Health Affairs On Health Care Unauthorized Immigrants Spend Less Than Other Immigrants And US Natives

Unauthorized immigrants and other immigrants who have been in the United States for less than five years have few options for accessing health care through public programs. In light of the ongoing national debate about immigration reform and the impact of the Affordable Care Act on immigrants, we examined differences in health care spending by nativity and legal status using Medical Expenditure Panel Survey data for the period 2000–09. We found that unauthorized, legal, and naturalized immigrants together accounted for $96.5 billion in average annual health care spending, compared to slightly more than $1 trillion for US natives. Unauthorized immigrants’ share of health care spending was $15.4 billion—the smallest of the groups. Just 7.9 percent of unauthorized immigrants benefited from public-sector health care expenditures (receiving an average of $140 per person per year), compared to 30.1 percent of US natives (who received an average of $1,385). Policy solutions could include extending coverage to unauthorized immigrants for the prevention and treatment of infectious diseases or granting them access to the Affordable Care Act’s insurance marketplaces, which start in 2014. The final version of federal immigration reform might also include strategies to expand immigrants’ access to health care. I mmigration has been a controversial subject of public discourse and policy efforts in the United States for decades, as both citizens and policy makers debate whether or not immigrants are responsible for lost jobs, lower wages, overcrowded emergency departments (EDs), and economic decline in the United States. Today unauthorized immigrants andpeoplewho immigrated less than five years ago have few options for accessing health care through public programs, leaving those immigrants the choice between paying for care out of pocket or securing private insurance. The safety net available to immigrants consists largely of hospital EDs and federally qualified health centers. Such limited access to highquality health care and to medical homes is not optimal, and it has merely shifted the financial burden of paying for the care of immigrants from publicly funded programs to private health insurance plans. The question of immigrants’ use of health services has been addressed by a group of recent studies, all of which have concluded that health care use and spending are lower among immigrants than among people born in the United States. One recent report compared differences in access to care by nativity and legal status and found that the percentage of unauthorized immigrants who lack health insurance has been growing over the past few years, and that there doi: 10.1377/hlthaff.2013.0113