Immigrant adults are a diverse group of people who make up 16% of the U.S. adult population and play a significant role in the nation's workforce and communities. In the run-up to the 2024 election, anti-immigrant rhetoric has intensified and immigration has become a major talking point for candidates. Trump's campaign has repeatedly called immigrants a source of crime, a burden on taxpayers, and a drain on government programs like Medicare and Social Security. Harris' campaign has also focused on immigration, emphasizing her tough stance on crime as a former attorney general of a border state, as well as her family's immigrant roots. Some states have also taken restrictive measures against immigrants, including requiring hospitals to collect information on patients' immigration status.
Against the backdrop of this rhetoric and recent state actions, data on immigrants' health care utilization and costs, as well as their contributions to the economy and labor force, including in the health care sector, can be informative. This brief presents key data on these topics based on analysis of a range of data sources, including the Survey of Immigrants, the largest nationally representative survey of immigrants to date, and other studies.
Immigrants are no more likely than U.S. natives to report using public assistance for food, housing, or health care, and undocumented immigrants remain ineligible for federally funded assistance.
The Immigrant Survey 2023 shows that despite lower household incomes and financial hardship, adult immigrants are no more likely than U.S. natives to say that they or someone living with them received public assistance for food, housing or health care in the past year. Overall, about one-quarter (28%) of immigrant adults and U.S. citizens say they received such assistance in the past 12 months (Figure 1).
Lawfully present immigrants face restrictions on their eligibility for federal programs, including Medicaid and the Children's Health Insurance Program (CHIP). In general, to be eligible for Medicaid or CHIP, lawfully present immigrants must have "qualified status," and many of them, including most lawful permanent residents or green card holders, must wait five years after obtaining qualified status before they can enroll in the program, even if they meet other requirements. Some lawfully present immigrants, such as refugees and asylum seekers, are exempt from the five-year waiting period. States can also expand coverage to lawfully residing immigrants who are pregnant and have children without the five-year waiting period. Lawfully residing immigrants can purchase insurance on the Affordable Care Act (ACA) marketplace and receive tax credits to offset the cost of that insurance without the five-year waiting period. Lawfully residing immigrants can also qualify for Medicare, but they must have a sufficient work history to qualify. If they do not have such a work history, they can purchase Medicare Part A after five years of continuous legal residence in the United States.
Undocumented immigrants are not eligible for federally funded programs, including Medicaid, CHIP, or Medicare, or to purchase coverage under the ACA Marketplaces program. Medicaid payments for emergency services may be made to hospitals or other providers on behalf of individuals who would otherwise be eligible for Medicaid if not for their immigration status. Emergency conditions include those that put a person's health in serious jeopardy or cause serious bodily impairment or dysfunction, although states have the discretion to determine which services are eligible for reimbursement under the Emergency Medicaid program.
Some states have established fully publicly funded programs that provide insurance coverage to immigrants regardless of immigration status, although they vary in eligibility and the scope of benefits provided. Research shows that expanding health insurance coverage for immigrants can reduce uninsurance, increase health care utilization, lower costs, and improve health outcomes.
Immigrants, especially those who are undocumented, use fewer health care services, including emergency care, than people born in the United States.
Overall, studies show that immigrants, including legal and undocumented immigrants, use fewer health care services than U.S. citizens. Moreover, the Immigrant Survey shows that among adult immigrants, likely undocumented immigrants are less likely than legal immigrants and naturalized citizens to report seeking or receiving health care in the U.S. or having visited a health care facility in the past year. About six in ten (63%) likely undocumented adult immigrants report visiting a health care facility in the past year, compared to 74% of legal immigrant adults and 82% of naturalized citizen adults.
The lower rates of seeking health care among immigrants are likely due to the fact that they are younger and healthier than their U.S.-born peers, and because they face increased barriers to care, including language access issues, confusion, and immigration-related fears. Previous analysis found that Trump-era policies have heightened these fears and contributed to a greater reluctance to seek health care.
Immigrants have lower health care costs than U.S. natives.
Reflecting lower levels of health care consumption, immigrants incur lower health care costs than their U.S.-born compatriots. Analysis of 2021 medical expenditure data shows that, on average, annual per capita health care expenditures for immigrants are about two-thirds of those for U.S. citizens ($4,875 vs. $7,277) (Figure 3). This reflects lower spending on most types of health care, including office visits, prescription drugs, inpatient care, outpatient care, and dental care. These findings are consistent with other studies that show that total health care costs for immigrants are between one-half and two-thirds that of U.S. natives, regardless of status, and that per capita spending from private and public insurance sources is lower for immigrants, especially undocumented immigrants. For example, one study found that undocumented immigrants are more likely to be uninsured and incur significantly lower health care costs per year than U.S. natives, and that despite differences in the likelihood of being uninsured, there are no significant differences in rates of uncompensated care between undocumented and native-born immigrants.
Immigrants contribute to the economy through their role in the labor force and tax contributions. Studies show that they help subsidize health care for U.S.-born people and stabilize Medicare and Social Security.
Immigrants support the nation's workforce by filling unmet labor market needs, and studies show that they do not take jobs away from native-born workers. They play a disproportionate role in filling jobs in important industries such as construction and agriculture, which are at increased risk of adverse health effects and injuries, including those related to climate factors. In addition, immigrants, as well as adult children of immigrants, play a huge role in the health care industry as physicians, surgeons, nurses, and long-term care workers (Figure 4). As the shortage of health care workers is projected to continue and the U.S. population aged 65 and older grows, immigrants can help alleviate this shortage.
Analysis shows that illegal immigrants contribute billions in federal, state and local taxes each year. It is estimated that more than a third of their taxes are payroll taxes that fund programs that are unaffordable to them, including Social Security, Medicare and the federal share of unemployment insurance. The study also found that immigrants pay more taxes and health insurance premiums into the health care system than they use, helping to subsidize health care for U.S.-born U.S. citizens. Earlier studies have shown that without the contributions illegal immigrants make to the Medicare Trust Fund, it would have reached insolvency sooner, and that illegal immigrants have a net positive impact on Social Security's financial position.