A POINT OF PERSONAL PRIVILEGE: Immigrants Aren’t the Problem. Our Denial Is.

What’s Changed Since 1990

The last major immigration reform was in 1990. Back then, the U.S. had a population of about 250 million people. Today it’s close to 340 million. The economy is more than three times larger. Labor demand has exploded in construction, healthcare, service, and agriculture.

And yet, the number of legal work visas we issue each year has barely budged.

We still grant about 140,000 green cards annually for all employment-based categories combined, that’s not just workers but also their spouses and children.

The H-1B visa program for high-skilled workers still has a cap of 85,000 new slots a year (65,000 plus another 20,000 for U.S. graduates).

Seasonal programs have grown a bit, the H-2A agricultural visas now reach about 250,000 workers, and H-2B temporary non-agricultural visas about 150,000, but those fluctuate and don’t lead to permanent residency.

That’s it. That’s the system.

“Well, They Should Just Come Legally”

The quotas haven’t grown with our economy. We haven’t made room for the workers we already rely on, because politicians on both sides worry that if they do, they’ll lose an election.

The reality? It’s easier to talk about walls than spreadsheets.

See, we’ve added ninety million people, tripled the economy, and aged dramatically as a country, but the number of employment-based pathways to live and work here legally looks almost exactly like it did when fax machines were cutting-edge.

So when someone says, “They should just come legally,” it’s worth remembering that the “legal line” we’re talking about hasn’t moved in 35 years. It’s not a line anymore, it’s an archaeological site.

Why We Haven’t Fixed It

The pattern is as predictable as it is embarrassing. The right says, “Secure the border first.” The left says, “Create a path to citizenship first.” And somewhere between the slogans, the actual work never gets done.

Part of the paralysis is political fear. Immigration is the third rail of modern politics. It can swing elections in border states, inflame talk radio, and divide both parties from the inside out. No one wants to risk it.

It’s not just fear of voters, it’s fear of headlines. “Senator Supports Pathway to Citizenship” doesn’t test well in a primary. Neither does “Senator Votes to Fund Border Technology.” So we get theater instead of policy.

Meanwhile, business owners can’t find workers, and border agents can’t get the resources they need. Everyone loses, except the fundraisers.

Republicans worry that legalizing long-term undocumented residents could mean millions of new voters who lean Democratic. Democrats worry that tightening enforcement or restricting benefits could alienate parts of their own base. So both sides hedge, posture, and wait for the other to go first.

Meanwhile, the country just keeps aging, the labor market keeps tightening, and the workforce we quietly depend on keeps operating in the shadows.

It’s not that we don’t know what to do. We do.

Economists, business leaders, and immigration experts have been saying the same thing for years: we need secure borders and a functioning legal system that matches our economic reality.

But that kind of nuance doesn’t fit neatly on a campaign mailer.

So we get the same show every few years: speeches about “fixing the broken system,” bills that go nowhere, and press conferences about “border crises” that magically reappear just in time for election season.

The result?

An economy that runs on labor we officially pretend doesn’t exist. A house we’re too proud to admit needs fixing, so we keep adding duct tape and calling it craftsmanship.

The Cost of Pretending

Because when you look past the headlines, what Oregon did wasn’t political. It was practical.

Hospitals can’t turn people away. Federal law says they have to treat anyone who walks in the door. But the same federal law says they can’t use Medicaid dollars for undocumented patients.

So who pays? You do. I do. We all do. The costs get buried in hospital budgets, local taxes, and higher premiums.

That’s what Healthier Oregon was built to fix.

And before anyone says, “So the state’s just giving free healthcare to people here illegally?” No. The state’s paying for care it’s already paying for, only this time in an organized way that saves money. The program doesn’t replace federal law; it keeps hospitals solvent and emergency rooms open for everyone.

This isn’t ideology. It’s risk management.

You can call that compassion if you want, but you should also call it good bookkeeping.

The Medicaid Miracle (We Barely Noticed)

A decade ago, when Congress expanded Medicaid under the Affordable Care Act, most people missed the real story. Everyone focused on who was getting coverage, but the bigger impact was who stayed in business.

Because of the expansion, hospitals, especially rural ones, finally had paying patients again. Clinics stabilized. Entire regions avoided collapse.

That may sound like bureaucratic trivia, but it’s not. Without that expansion, hundreds of hospitals, especially in small towns, would have closed. Medicaid may be messy, but it’s the duct tape holding American healthcare together.

Critics love to call it wasteful. But you know what’s wasteful? Letting a hospital shut down in a county where the next one’s two hours away.

Medicaid expansion didn’t just cover more people; it quietly kept the entire U.S. healthcare system from imploding.

And now, in 2025, we’re right back at the edge. Costs are climbing, federal support is shrinking, and hospitals are once again hanging by a thread.

