Bruce Lesley is incensed at one dimension of the debate about birthright citizenship that he says is being completely overlooked. “It’s in the words: ‘birth’ right citizenship — this is about babies.” Lesley, president of First Focus on Children, filed an amicus brief for Trump v. Barbara, the case the Supreme Court heard April 1.
In recent congressional hearings about ending birthright citizenship, Lesley says lawmakers and witnesses discussed administrative challenges, history and politics — but not children. “The word ‘child’ does not cross their lips,” he says. That omission matters, he argues, because any change would affect every baby born in the U.S.
Under current law, babies born in American hospitals or birth centers are automatically citizens with immediate access to supports. Pregnant women are eligible for Medicaid in every state regardless of immigration status, covering prenatal, birth and postnatal care. Medicaid pays for roughly 40% of U.S. births, and newborns are typically eligible for Medicaid for the first year of life. Even so, the U.S. has higher maternal and infant mortality than peer countries.
An estimated 300,000 babies were born to parents without legal status in 2023; about 3.6 million babies are born in the U.S. each year. If birthright citizenship were ended, parents of every newborn could be required to prove their own citizenship to secure benefits for the child. Lesley warns this would break the continuity of care families now rely on: well-child visits, immunizations and other early services could be disrupted if eligibility for Medicaid, SNAP or WIC is questioned.
Hospitals currently help families obtain Social Security numbers for newborns — a step that enables enrollment in health insurance and other supports. If the presumption of citizenship is removed, hospitals, doctors and administrators would likely need to change practices and policies; the American Hospital Association, the American Medical Association and the American Academy of Pediatrics declined to comment on the case.
The practical burdens of proving parentage and citizenship could be heavy and costly. Hannah Steinberg, staff attorney at the ACLU Immigrant Rights Project, notes about 10% of birth certificates list the father as unknown. In those situations — or when babies are found with no known parents — a system that ties a child’s status to parental documentation could leave entitled children without citizenship in practice, even if law recognizes them. Steinberg says an executive order aiming to strip birthright protections would upend administrative procedures across federal, state and local systems.
Lesley adds that children of same-sex couples, surrogates, assisted reproduction users, or parents whose documents were lost to fire or disaster could face added complications if proofs of parentage and citizenship become necessary.
The debate itself already appears to be affecting care. Arturo Vargas Bustamante of the UCLA Latino Policy and Politics Institute says fear about immigration policies keeps some people from seeking prenatal care, which can lead to worse outcomes such as low birth weight and lifelong consequences. He notes the disproportionate impact on Latino families: about 75% of children with noncitizen parents are Latino, a point highlighted in a UCLA policy brief on ending birthright citizenship.
President Trump issued an executive order on his first day in office seeking to limit birthright citizenship; that order has been blocked in lower courts. If the Supreme Court upholds restrictions, advocates warn, the practical effect would be sweeping changes to how newborns are treated in hospitals, which families can access critical early supports, and how quickly and easily infants can receive the care vital to healthy starts in life.