Rosa MarÃa Carranza attends a protest supporting the
temporary protected status program outside the Phillip Burton Federal
Building and U.S. Courthouse in San Francisco on Nov. 18, 2025.
Carranza, a resident of neighboring Oakland, worries she could lose her
legal status and risk indefinite detention or deportation.
Hiram Alejandro Durán/El TÃmpano
OAKLAND, Calif. — Rosa MarÃa Carranza leaned forward to hold a
3-year-old's back as the girl climbed a rock in the forested hills of
northeast Oakland.
Dressed in hiking gear and beaded necklaces,
Carranza, 67, maneuvered between trees and children on a sunny morning
in December. "Hold onto that branch," she said in Spanish. "You can do
it, my love!"
Carranza, a child development professional who
grew up swinging through trees and swimming in rivers in El Salvador,
said she feels at home in the forest at the outdoor preschool she
co-founded. She has worked with children and teens as a caregiver and
educator for more than three decades, long enough to know when to lean
in and when to step back to let her students find their own footing.
This article was produced in collaboration with El TÃmpano.
When
she transitioned to working part time last year, Carranza counted on
getting Medicare and Social Security checks — benefits given to American
workers and lawfully present immigrants when they retire, if they meet work history and age or disability requirements.
She's contributed tens of thousands of dollars into Medicare and
Social Security over 24 years, according to her Social Security
Administration earnings record, reviewed by El TÃmpano and KFF Health News. But Carranza and an estimated 100,000 other lawfully present immigrants will soon be cut out of Medicare.
Rosa MarÃa Carranza encourages a toddler to navigate
uneven ground at Joaquin Miller Park in Oakland, Calif., on Dec. 5,
2025. Carranza will lose Medicare when a federal policy restricting
health care coverage for some lawfully present immigrants takes effect
next year.
Hiram Alejandro Durán/El TÃmpano
The GOP's One Big Beautiful Bill Act, signed last July by
President Trump, barred certain categories of lawfully present
immigrants — including temporary protected status holders, refugees,
asylum-seekers, survivors of domestic violence, trafficking victims and
people with work visas — from Medicare.
Those already in the
program, like Carranza, will be disenrolled by Jan. 4 — a move by
Republican lawmakers to rein in Medicare spending, as they and Trump
have argued that taxpayer dollars should not be used to pay for the
health care of immigrants in the U.S. without authorization.
"The Democrats want Illegal Aliens, many of them VIOLENT CRIMINALS, to receive FREE Healthcare," Trump posted on Truth Social two months after he signed the bill into law. "We cannot let this happen!"
However, the categories of immigrants now losing coverage do
have legal status. Neither the White House nor the Department of Health
and Human Services responded to a question about whether it was fair to
disenroll legal residents from Medicare.
Undocumented immigrants were already ineligible for Medicare or most other federally funded public benefits.
Carranza
is worried that she could also lose legal permission to live in the
United States if the Trump administration ends temporary protected
status for Salvadorans, as it sought to do during his first term.
If that happened, Carranza would lose legal residency, risking time in an immigration detention center or deportation.
"This is like a horror movie, a complete nightmare," Carranza said. "This is not how I imagined getting old."
"Under constant attack"
Carranza
left El Salvador in 1991 during a brutal civil war, leaving behind
three young children, to earn money to send home to her family. She
overstayed her visa until 2001, when she qualified for temporary
protected status, after two earthquakes struck El Salvador, killing more than 1,100 people and displacing 1.3 million.
Temporary
protected status, or TPS, was passed by Congress and signed into law by
Republican President George H.W. Bush in 1990. It allows people such as
Carranza, from select nations undergoing armed conflict, civil war and
climate disasters, to live and work in the United States if being in
their home country poses a risk.
Carranza missed her youngest daughter's graduation from
kindergarten and first medal-winning performance in track. She worked
overnight shifts babysitting newborns and later substitute-taught in
public schools in the San Francisco Bay Area to pay for her children's
schooling in El Salvador, and for 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 gazed in awe as
they uncovered little treasures buried in the redwood forest of the
Oakland park where she co-founded Escuelita del Bosque, a Spanish
immersion preschool that teaches children outdoors.
The trade-off was supposed to be a peaceful retirement. But
Congress narrowed Medicare eligibility to citizens, lawful permanent
residents, Cuban and Haitian nationals, and people covered under the
Compacts of Free Association, agreements between the United States and
Pacific island nations.
The move followed Trump's efforts to
bar some immigrants with legal status from Medicaid, marketplace
insurance subsidies and social support services, such as food
assistance, housing subsidies and medical visits in federally funded
health centers. Altogether, 1.4 million lawfully present immigrants were
projected to lose health insurance, according to KFF, a health
information nonprofit that includes KFF Health News.
A spokesperson for House Speaker Mike Johnson, Taylor Haulsee, did not respond to requests for comment.
Michael
Cannon, director of health policy studies at the Cato Institute, a
libertarian think tank, said Republicans wanted to enact tax cuts and
eliminate health insurance for immigrants because it wouldn't upset
their base.
"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 a welfare state."
Medicare data on lawfully present immigrants is not available. However, undocumented immigrants paid $6.4 billion into Medicare
and $25.7 billion into Social Security in 2022, according to the
Institute on Taxation and Economic Policy. The Congressional Budget
Office estimated that the Medicare restrictions alone would reduce
federal spending by $5.1 billion by 2034.
