medal performance. She worked nights as a babysitter for newborns, then worked as a substitute teacher in San Francisco Bay Area public schools to pay for her children’s education in El Salvador and her own classes at City College of San Francisco, where she earned a degree in child development.
And she cared for dozens of 3-, 4- and 5-year-olds who watched in awe as they discovered tiny treasures buried in the redwoods of Oakland Park. There she co-founded Esquerita del Bosque, a Spanish immersion preschool that teaches children outdoors.
In return, he was supposed to have a peaceful retirement. But Congress limited Medicare eligibility to citizens, lawful permanent residents, Cubans and Haitians, and those covered by the Compact of Free Association, an agreement between the United States and Pacific Island nations.
The move followed President Trump’s efforts to bar some legal immigrants from receiving social assistance services such as Medicaid, marketplace insurance subsidies, food assistance, housing subsidies, and medical visits at federally funded health centers. According to KFF, a health information nonprofit that includes KFF Health News, 1.4 million legal immigrants overall are expected to lose health insurance.
Taylor Halsey, a spokeswoman for House Speaker Mike Johnson, did not respond to a request for comment.
Michael Cannon, director of health policy research at the Cato Institute, a libertarian think tank, said Republicans want to enact tax cuts and eliminate health insurance for immigrants to keep their immigrant base intact.
“They don’t want to turn the United States into a welfare magnet,” he said. “And they resent the government for making them pay for the welfare state.”
Data on immigrants who are in the country legally is not available, but immigrants without legal status paid $6.4 billion in Medicare and $25.7 billion in Social Security in 2022, according to the Institute on Taxation and Economic Policy. The Congressional Budget Office estimates that Medicare regulations alone will reduce federal spending by $5.1 billion by 2034.
Health experts say eliminating insurance coverage for immigrants with legal status is unprecedented.
“This is actually the first time Congress has stripped Medicare from any group,” said Drishti Pillai, KFF’s immigration health policy director. “This change affects immigrants who are legally in the United States, many of whom have already worked and paid into the system for decades.”
If older adults like Carranza lose Medicare coverage, clinicians predict they will delay care and lead to more critically ill patients, especially in hospital emergency rooms.
Teresa Chen, an emergency medicine physician at Zuckerberg San Francisco General Hospital and clinical assistant professor of emergency medicine at the University of California, San Francisco, said older adults can become ill suddenly and quickly, making them more susceptible to cardiovascular diseases such as heart disease and high blood pressure, especially if they put off routine care.
“It’s very easy for them to fall off a cliff,” Chen said.
Carranza goes hiking and considers herself healthy, but admits that she is getting older and finding it harder to keep up with her children in the woods.
Late last year, she was diagnosed with high blood pressure, and in January she was rushed to the emergency room after waking up with chest tightness and her blood pressure rising to dangerous levels. A few weeks later, while walking, she tripped over a curb and fell to the ground. The next day she woke up with a swollen foot. Doctors at a local hospital told her she had arthritis.
Although it was a scary moment, she said she was grateful that her urgent care visit was only $10 and her primary care doctor’s visit was only $5. But that will change once she loses Medicare by early next year.
She said the stress of knowing she could lose health insurance coverage and legal status while masked federal agents were detaining immigrants like her across the country was taking a toll on her mental health. She is looking for a therapist and acupuncture service to treat her insomnia and anxiety, as well as the feeling of being “constantly attacked.”
I can’t rely anywhere
In California, which has the largest number of elderly immigrants, Carranza could have purchased state-sponsored insurance, but the state this year froze enrollment for adults 19 and older or asylum seekers who hold TPS without authorization in the United States. Other states with Democratic governors, such as Illinois and Minnesota, have also cut health care programs for immigrants under budget pressure.
California Gov. Gavin Newsom in January proposed a state budget that would not backfill federal health care cuts for the roughly 200,000 people who entered the country legally, citing a $1.1 billion annual price tag and a shortfall in the state’s budget.
“Given these fiscal pressures, the administration cannot backfill changes in federal policy,” said California Department of Treasury Spokesperson HD Palmer.
But some Democratic lawmakers and consumer advocates say states should intervene. State Rep. Mia Bonta, who chairs the Assembly Health Committee, said she is working on a solution in the Legislature’s budget to get immigrants, including seniors, who lose health insurance into Medi-Cal, the state’s version of Medicaid.
East Bay Democrats are especially concerned about people like Carranza. People who have “lived here for decades and contributed to this economy, contributed to our cultural fabric and our community, built families and lives, and now want to be able to retire with dignity, live with dignity, and get the health care they need.”
signs of the future
Last April, Carranza got a glimpse of what it’s like to lose health insurance and retirement benefits when she received a letter from the Social Security Administration informing her that she was no longer eligible for retirement benefits because she was not legally present in the U.S., even though she was not legally present in the country. Medicare subsequently stopped paying for her medical insurance, resulting in her disqualification.
As a TPS holder with a work permit, she knew a mistake had been made. But without the check, Carranza didn’t have money to pay one month’s rent. She raised the rent by babysitting the landlord’s children. Last May, the office of Oakland Democratic Rep. Latifah Simon helped Ms. Carranza collect her retirement benefits, but it took months for her to get her health insurance back.
The experience left her shaken.
“I’ve been working for the system here for over 30 years and it’s like a slap in the face,” Carranza said. “And in return, this is what we have now.”
She lies awake at night imagining the future. This is where she has spent half her life, with no health insurance or possibly Social Security benefits. Alternatively, two of her three children remain in El Salvador. Her daughter, a green card holder who lives in Texas, wants to become a citizen so she can apply for Carranza’s permanent residency, a process that could take years. And the possibility she fears most: indefinite detention or deportation.
On a recent morning in his basement studio in Oakland, Carranza pulled a box from the back of a closet. Inside was a thick stack of identification documents, including old driver’s licenses, Social Security cards, and dozens of federally issued work IDs.
“My life is in that box,” she said.
This article was produced in partnership with El Tímpano, a citizen media organization that serves and reports on the Bay Area’s Latino and Mayan immigrant communities..