Under H.R. 1, the big federal budget law that passed last summer, states like Oregon are losing billions in Medicaid and food-assistance funding. The bill also cuts how much the federal government reimburses states for emergency care to non-citizens.

In short: Washington took a step back, and states are being asked to step in.

Why States Are Filling the Gap

So Oregon looked at the math.

If hospitals are already providing care, why not manage it instead of pretending it’s free? Why not spend a little now to avoid paying a fortune later?

That’s what Healthier Oregon does. It’s not radical. It’s the bureaucratic equivalent of replacing your roof before it caves in.

And Oregon isn’t alone. And no, this isn’t some progressive experiment. States run by both parties have expanded or protected Medicaid because they’ve seen what happens when you don’t. Rural Texas hospitals close at one of the highest rates in the country—not because of immigration, but because of uncompensated care.

Because here’s the uncomfortable truth: if you think healthcare for undocumented immigrants is expensive, try not providing it.

The Moral Math

It’s easy to say, “Why should taxpayers foot the bill?”

But here’s the thing, undocumented workers pay taxes. That’s right, they are already paying into the system.

They pay payroll taxes, property taxes (through rent), and sales taxes. Many file income taxes using ITINs—Individual Taxpayer Identification Numbers.

They contribute billions each year to Social Security and Medicare, even though they’ll never get those benefits back.

For anyone wondering, that’s not a partisan talking point; the data comes straight from the IRS and Social Security Administration. Undocumented workers paid an estimated $12 billion into Social Security last year alone. Honestly, money they’ll never see again.

So when critics say, “They don’t pay taxes,” the truth is they’re actually helping to fund the retirements of the very Americans who think they’re freeloading.

Irony’s expensive, but apparently we can afford it.

So when we talk about costs, it’s worth remembering they’re already paying. We just don’t let them benefit from the very system their labor sustains.

If We Did Nothing

Let’s imagine, for a moment, that Oregon pulled the plug on Healthier Oregon and similar programs.

What would happen?

Emergency rooms would overflow. Hospital write-offs would spike. Small rural hospitals would start closing. Health insurance premiums would rise even faster to cover the shortfall.

Cutting off care doesn’t stop the costs; it just changes who gets the invoice.

And for those who argue that denying care would force people to “self-deport,” it doesn’t.

You see, people don’t vanish when they get sick, they wait until it’s life or death, then show up in the ER. And guess who pays for that? Everyone with insurance, every taxpayer, every local government trying to balance a budget.

The Federal Fix We Keep Avoiding

Of course, this isn’t a problem states should have to solve on their own.

A real federal fix would do three things:

1. Modernize immigration law. Create legal paths that match our actual labor needs. Shorten visa backlogs. Give long-term residents a way to earn status through work and taxes.
2. Restore Medicaid’s balance. The program that once saved the healthcare system is now being slowly hollowed out. We need a stable federal match rate so states aren’t left scrambling.
3. Make healthcare prices make sense. Every part of the system, hospitals, insurers, drug companies, operates like a separate economy with its own rules. Transparency and consistency would go a long way.

None of that is partisan. It’s just plumbing maintenance for a democracy.

Some will call that “amnesty.” It’s not. It’s accountability. We’ve already invited this labor force into our economy; the question is whether we keep pretending they’re ghosts or finally give them a legal framework that works for both them and us.

What States Can Do Now

While Washington debates adjectives, states are doing verbs.

They’re building bridges where the federal government left potholes, like expanding coverage, stabilizing hospitals, and keeping their economies upright.

Oregon’s not trying to save the world. It’s trying to keep its healthcare system from bleeding out on the table.

And that’s worth saying out loud: this is not charity. It’s triage.

And if that offends your sense of fairness, consider this: it’s not about rewarding anyone. It’s about protecting everyone. When a hospital closes or a clinic cuts services, the people who lose access aren’t undocumented, they’re your neighbors.

A Hopeful Ending

Still, I think there’s something encouraging about all this.

For all the shouting, states like Oregon are quietly proving that governance still works. That you can make responsible, compassionate, economically sound decisions without waiting for the next federal miracle.

It’s easy to see dysfunction in Washington and think the whole system’s broken. But look closer, and you’ll find thousands of people, nurses, doctors, caseworkers, local leaders, still showing up every day to keep it from falling apart.

And maybe that’s what real American optimism looks like now. Not blind faith, but stubborn maintenance.

We are, after all, a country of fixers. Our ancestors didn’t come here because everything worked. They came here because it didn’t, and they believed they could make it better.

That belief built the nation. It’s still what keeps it running.

There’s a quiet majority out there, people who aren’t shouting on cable news or posting memes, who understand this. They know that immigration isn’t the villain, and bureaucracy isn’t the hero.

And maybe that’s the moral of this whole conversation: the problem isn’t that people come here looking for a better life. The problem is that we keep forgetting that’s exactly how all of us got here.