Our Healthcare System Couldn't Survive Without Immigrants

A new paper out Monday in the journal Health Affairs shows that immigrants pay more in health insurance premiums than their insurers spend on their healthcare, whereas the opposite is true for native-born Americans. Immigrants are, in effect, subsidizing American healthcare.

The paper, a full copy of which was shared with Splinter, found immigrants “made large net contributions” to their health insurance “in every year in the period 2008–14, with little change over time.” Immigrants also “paid $24.7 billion more in premiums than insurers paid for immigrants’ care.” Their premium payments were an average of $1,123 more than their insurers’ expenditures—meaning they paid over a thousand dollars more than they actually received in care. Undocumented immigrants had an even higher per person gap between premiums and expenditures. Native-born Americans, meanwhile, had a net deficit of $163 per person. For working-age populations only, immigrants’ net subsidies were $1,640 per person higher than for native-born Americans.

Both recent and well-established (which the study defines as immigrants who’ve lived in the country for more than 10 years) immigrants provided net subsidies. Recent immigrants’ subsidies were about twice as high as among established immigrants, but “because premium contributions also increased with time in the U.S., immigrants made a net contribution to private health insurance regardless of their length of residence in the US.”

The study’s authors wrote that the difference is mostly due to immigrants having lower costs of care, partly because they’re generally younger and healthier, but also because of a “reluctance to seek care.” The authors also point to a difficulty accessing healthcare for some immigrants due to language barriers, and noted that interpreters are not covered by insurance or Medicare. Undocumented immigrants are also prevented from purchasing healthcare on the Affordable Care Act exchanges, which this study did not cover.

The study’s authors argue that policies that further curtail immigration to the U.S. would likely “worsen the private insurance risk pool”—that is, if the insured population is sicker or using more care, the cost of premiums would go up.

Last month, a report in the International Journal of Health Services reviewing previous studies showed that immigrants contributed more to Medicare than they received in care. Immigrants are required to pay taxes, including Medicare and Social Security taxes—even those on non-immigrant visas. Similarly, undocumented immigrants pay into a system they can’t use, and even immigrants who enter the country with the proper documentation can’t draw on these programs for the first five years after they enter the country. A 2013 study showed that immigrants contributed “$115 billion more to the Medicare program than they drew out” between 2002 and 2009.

Though more evidence is hardly needed, this is another example of the dangers and stupidity of the Trump administration’s proposed “public charge” rules for green card applicants. The idea that immigrants are coming here to leech off America’s generous benefits is wrong in every way—that isn’t why people come here, they pay more into the system than they receive, and our benefits are shit and hard to access anyway. No one is crossing the border to get that sweet Medicaid. In fact, our health insurance system might not work at all without immigrants.