A sweeping Trump administration proposal to replace deported immigrant farmworkers with Medicaid recipients is drawing fierce condemnation in the District of Columbia, where Black residents make up a significant share of the program’s enrollees and would be disproportionately affected.
Agriculture Secretary Brooke Rollins this week described the administration’s plan in blunt terms, telling reporters that “with 34 million people, able-bodied adults on Medicaid, we should be able to do that fairly quickly.” Rollins insisted there would be “no amnesty” for undocumented farmworkers and characterized Medicaid as a reservoir of replacement labor.
Health policy experts and civil rights groups are warning the proposal amounts to a form of coerced work and would be catastrophic for low-income D.C. residents who rely on Medicaid to survive.
According to the Kaiser Family Foundation’s analysis of the American Community Survey, 40.9% of Medicaid enrollees in D.C. are Black, compared to 36.7% who are White. Another 22.4% fall into other racial and ethnic categories, including Latino and Asian residents.
“This is a policy that explicitly targets poor Black and brown residents of the District,” said a local civil rights advocate. “They are taking a program that exists to guarantee health care and twisting it into a list of people they believe should be forced into field labor.”
While Rollins framed the idea as a way to move toward “100% American participation,” Medicaid enrollees in D.C. are overwhelmingly working-age adults, parents, and children. In 2023:
- 28% of Medicaid recipients were 18 and younger
- 19% were between 19 and 26
- 29% were between 27 and 44
- 22% were between 45 and 64
- 11% were 65 and older
Advocates note that many adults on Medicaid already work low-wage jobs that do not offer insurance, care for children or aging relatives, or live with chronic health conditions.
President Trump has also floated proposals to require farmers to house and directly supervise migrant laborers to shield employers from ICE raids, a policy critics say would institutionalize indentured servitude. Rollins’ remarks suggest the administration now aims to go further, using Medicaid as a tool to conscript Americans into agricultural labor.
The White House has not answered questions about how the plan would operate in D.C., where Medicaid enrollment remains a cornerstone of public health and disproportionately serves the communities most at risk of poverty.
Health law experts say no federal statute allows Medicaid benefits to be conditioned on mandatory employment, and any such requirement would almost certainly face constitutional challenges under the 13th Amendment’s ban on involuntary servitude.
“This is not a workforce strategy — it’s an attempt to rebrand exploitation as economic policy,” said a public health researcher in Washington. “The idea that you can strip people of their dignity and health coverage if they don’t go pick vegetables is horrifying.”
Rollins did not specify how the policy would be implemented or whether Medicaid recipients who refused farm work would lose their benefits. But she was unequivocal about the administration’s intent.
“There are plenty of workers in America,” she said Tuesday.
