Another take is that they believe in inherit hierarchy that must be conserved.

In this situation, being German is very high on the ladder, so even if they accept immigrants, they would only do so because there are plenty of foreigners that would be lower.

It’s less about where you draw the exclusion line, and more about that their entire worldview is a pyramid in which only a few groups can have a good life if that is built on the shoulders of a larger, lower group.

This is why it’s not about healthcare, it’s about equality. Even if you convince them that everyone deserves healthcare, they would automatically believe that since they are in the top group, they have to get a better kind of healthcare.

This is also why they would never see someone that is fully integrated as true Germans, cause even within the top group, there is a structure.

And of course, their worse fear is being in the bottom group.