Study finds immigrants use fewer U.S. healthcare resources

Opponents of increased immigration argue that migrants strain the U.S. healthcare system by driving up utilization at emergency departments and contributing to uncompensated care.

But a study published Tuesday in the International Journal of Health Services finds those assertions to be false, with immigrants overall paying more toward healthcare than they use.

An analysis of 188 peer-reviewed studies dating back to 2000 on the relationship between immigration and U.S. healthcare expenditures found per capita total health spending for immigrants was $1,139 compared to $2,546 among U.S.-born individuals.

The study found immigrants' expenditures were one-half to two-thirds that of U.S.-born individuals, even when citizens were insured.

The results were even more stark among undocumented immigrants, who were found to have lower expenditures compared to both naturalized immigrants and U.S.-born citizens and contributed a greater amount to Medicare's trust fund than they withdrew. The Medicare trust fund is financed through a combination of payroll taxes, general tax revenue and premium payments.

As a group, immigrants consume roughly 8.6% of all healthcare expenditures despite making up 12% of the total populations, according to the study. By comparison, U.S.-born individuals account for 90% of the population and are responsible for 93% of the country's healthcare expenses.

Undocumented residents accounted for 1.4% of total U.S. medical expenditures despite making up 5% of the population, responsible for $96.5 billion of healthcare spending from 2000 to 2009 compared with $1 trillion spent on U.S.-born individuals during the same period.

Latino immigrants are 20% less likely to have health insurance than U.S.-born individuals, which could result in immigrants rejecting or delaying medical care for fear of paying out of pocket. But the study found insured immigrants also accounted for fewer expenditures, accounting for 52% lower costs than insured U.S.-born individuals while uninsured immigrants had 61% lower medical expenditures than uninsured U.S.-born individuals.

Study co-author Dr. J. Wesley Boyd, an associate professor of psychiatry in Harvard Medical School's Center for Bioethics, said the lower expenditures among insured immigrants seems to indicate that that population makes up a low-risk insurance pool that helps subsidize more frequent healthcare users.

"On average immigrants tend to be younger and healthier than native-born Americans and therefore when they do have health insurance they're contributing more into insurance pools than they're taking out," Boyd said.

Boyd lamented that false preconceptions have informed many substantial policies.

In 1996, the Personal Responsibility and Work Opportunity Reconciliation Act banned undocumented immigrants from gaining access to Medicaid, Medicare and the Children's Health Insurance Program and kept those restrictions in place five years after obtaining legal status.

Even provisions within the Affordable Care Act, as part of a political compromise, kept the exclusions on immigrants, prohibiting those who had lived in the U.S. legally for less than five years from purchasing qualified health plans under the health insurance marketplace and denied undocumented immigrants access to either health insurance or Medicaid.

"I think the assumption behind that was they haven't been here long enough and therefore don't deserve any government help," Boyd said.

Anti-immigrant sentiments have ramped up during the Trump administration and anecdotally providers have said they've seen immigrants express concern over how seeking medical care would jeopardize their resident status.

In May, the White House announced a proposal that would prevent a legal immigrant with a temporary visa awaiting permanent residency from getting a green card if they used a form of government assistance, including SNAP, tax credits, an Obamacare health plan or Medicaid.

Boyd said the study's findings show denying immigrants access to healthcare can harm the industry.

"Politicians are shooting themselves in the foot fiscally if they are trying to be tough on immigration and restrict the ability of immigrants either to come into the country in general or to receive access to healthcare in particular," Boyd said. "The more immigrants we have in the insurance pool the better our country is going to do from a fiscal perspective and I would say from a moral perspective as well."