The myth that will not die: Health care for immigrants

You can depend on it. Whenever we write an article or a blog about the woes of the U.S. health care system, at least one person writes back to complain about how illegal immigrants get free health care.

Some recent examples:

One of the biggest costs in Healthcare is not even mentioned in Obama's plan.....Illegal Aliens get free healthcare!!

It just boggles my mind that we take care of ILLEGALS and their families and the unemployed but offer no assistance to a hard-working, tax-paying AMERICAN CITIZEN.

And an anti-reform chain email that's circulating in various versions on the Internet ups the ante by claiming that the House health care bill* says that "HC will be provided to all non-US citizens, illegal or otherwise, will be provided with health care services."

To get this latter assertion out of the way first, it's a fiction. The bill specifically says that that undocumented aliens aren't eligible for subsidized health insurance. See for yourself:

It's unclear where the larger urban myth of "free health care for illegals" originated, but it's not true either.

"No matter what studies show or the clear language of the eligibility rules, the myth that immigrants get free care persists," says Sonal Ambegaokar, health policy attorney at the National Immigration Law Center, a non-profit group in Los Angeles.

Here are the facts about this combustible subject:

Illegal immigrants are not eligible for any of the major government-run health programs, including Medicare, Medicaid, or CHIP. Period. Legal immigrants have to be in the U.S. lawfully for five years to sign up for these programs and have to meet the same eligibility standards as anyone else. The 2009 revision of the Children's Health Insurance Program gives states the option of removing the five-year waiting period for children and pregnant women; everybody else still has to wait. It's not yet known how many states will sign on for this.

The lone federal program that occasionally covers a limited amount of health care for immigrants is an obscure one called Emergency Medicaid. Here's how it works: if an immigrant, whether here legally or not, shows up at an emergency room with a true medical emergency, Emergency Medicaid will pay to treat it. But there are several catches. Immigrants have to meet the same Medicaid eligibility standards as citizens, meaning that if they're single or childless adults, in the vast majority of states they're completely out of luck because people in those categories rarely qualify for Medicaid. Also, they have to be really poor. Also, Emergency Medicaid doesn't pay for non-emergency or routine care. "If they need a hospital admission or followup care, it wouldn't be covered and they'd be billed for it," explains Ambegaokar.

Not even the U.S. Government Accountability Office, the authoritative watchdog of government spending, has been able to figure out how much Emergency Medicaid money is spent nationwide on illegal immigrants as opposed to legal ones, as it acknowledged in a 2004 report. The proper records just don't exist.

But in 2007, researchers from the University of North Carolina School of Medicine published a detailed study of Emergency Medicaid in their state. It turned out that 99 percent of benefits went to undocumented immigrants—but the entire program added up to less than 1 percent of the state's total Medicaid budget that year. The vast majority of the spending was for pregnancy complications and delivering babies.

The best estimate we could find of national spending on illegal immigrants came from an article in the November-December, 2006 edition of Health Affairs. (The full article requires a subscription but a good summary is here). The authors concentrated on Los Angeles County, where, by luck, a huge local survey had produced some hard-to-get information on the immigration status and health care use of adults aged 18-64. (As you can imagine, illegal immigrants don't like to answer questions.)

While illegal immigrants were 12 percent of LA's working-age population, they only accounted for 6 percent of health care spending. And taxpayers footed a lower percentage of their medical bills than they did the bills of native-born citizens. Extrapolating the LA results to the United States, the researchers calculated illegal immigrants accounted for about $1.1 billion in public health spending nationwide in 2000, the year studied. That was about 0.08 % of national health spending that year. Meanwhile, illegal immigrants using fake Social Security numbers are paying many times that sum every year into the Social Security and Medicare funds towards benefits they will never collect.

Oh, and one more thing. Without immigrants, we would be hard-pressed to have a functioning health-care system at all. A 2004 report from the Immigration Policy Center found that immigrants made up:

• 25% of physicians
• 12% of registered nurses
• 15% of pharmacists
• 14% of dentists
• 17% of nursing, psychiatric, and home health aides
• 16% of clinical lab technicians

If you want to learn more about this subject, here are some trustworthy resources:

• The Kaiser Family Foundation
• National Immigration Law Center

Finally, a blog recently posted on Maggie Mahar's Health Beat recently made the case that if the United States were less punitive and more generous about health care for immigrants, both legal and illegal, we would all be better off. Read it here.

—Nancy Metcalf, Senior Program Editor

*links to PDF