Verified by 
by Lila Flavin, BA and J. Wesley Boyd, MD, PhD
Martin had classic symptoms of untreated hypothyroidism: he spoke slowly, his puffy cheeks weighed down his smile, and he was shivering as he lay on the gurney in the stuffy emergency department room, his wife continually pulling the blanket up around him. Martin is an undocumented immigrant from Central America, and some health care policy debates in the past few years have blamed immigrants like Martin for driving up health care costs.
Indeed, fifty-two percent of the American public believe that immigrants are responsible for excessive health care costs (Pew Research Center for the People & the Press). And presumably to avoid subsidizing health care for those thought to be undeserving, the Affordable Care Act passed in 2010 denied insurance to immigrants unless they’d been in the US five years, while it increased insurance coverage for most other Americans.
But does limiting health care to immigrants really help with costs? In a paper we have just published in the International Journal of Health Services, we systematically reviewed all papers published after the year 2000 related to medical expenditures by immigrant populations. Overwhelmingly, each study came to the same conclusion: immigrants spend one-half to two-thirds as much as US born individuals. US-born individuals make up 90 percent of the population and 93 percent of health expenditures, whereas immigrants make up 12 percent of the population and only 8.6 percent of medical expenditures. And despite the fact that 5 percent of our population is comprised of undocumented immigrants, they make up only 1.4 percent of total expenditures.
Some may say that it is precisely because immigrants are uninsured that they spend less. But that’s not true either. Expenditures for insured immigrants are still 52 percent lower than those of insured US born individuals. Immigrants tend to be younger and healthier when they arrive to the United States, and because of this constitute a low-risk pool that subsidizes the insurance market for US-born individuals. Most surprising of all, two studies by Zallman and colleagues found that immigrants paid more to the Medicare Trust Fund than they withdraw and generated a yearly surplus of $11-$17 billion to Medicare (of which $2-$3 billion were contributed by undocumented immigrants) from 2002 to 2009 and thereby extended the life of Medicare.
Martin was diagnosed with hypothyroidism five years ago, for which he took a medication called Levothyroxine. After he lost his insurance two years ago, he didn’t go to a doctor or refill his prescription which would have cost him $16 a month out of pocket. When the symptoms became too much to bare, he waited another week until his heart rate became dangerously low and almost killed him.
Other than his thyroid condition, Martin was healthy—and if he had kept his insurance he almost certainly would have been using less of his insurance than he was paying for, just like most immigrants.
As medical personnel, we are appalled that individuals are denied insurance coverage at all, but especially when the reasons they are denied insurance are simply false.
Immigrants like Martin, regardless of their immigration status or insurance status, spend half or less of what Americans do on healthcare, and generally subsidize the public and private insurance system for US born individuals. Instead of blaming people like Martin for rising healthcare costs, we ought to ensure access to healthcare and provide them with insurance.
Lila Flavin, BA, is a graduate of Princeton University and is a 4th year medical student at Tufts Medical School whose clinical and research interests include immigrant and LGBTQ healthcare.
