Milton Friedman was right
“It’s just obvious you can’t have free immigration and a welfare state.” — Milton Friedman
Decades ago, the late Nobel laureate economist Milton Friedman stated bluntly that open borders and a welfare state are mutually exclusive. You can pick one. Not both. It was true then, and it’s painfully true now.
In Olympia, that warning has been ignored. Again. House Democrats just passed Substitute House Bill 1392, a bill that attempts the impossible: to offer taxpayer-funded healthcare (Medicaid/Apple Health) to illegal immigrants while keeping Washington’s strained healthcare system afloat. That’s not compassion—it’s recklessness.
Washington’s Apple Health program is our version of Medicaid, which is primarily meant for indigent citizens and legal residents. It’s funded through a federal-state partnership. But here’s the issue: federal law prohibits Medicaid funding for illegal immigrants. So, when Olympia expands Apple Health to cover those people, the entire cost is picked up by you—the Washington state taxpayer. No federal match. No reimbursement. Just a ballooning bill.
To paper over this mess, SHB 1392 imposes new taxes on private insurance plans. So, if you’ve got Kaiser, Regence, Premera—brace yourself. Your premiums are going up, not to improve your benefits, but to subsidize government healthcare for individuals who aren’t in the United States legally. It’s like trying to heat a drafty house by opening all the windows and cranking up the thermostat. The energy burns fast, the bill skyrockets, and everyone’s still cold.
Providers—your local doctor, your rural hospital—are already being underpaid. Apple Health reimburses them on average only about half the actual cost of the care they provide. Some get even less. Providers are walking away. Clinics are closing. Access is shrinking. And now we’re diluting the Medicaid pool even further by expanding eligibility to those who explicitly do not qualify under federal law. It’s unsustainable. It’s unfair. And it’s foolish.
Supporters of SHB 1392 argue we’ll make it all work by triggering more federal matching dollars through some complex credit scheme. That’s a reckless bet. The feds are already trying to rein in spending—focusing on Social Security, Medicare, and Medicaid’s core mission.
On this point, let’s set the record straight. Medicaid isn’t Medicare. It’s not Social Security. It’s not a magic money tree. It’s a cost-sharing program meant to ensure low-income citizens can access basic care. If we align our management of Apple Health with federal reforms, we could increase provider reimbursements. We could make Apple Health cards more widely accepted. And we could get rural residents—folks in South Bend, Longview, Aberdeen—access to a doctor in their community, not hours away in Tacoma.
But no. Instead, we’re drilling holes in the bottom of the boat and praying it somehow stays afloat.
Reforming Apple Health isn’t about being “anti-immigrant.” It’s about math. It’s about keeping our promises to the people Medicaid was built to serve. We all want to support providers and patients. But we must be disciplined in how we do it. Right now, we’re over-promising, under-delivering, and hoping no one notices the fiscal cliff ahead.
In rural communities like those in my district, patients already struggle to find doctors who accept Apple Health. Hospitals are stretched thin, and providers are burning out. When we expand coverage beyond what our system can sustain, we’re not helping more people—we’re forcing vulnerable Washingtonians, including low-income families, seniors, and people with disabilities, to wait longer, travel farther, and go without the care they need. That’s not compassion. That’s collapse in slow motion.
Milton Friedman was right. You can’t have a welfare state and open borders. And trying to build both on the back of your paycheck? That’s not progressive—it’s regressive.
We have a responsibility to protect the integrity of our Medicaid system and ensure that it delivers on its promise—for the people it was designed to serve. SHB 1392 may be well-intentioned, but it’s fiscally unsound and practically unworkable. If we don’t refocus the program, we risk collapsing Apple Health under the weight of false promises and reckless bets.
Jim Walsh was elected to the Washington State House of Representatives in 2016. He represents the 19th Legislative District, encompassing portions of Cowlitz, Grays Harbor, Lewis, Pacific, Thurston, and Wahkiakum counties. Walsh is also chair of the Washington State Republican Party.