Rosa MarÃa Carranza holds hands and sings with toddlers
while they walk along a trail in the forested hills of northeast
Oakland, Calif., on Dec. 5, 2025. Carranza co-founded Escuelita del
Bosque, a Spanish immersion preschool at which children spend much of
their day learning and exploring outside.
Hiram Alejandro Durán/El TÃmpano
Losing a lifeline
Health experts say eliminating coverage for immigrants with legal status is unprecedented.
"This
is actually the first time that Congress has taken away Medicare from
any group," said Drishti Pillai, director of immigrant health policy at
KFF. "This change is impacting immigrants who have lawful presence in
the U.S., and many of whom have already worked and paid into the system
for decades."
As older adults like Carranza lose their Medicare
coverage, clinicians anticipate that they will delay their care,
leading to an increase in severely ill patients, especially in hospital
emergency rooms.
Seniors can become sick suddenly and quickly, and they are more
vulnerable to cardiovascular diseases such as heart disease and high
blood pressure, especially if they put off routine care, said Theresa
Cheng, an emergency physician at Zuckerberg San Francisco General
Hospital and assistant clinical professor of emergency medicine at the
University of California, San Francisco.
"It's quite easy for them to fall off the cliff," Cheng said.
Carranza
hikes, eats fresh foods and considers herself healthy, but she
acknowledges that she is aging and starting to struggle to keep up with
the kids in the forest.
Late last year, she was diagnosed with
high blood pressure, and in January, she woke up with a tight chest and
went to urgent care because it had spiked to dangerous levels. A few
weeks later, she tripped on a curb while walking and fell to the ground.
She woke up the next day with a swollen foot. A doctor at the local
hospital told her she had arthritis.
These were scary moments,
she said, but she was grateful to have to pay only $10 for the urgent
care visit and $5 to see her primary care doctor. However, that will
change when she loses Medicare by early next year.
The stress
of knowing she will lose health insurance coverage, and potentially her
legal status, all while masked federal agents are detaining immigrants
like her across the country, has taken a toll on her mental health, she
said. She is searching for a therapist and acupuncture services to treat
her insomnia and anxiety — and the feeling that she is "under constant
attack."
Nowhere to turn
In California, home to the largest number of immigrant seniors, Carranza could have enrolled in state-sponsored insurance, but this year the state froze enrollment
for adults 19 and older who are TPS holders, in the U.S. without
authorization, or asylum-seekers. Other states with Democratic
governors, such as Illinois and Minnesota, have also scaled back their health programs for immigrants amid budget pressures.
In January, California Gov. Gavin Newsom proposed a state budget
that would not backfill federal health care cuts to about 200,000
lawfully present immigrants, noting the $1.1 billion annual price tag
and state budget shortfalls.
"Given these fiscal pressures, the
administration cannot backfill for this change in federal policy,"
California Department of Finance spokesperson H.D. Palmer said.
But
some Democratic lawmakers and consumer advocates say the state should
step in. State Assembly member Mia Bonta, who chairs the Assembly's
health committee, said she is working on a legislative budget solution
to bring immigrants who will lose health coverage, including older
adults, into Medi-Cal, the state's version of Medicaid.
The
East Bay Democrat is especially concerned for people like Carranza, "who
have lived here for decades and contributed into this economy, who have
given into our cultural fabric and into our communities and who built
families and lives and who are now wanting to be able to retire with
dignity and live with dignity and have the health care that they need."
State and federal IDs belonging to Rosa MarÃa Carranza,
including Social Security, driver's license, and work authorization
cards, are displayed on a table at her home in Oakland, Calif. Carranza,
who has lived and worked in the United States for decades with
temporary protected status, keeps the cards as a record of her legal
authorization to work.
Hiram Alejandro Durán/El TÃmpano
A sign of the future
Last
April, Carranza got a glimpse of what losing her health coverage and
retirement benefits could look like. The Social Security Administration
sent her a letter informing her that she no longer qualified for
retirement benefits because she was not lawfully present in the U.S. —
even though she was. Then Medicare stopped payments to her health plan,
which disenrolled her as a result.
As a TPS holder with a work
permit, she knew a mistake had been made. Yet, without her check,
Carranza didn't have money to pay her rent for a month. She worked off
her rent by babysitting her landlords' children. In May, the office of
U.S. Rep. Lateefah Simon, an Oakland Democrat, helped Carranza recover
her retirement benefits, but it took months for her to get her health
insurance back.
The experience left her reeling.
"It's like getting
slapped on the face after more than 30 years working for the system
here," Carranza said. "And in return, this is what we have now."
She
lies awake at night imagining the future: here, where she's spent half
her life, without health insurance and possibly Social Security
benefits; or in El Salvador, where two of her three children remain. Her
daughter, a green-card holder who lives in Texas, hopes to become a
citizen so she can petition for permanent residency for Carranza, but
the process can take years. Then there's the possibility she fears most:
indefinite detention or deportation.
On a recent morning in
her basement studio in Oakland, Carranza pulled a box from the back of
her closet. In it was a thick stack of identification cards that
included old driver's licenses, her Social Security card, and dozens of
work IDs issued by the federal government.
"My life is in that box," she said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF. This article was produced in collaboration with El TÃmpano, a civic media organization serving and covering the Bay Area's Latino and Mayan immigrant communities.
