If we deny health care to undocumented immigrants, can we save money?
By Samuel Metz, MD
Let’s break this into specific questions.
Does the cost of immigrant health care exceed what they pay?
Immigrants subsidize care of for native-born Americans. Medicare receives more in payments from immigrants than it spends on immigrant care, an annual excess of $16 billion. For Social Security, immigrants generated an excess of $12 billion in payroll taxes for benefits they are ineligible to enjoy.
Is immigrant health care more expensive than that of native-born Americans?
The total cost of providing health care to all immigrants is estimated at $39 billion annually. This figure is less than 2% of the $2.6 trillion spent by all Americans. Of the approximately 12 million undocumented immigrants in the US, nearly 40% were covered by private insurance. The six million undocumented immigrants who were uninsured consumed $4.3 billion in health care, a mere $716 per person annually. This is less than one tenth that consumed by native born Americans.
All studies looking at this issue determined that immigrants, both documented and otherwise, consumed less health care per person per year than native born Americans.
Does providing health care to undocumented immigrants encourage illegal immigration to the US?
Immigrants come here for jobs, not health care. Undocumented Latino immigrants, for example, primarily sought out states with employment opportunities. Secondary considerations were family and housing. In contrast, readily accessible public health care played a negative role: those states with the least generous public health care benefit programs show the most rapid rise in immigrant population.
To our shame, almost no one travels to the US, legally or otherwise, seeking affordable health care. Of medical tourists around the world who leave their home country to find affordable health care, 99% of them are Americans seeking care elsewhere. In fact, all other industrialized countries provide better care to a larger proportion of their residents at much lower cost than we do.
If we exclude undocumented immigrants, will our health care spending go down?
As demonstrated above, the absolute amount potentially saved in refusing health care to those without residency documentation is small, less than 2% of total health spending.
Additionally, even this small savings disappears when we include the cost of enforcing such a policy. The Government Accounting Office found that state efforts to exclude immigrants without documentation from Medicaid were expensive – very expensive: states on average spent $100 on administration to save 14 cents in health care.
Worse, these efforts to verify residency resulted in delay or denial of Medicaid to US citizens who could not provide required documentation.
Is it legally right to reward immigrants who arrive illegally with free health care?
Some advocate the US should punish criminals (i.e., people who enter the US illegally) by denying health care unless they pay for it themselves. This position runs contrary to an interesting legal principle: The only people in the US constitutionally entitled to medical care at public expense are convicts in jail. Shockingly, we find stories of native born Americans who commit crimes specifically to get the health care they could not afford as free citizens but they would receive as convicted felons.
It would take convoluted legal maneuvering to determine that undocumented workers who pay more in taxes than they receive in public benefits should be excluded from universal health care while convicted felons who pay no taxes are included.
Are there still reasons to deny health care to undocumented immigrants?
Some object to providing any essential public services to people who look different, speak a different language, possess a different skin color, or worship a different God. Why object? Because these different people might vote Democratic.
Sorry. Can’t help you with that one.
— This Article was originally published in the September 2013 issue of the Rogue Valley Community Press