Health Affairs: U.S. natives may accumulate more healthcare expenses than immigrants

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Prompted by recent healthcare and immigration reform debates, an investigation of healthcare spending from 1999 to 2006 found that the cost of providing healthcare to immigrants is lower than the cost of providing care to U.S. natives and that immigrants are not contributing disproportionately to high healthcare costs in public programs, including Medicaid, according to a study published online Feb. 11 in Health Affairs.

The Current Population Surveys also revealed that noncitizen immigrants were considered to be more likely than U.S. natives to have a healthcare visit classified as uncompensated and charity care, wrote Jim Stimpson, PhD, assistant professor of social and behavioral sciences at the University of North Texas Health Science Center in Fort Worth, and colleagues.

“The debate about health reform throughout 2009 ignored how the immigrant population and particularly noncitizens, would be treated under a new system,” wrote the authors. “The Personal Responsibility and Work Opportunity Reconciliation Act blocked immigrants’ access to much public health insurance coverage, which we suspect is partly responsible for the high level of uncompensated and charity care being provided to noncitizens. The noncitizen and recent immigrant populations have been given few options to obtain high-quality, affordable healthcare."

The researchers utilized data between 1999 and 2006 from the publicly available Medical Expenditure Panel Surveys (MEPS) for their study, and information on nativity and legal status of the individuals was determined by the MEPS. The respondents were classified as people born in the U.S., naturalized citizens and noncitizen immigrants. The included data set consisted of 196,670 U.S. natives, 13,958 naturalized citizens and 21,761 noncitizen immigrants from 1999 through 2006.

According to the research, nearly 12 percent of people in the U.S. are immigrants and of these, 47 percent are naturalized citizens and 53 percent are noncitizens. While healthcare expenditures increased for all groups between 1999 and 2006, expenditures for noncitizens were about 50 percent smaller on average than those for U.S. natives. In addition, total per capita healthcare spending for noncitizens was $1,904, compared to $3,723 for U.S. natives.

The researchers also noted a negligible difference between U.S. natives and noncitizens in uncompensated care, with a range of 2 to 4 percent.

Moreover, the authors wrote that although public spending for U.S. natives was found to be slightly higher than spending for immigrants in every year of the study period, this may the result of noncitizens’ being less likely than citizens to be covered under public insurance programs.

“If covered under public insurance, immigrants may have disproportionately high public health spending,” said the authors.

The researchers noted several limitations of their study, including not being able to separately classify legal residents and undocumented or unauthorized immigrants. Another constraint was that state of residence should be accounted for, as some states have different policies and approaches toward covering immigrants’ health expenditures.

“Careful study will still be needed to estimate how changes in national immigration policy will affect public healthcare programs,” concluded Stimpson and colleagues, who added that future federal and state health insurance initiatives should consider this research during healthcare and immigration reform debates.