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Immigrants and health care – who’s paying, who’s getting

Immigrants Contributed An Estimated $115.2 Billion More To The Medicare Trust Fund Than They Took Out In 2002–09 – that’s the headline from a piece in Health Affairs this month.

“immigrants may be disproportionately subsidizing the Medicare Trust Fund, which supports payments to hospitals and institutions…In 2009 immigrants made 14.7 percent of Trust Fund contributions but accounted for only 7.9 percent of its expenditures—a net surplus of $13.8 billion. In contrast, US-born people generated a $30.9 billion deficit…

Most of the surplus from immigrants was contributed by noncitizens [emphasis added] and was a result of the high proportion of working-age taxpayers in this group. Policies that restrict immigration may deplete Medicare’s financial resources.”

When one considers that birth rates among citizens are declining, and thus there will be fewer young working folks to support us aged people, the current anti-immigrant/nativist stance starts to look a little problematic.

Fact is, Medicare and Social Security depend on contributions from working age people; if we drastically restrict immigration and deport all undocumented aliens those two programs will be in dire financial straits much sooner than anticipated.

Conversely, a more “open” policy would go a long way toward reducing the strain on Medicare and SS.

Just saying.

11 thoughts on “Immigrants and health care – who’s paying, who’s getting”

  1. Joe,
    When you say immigrant, are you referring to immigrants here legally or illegally?

    1. Both. However you should read the health Affairs article to get their definition.

  2. Great points, the flip side is what happens when all the non-citizen immigrants start to age, retire and become a bigger net drain on the system?

    And as the strict constructionists (Illegals are illegal) would argue – “Well if we kick out the illegals and non-US born, those jobs will be filled by US born workers and we will still collect the contributions from them, reducing the overall deficit status of US born.” Now we just have to repeal that tricky part 1 of the 14th Amendment.

  3. Good points Joe – that’s what our ex-governor Jeb Bush pointed out in his latest public speech – I think his remarks were received with lukewarm support at best.

  4. So history repeats, rapidly now, as America faces the European dilemma: How to pay for the multitude of promises made by career politicians. See America Alone by Mark Steyn

  5. Brandon I’ve heard that myth before re US citizens would have this huge employment opportunity if only for not the “illegals”. Well a have a sad societal point. Most of the jobs these “illegals” have were obtained because employers couldn’t find enough “citizens” who wanted to do that menial type of work.

  6. you may be right on the programs of SS and Medicare; however, you have not provided a (net) out analysis of the collective burden on federal and state programs. That is the real question: if immigration essentially functions as a cost-shift from federal to state governments, then your point is moot.

    1. Erik – welcome to managed care matters. As a Columbia University student, professor, or employee I’m sure you know Medicaid is a state and federally funded program, therefore a big chunk of that is already accounted for. If you read the citations, you would have seen an in-depth discussion of other cost areas. And, you imply this is a cost-shift, without a shred of evidence to support that assertion.

      One hopes you aren’t a professor.

  7. many thanks for your rude and ad hominum response to a basic comment without animus.

    1) as you know, many illegal immigrants would not be eligible (certainly at first, or in some states even at all) for funding through Medicaid. Thus, there may indeed be a cost-shift at the local level, especially if the care is provided at the hospital level.

    2) As you rightly point out, there is a discussion of other cost drivers- but the point still stands that the net figure is the one of importance, not one simply pointing out the impact on federal reimbursement programs. This is because although the federal government will pass the law, the states will be on the hook to pay for a substantial portion of it.

    One hopes you may treat participants with a basic degree of respect in the future without resorting to ad hominum attacks

    1. Erik – wow, you’re a little sensitive. I guess hoping someone “isn’t a professor” is highly insulting. I thought it was pretty humorous, and certainly not an ad hominem attack.

      My comment was simply a response to your aggressive, ill-informed, and conjectural comment. You commented that “if immigration essentially functions as a cost-shift from federal to state governments, then your point is moot.” without providing any evidence whatsoever to back up that “if/then” statement. That’s a strawman, and a weak one at that, and wouldn’t stand up in any college classroom.

      That just isn’t helpful, and as I’ve said a gazillion times on this blog, if you want to debate, fine, but support your statements with data, citations, sources. If you are new to MCM, I expect readers to provide support for their assertions and not make claims without such support.

      You didn’t. And you still haven’t.

      As noted in the citations in my post, the taxes paid by/due to undocumented workers far outweigh the spending for services; you are correct in that many of those workers don’t have Medicaid, however there’s no evidence they use much in the way of services; therefore there is very likely a net gain.

      Finally, in reference to Medicaid, the Feds are initially paying 100% of the expanded coverage then 90% thereafter. I’d argue that 10% is not a “substantial” portion of Medicaid expansion expense.

      I’ve been writing this blog for almost nine years, and am open to discussion and debate based on facts and solid sourcing. I look forward to the citations supporting your statements.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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