"Everybody Knows" Is Not a Credible Source on Immigrant Health Care

I’m on a “mythbusting bender” of sorts this weekend.  Talk to some people, and they’ll tell you with a straight face that our poor health outcomes as a nation are related to how many immigrants we have.  Immigration, we’re told, is to blame for skyrocketing costs and “over-inflating” the number of uninsured number we usually cite.  Look into the numbers, though, and surprise – this “everybody knows” theory is blown to smithereens.

Look, sometimes clear falsehoods go unchallenged because people like you and me just don’t know enough.  For example, a while back, I compare US health outcomes (good for infrequent but costly interventions, mediocre overall, and terrible for preventable illness) to Canadian health outcomes (pretty good on the costly stuff, very good over all, very good for preventable illness), and a number of commenters jumped on to say you can’t compare Canada and the U.S. because we have more people crossing the border.  The charitable folks meant we were a melting pot.  The uncharitable folks meant Canada is more “monochromatic,” shall we say (those comments were deleted, per the site policy).  Now what I should have done was spend some hours researching this.  I didn’t, and that’s my bad.

Luckily, the American Journal of Public Health did my job for me.  Looking at the health expenditure data for immigrants and comparing it to that for American-born patients, an article printed in the most recent issue found that, “that immigrants’ medical costs averaged about 14% to 20% less than those who were US born.”

Now you might jump to the conclusion that this is because the immigrant population is disproportionately uninsured or might have complications getting insurance because of their status, and that they’re just not showing up at the hospital or doctor’s office.  First, this would make them, basically, a miracle segment of the population.  Your health conditions don’t disappear because you don’t have insurance, and the uninsured generally have higher per-head costs than the insured for the simple fact that if they forgo care, they ultimately have to get much more expensive treatment and interventions later on.  Second, it turns out these lower cost rations are true even when the person is fully insured.  In fact, try this jaw-dropping statistic out for size:  “Approximately 44% of recent immigrants and 63% of established immigrants were fully insured over the 12-month period analyzed.”  That makes them more at-risk – the national average for everybody is 84% with coverage – but a far cry from the “freeloading” caricature of the talking points.  (Keep in mind that this data was collected in 2003 and 2004, when there was still a 5-year waiting period for legal immigrants with “green cards” for Medicaid, SCHIP and other federal health services.  The recent expansion of SCHIP did away with that description.)

So that’s all immigrants, but what about the undocumented?  New England Journal of Medicine has the answers in an article a few years back:  “In a study from the RAND Corporation, researchers estimated that undocumented adult immigrants, who make up about 3.2% of the population, account for only about 1.5% of U.S. medical costs.”  In case it’s not obvious, that means undocumented workers also make up less of our health care costs.  And though there are variances state by state, undocumented workers make up about 20% of the uninsured – meaning that half of those who are in this country to work, even if they don’t have the right paperwork, do have some form of health coverage.

Immigrants as a group have often been America’s scapegoats – and I say this as an Irish-American who 100 years ago would have been told he “need not apply” for jobs.  But we’re going to have to find someone else to pick on for our high-cost, underperforming health care system.  The evidence doesn’t support it.

(Photo credit:  Korean Resource Center on Flickr.)