As I live in southern Arizona, I expect immigrants, especially illegal immigrants, to be the scapegoat for the problem de jour. The county hospital is running a deficit for the 15^th consecutive year? It’s the illegals. But it doesn’t stop there – state and city government mismanagement, educational system woes, the housing market collapse, even global warming – all are somehow caused by illegal immigrants. “Blame Mexico” may not be admirable root cause analysis, but it’s a surefire way to identify a redneck. Now a new Health Affairs report has debunked a nationwide craze of immigrant scapegoating.

We’ve all heard about the burden immigrants are placing on our nation’s healthcare costs. That’s why illegal immigrants have been excluded from healthcare legislation (no, Obama wasn’t lying when he said that, Joe Wilson.) They already run up our healthcare tab, so why should we subsidize them so they can obtain yet more services? Reform, if it happens, will be expensive enough. Forget the positive public health aspects of true universal healthcare; we just can’t afford to cover outsiders.  Hmmm.

Health Affairs turns the tables on that thinking, finding that we can easily afford to cover immigrants. It’s the natives who are driving healthcare costs into the stratosphere. In a study of 1999-2006 healthcare expenditures for adult naturalized citizens and non-citizen immigrants (including “illegals”), the Health Affairs team found that non-natives are infrequent healthcare users, making them potentially inexpensive to cover. That’s despite their numbers exploding by 8.5 million over the 7-year period.

It turns out we do a pretty good job of terrorizing illegal immigrants, making them highly averse to seeking care. Yes, if they do receive healthcare services, providers will likely be uncompensated – that’s what happens when you force low-income folks to go to the ER.  But overall, per capita spending on noncitizens is 50% less than that for citizens. In fact, 50% of noncitizens had annual per capita expenses of $200 or less during the study period. That’s less than the cost of a single asthma inhaler.

Unsurprisingly, costs for naturalized citizens are growing (think the “Medicare Effect” for those newly eligible for coverage), while costs for noncitizens are shrinking. These findings are in line with 1996 legislation, the Personal Responsibility and Work Opportunity Reconciliation Act (sounds very Republican, doesn’t it?), barring new immigrants from Medicaid eligibility until they attain 5 years of US residency. We should know by now that delaying access to care increases the overall cost of care.

The take-home message is clear: “ … the balance of the evidence appears to suggest that providing health care to immigrants costs significantly less than providing it to the native-born.” Moreover, illegal immigrants pay into Medicare and Social Security programs that they cannot draw from. They are a boon to US social services. So help a redneck out; next time one tells you “it’s the illegals”, tell him to look in the mirror instead.

Photo Credit: Health Affairs, Trends In Health Care Spending For Immigrants In The United States

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