Assessment of Immigrants’ Premium and Tax Payments for Health Care and the Costs of Their Care

Abstract

ImportanceSome worry that immigrants burden the US economy and particularly the health care system. However, no analyses to date have assessed whether immigrants’ payments for premiums and taxes that fund health care programs exceed third-party payers’ expenditures on their behalf.ObjectiveTo assess immigrants’ net financial contributions to US health care programs.Design, Setting, and ParticipantsThis cross-sectional analysis used 2017 data from the Medical Expenditure Panel Survey (MEPS) and the Current Population Survey (CPS) and 2014 to 2018 data from the American Community Survey. The main analyses used data from the calendar year 2017. Data from the calendar years 2012 to 2016 were also reported. Data were analyzed from June 15, 2020, to August 14, 2022. Participants comprised 210 669 community-dwelling respondents to the MEPS and CPS (main analysis) and nursing home residents who were included in the American Community Survey (additional analysis).ExposuresCitizenship and immigration status.Main Outcomes and MeasuresTotal and per capita payments for premiums and taxes that fund health care as well as third-party payers’ expenditures for health care in 2018 US dollars.ResultsAmong 210 669 participants, 51.0% were female, 18.3% were Hispanic, 12.3% were non-Hispanic Black, 60.3% were non-Hispanic White, and 9.2% were of other races and/or ethnicities. A total of 180 084 participants were respondents to the 2018 CPS, and 30 585 were respondents to the 2017 MEPS. Among the 180 084 CPS respondents, immigrants accounted for 14.1% (weighted to be nationally representative), with the subgroup of citizen immigrants accounting for 6.8%, documented noncitizen immigrants accounting for 3.7%, and undocumented immigrants accounting for 3.6%; US-born citizens constituted 85.9% of the population. Relative to US-born citizens, immigrants were more often age 18 to 64 years (79.6% vs 58.3%), of Hispanic ethnicity (45.0% vs 14.0%), and uninsured (16.8% vs 7.4%); similar percentages (51.4% vs 50.9%) were female. US-born citizens vs immigrants paid similar amounts in premiums and taxes ($6269 per capita [95% CI, $6185-$6353 per capita] vs $6345 per capita [95% CI, $6220-$6470 per capita]). However, third-party expenditures for immigrants’ health care ($5061 per capita; 95% CI, $4673-$5448 per capita) were lower than their expenditures for the care of US-born citizens ($6511 per capita; 95% CI, $6275-$6747 per capita). Immigrants, in general, paid significantly more per person (net contribution, $1284; 95% CI, $876-$1691) than was paid on their behalf. Most of this surplus was accounted for by undocumented immigrants, whose contributions exceeded their expenditures by $4418 per person (95% CI, $4047-$4789 per person). US-born citizens collectively paid $67.2 billion (95% CI, −$2.3 to $136.3 billion) less in premiums and taxes than third-party payers paid for their care. This deficit was mostly offset by the $58.3 billion (95% CI, $39.8-$76.8 billion) net surplus of payments from immigrants, 89% of which ($51.9 billion; 95% CI, $47.5-$56.3 billion) was attributable to undocumented immigrants.Conclusions and RelevanceIn this study, immigrants appeared to subsidize the health care of other US residents, suggesting that concerns that immigrants deplete health care resources may be unfounded.

DACA, public health, and immigrant restrictions on healthcare in the United States

“…Researchers have shown that in both private and public insurance schemes, immigrants often contribute more through taxes and premiums than they receive in benefits. 24 , 25 , 26 Although the composition of eligible immigrants differs by state, evidence from emergency Medicaid in California—the state with the greatest number of immigrants in the country—has shown that the cost of emergency services for undocumented immigrants is lower compared to U.S. citizens and other immigrant groups. 27…”

Economic Impact of a Change in Medicaid Coverage Policy for Dialysis Care of Undocumented Immigrants

“…With this health care policy change, undocumented immigrants are able to work and contribute a tax surplus to the US financing system, helping to subsize the health care of US residents. 10 The health care policy change in Colorado reimbursing outpatient dialysis centers at Medicaid rates took effect on February 1, 2019. Data from the Colorado Department of Health Care Policy and Financing show that the annual Emergency Medicaid Service (EMS) dialysis expenditures for all undocumented immigrants with kidney failure undergoing emergency-only hemodialysis in 2017 and 2018 (n581 and n578 per month, respectively) was almost $20,000,000, with an average monthly EMS dialysis patient expenditure of $20,000 (Figure 1).…”

“…With this health care policy change, undocumented immigrants are able to work and contribute a tax surplus to the US financing system, helping to subsize the health care of US residents. 10…”

Who Pays for Immigrants’ Health Care in the US?

“…Ommerborn et al 1 provide empirically based data that may contribute to public debates about the role of immigrants in US society and public health policy.…”

“…Surveys generally do not ask all of the necessary questions about immigration status, in part because asking these questions could cause respondents to incriminate themselves, posing legal and ethical challenges, and because asking detailed questions likely jeopardizes response rates from some populations. Thus, Ommerborn et al, 1 like other researchers, impute legal status based on responses to other questions. However, the imputation process may be biased and weaken the estimates.…”