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(DV) Skala: Rethinking Immigrants' Health Crisis







Rethinking Immigrants’ Health Costs
by Nicholas Skala
August 6, 2005

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In the mixed-up America we live in, where skyrocketing insurance premiums leave 45 million uninsured, half of all personal bankruptcies come in the wake of an illness or medical bill, and 96 percent of millionaires report being worried about health costs; friends of the status quo have had a tough time coming up with reasons we should avoid fundamental reform of our health system. As one popular argument -- that American health care is just a little “market competition” away from perfection -- has all but withered entirely, we’ve seen the resurgence of a golden oldie: blaming immigrants for our high health costs. The Bush campaign predicated a comeback tour for this timeless classic, and recent history has seen politicians and policy groups in New York, California, Texas, Arizona and Florida dust off complaints about immigrants squeezing their state budgets by lavishing themselves with “unlimited free health care.”

But with the publication of a groundbreaking study last week, researchers at Harvard and Columbia Universities have finally laid this debate to rest. Published in the August issue of the American Journal of Public Health, a distinguished team led by Dr. Sarita Mohanty found that not only is the assumption that immigrants are using more than their fair share false, in fact the opposite is true: immigrants use less than half as much care as native-born Americans. Their analysis of a representative cross section of the immigrant population (including both legal and undocumented immigrants) found that while they constitute 10.4 percent of the U.S. population, immigrants account for less than 8 percent of total health spending. While per capita spending averaged $2,564 for the native-born population, immigrants averaged only $1,139, and nearly a third of the immigrant population uses no health care at all in a given year. The study effectively turned the conventional thinking on its head.

“Our study dispels the myth that expensive care for immigrants is responsible for our nation’s high health costs,” Mohanty said upon the study’s release on July 25. “The truth is, immigrants get far less care than other Americans.”

But that’s not the end of the surprises. Immigrant families aren’t simply getting nothing in return for contributing nothing. They’re paying for care the same way everybody else does, through taxes and insurance premiums. They’re just not getting much of anything in return. So where are all these immigrant health dollars going? Well, they’re being used to buy health care for the native-born population.

“Our data indicates that many immigrants are actually helping to subsidize care for the rest of us,” said Dr. Steffie Woolhandler, study co-author and co-founder of Physicians for a National Health Program ( “Immigrant families are paying taxes -- including Medicare payroll taxes -- and most pay health insurance premiums, but they’re only getting half as much care as other families.”

And even as they pay for native-born Americans’ doctor visits, immigrants’ children are receiving shockingly low levels of care. Perhaps the study’s most disturbing finding is that immigrant children receive 74 percent less care overall than native-born youngsters, including huge disparities in care received in doctors’ offices and prescription medications. They also had significantly fewer visits to the emergency room. Not surprisingly, when they did visit the ER, their costs were three times higher than native-born kids, suggesting that immigrant children often go without needed primary and preventative care until they find themselves in a life-threatening (and costly) situation.

The study’s authors note early on that the conventional wisdom -- that immigrants place a disproportionate burden on our health care system -- has resulted in a number of misguided policy initiatives that attempt to limit immigrants’ access to health services; and they take care to discourage perusing similar ones. “Further restricting their eligibility for care would save little money and place many immigrants – especially children -- at grave risk,” Mohanty points out.

Similarly, opponents of national health insurance have long used predictions of a health system bankrupted by an influx of immigrants as a means to dissuade potential supporters. But as Dr. Olveen Carrasquillo of Columbia University has pointed out, this study proves that a national health program could not only provide comprehensive benefits to the entire native-born population, it could afford to include immigrants without raising the amount of taxes we already pay for health care, incidentally the highest on the planet.

As Medicare, our nation’s popular and stunningly successful social insurance program, turns 40; progressive legislators should use this new data to establish the viability of a national health insurance system -- “Medicare for all.” Rep. Luis Gutierrez, a cosponsor of the U.S. Medicare for All Act (HR 676), has already seized on the study’s findings to help dispel the myths about immigrant contributions to our health system. As the public debates over our failing health system continue to heat up, let’s hope many of his colleagues will too.

Nicholas Skala is a health policy researcher based in Chicago. He can be reached at:

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