Health care spending by unauthorized immigrants is lower than other immigrants and US natives

Background: Much of the current debate on immigration has centered on whether undocumented immigrants should be granted citizenship or some other form of permanent residency status that could make them eligible for public services—in particular, for health care. The Affordable Care Act of 2010 specifically blocked unauthorized immigrants from participation in the public insurance programs and the private health insurance marketplaces. Given the continuing debate about immigration reform and the impact of health reform on the immigrant population, we set out to compare the differences in medical expenditures by nativity and legal status.

Methods: We use data on sociodemographic characteristics of unauthorized immigrants collected by Passel and Cohn (Pew Hispanic Center, 2009) to estimate health care costs for unauthorized and legal immigrants. Regression imputation was used with pooled data from the Medical Expenditure Panel Survey from 2000-2009 to estimate health care expenditures and utilization for unauthorized immigrants.

Results: Unauthorized immigrants are estimated to have lower healthcare expenditures compared to other immigrants or US natives. Overall, an average unauthorized immigrant will spend $1,150 per year on healthcare compared to $1,915 for legal residents, $3,704 for naturalized citizens, and $3,824 for US natives. 40% of unauthorized immigrants are predicted to have zero healthcare expenses in 12 months compared to just 13% for US natives. Unauthorized immigrants and legal residents are more likely to have uncompensated expenses compared to naturalized citizens and US natives. Healthcare expenditures for unauthorized immigrants are estimated to total $13.7 billion, representing 1.2% of annual US healthcare expenditures and 15% of total expenditures by all immigrants. Expenditures by setting indicated that unauthorized immigrants had lower expenditures for emergency room settings compared to other immigrants and US natives.

Conclusions: Consistent with other studies on immigrants and health expenditures, we found that unauthorized immigrants have lower medical care utilization and expenditures and higher uncompensated care compared to other immigrants and US natives.

Implications: Our finding suggests that national policies that have restricted access to care, particularly public health insurance, since 1996 have contributed to lower expenditures and higher uncompensated care for unauthorized immigrants. Federal immigration reform is the most likely candidate to address poor access for immigrants and high costs of uncompensated care rather than changes to health policy.