Do Immigrants Drain the U.S. Health-Care System?

THE QUESTION
When Lila Flavin, M19, “started hearing [political] rhetoric that immigrants, particularly undocumented immigrants, are a burden to our health-care system,” she “wanted to look at the data and see if there was any truth to it.”

THE RESEARCH
Flavin, who worked as a Spanish translator at an outpatient clinic when she was an undergraduate at Princeton University, collaborated with colleagues at Harvard Medical School and Cambridge Health Alliance to review 188 studies that used data from the Medical Expenditure Panel Survey (MEPS), which surveys individuals, their providers, and employers across the U.S. The study, with Flavin as first author, focused on the sixteen most relevant studies and was recently published in the International Journal of Health Services.

THE RESULTS
“We found that immigrants have medical expenditures that are half that of United States-born individuals. Undocumented immigrants spend a disproportionately small amount of total health-care dollars in this country—they account for 5 percent of the population but only 1.4 percent of total health-care spending,” Flavin said. Why? The researchers hypothesize it’s because new immigrants are often younger and healthier than the general U.S. population, language barriers or lack of insurance can prevent access to care, and they fear deportation. But the end result is a benefit to existing citizens. “Perhaps most surprisingly,” Flavin said, “immigrants pay in more than they withdraw, generating an annual surplus of $11 billion to $17 billion to the Medicare Health Insurance Fund.”

THE NEXT STEPS
None of the MEPS data included the years after the Affordable Care Act was put in place, so the numbers may be different now. In the future, it will be important to study how the ACA has influenced expenditures among immigrants and U.S.-born individuals, Flavin said.

This article originally appeared in the Winter 2019 edition of Tufts Medicine.