The Bell Policy Center continues to deliver the facts behind the rhetoric on immigration issues.

In this piece, Bell Senior Policy Analyst Robin Baker, Ph.D., debunks the claim that immigrants, legal or otherwise, cost a bundle for subsidized health care.

Look for more information on immigration at the Bell's website:
www.thebell.org > Immigration

By Robin Baker

Immigrants are not the reason why health care costs so much today.

Yet Defend Colorado Now, a group opposing illegal immigration, plans to ask Colorado voters to approve a constitutional amendment to prevent these immigrants from receiving state and local government services.

The group argues, among other things, that health care costs for these immigrants come at the expense of U.S. citizens. While the rhetoric is hot, it is not accurate.

In fact, immigrants -- legal and undocumented -- use less subsidized health care than U.S. citizens, and the only subsidized health care available to undocumented immigrants is emergency treatment.

Immigrants are not driving up the costs of health care.
It's the growing number of uninsured citizens relying on emergency medical and charity care.

Legal immigrants use less subsidized care

To understand how much immigrants tap the U.S. health care system, a team of six university-based doctors analyzed a national survey of 21,000 people, including 2,800 immigrants. They found the immigrants received an annual per capita average of $1,139 worth of care, less than half the $2,564 in care for the U.S. citizens.
The doctors published their study results in the August 2005 issue of the American Journal of Public Health.

A separate study by the Center on Budget and Policy Priorities found that only 13 percent of qualified immigrant parents used Medicaid in 2001, compared to 22 percent of U.S. citizen parents.

Likewise, only 24 percent of qualified immigrant children used Medicaid compared to 47 percent of citizen children.
Legal immigrants who arrived after Aug. 22, 1996, are not eligible for Medicaid insurance for five years. After the five-year limit, their sponsor's income and assets are used to determine Medicaid eligibility.

Illegal immigrants: emergencies only

Undocumented immigrants are not, and never have been eligible for Medicaid insurance.
The only exception -- emergency medical care for a life-threatening injury or illness -- is mandated by the federal government. This only covers treatment to stabilize the patient. That means no follow-up, no rehabilitation and no drug treatment. A U.S. citizen in a similar situation would qualify for full Medicaid insurance benefits.

The U.S.-born children of undocumented immigrants may qualify for a wider array of Medicaid health care under strict family eligibility limits, but only the child's health care is covered.

Uninsured citizens a bigger burden

Because undocumented immigrants are only eligible for emergency medical care, their per-capita hospital costs are higher, but overall medical service costs are lower.

For hospitals, the real problem is the increasing numbers of uninsured patients seeking care combined with decreasing reimbursement for Medicaid patients.

The Government Accountability Office (GAO) noted in a 2004 report that hospitals don't usually ask patients their immigration status, so the extent of care for undocumented immigrants is unknown. The GAO estimates that more undocumented immigrants are seeking care, but these patients still represent a small share of total charity care.

The Kaiser Commission on Medicaid and the Uninsured notes that 19 percent of working-age U.S. citizens were uninsured in 2004.
Kaiser also found 40 to 50 percent of immigrants not naturalized are uninsured. But because they are just 8 percent of the U.S. population, they had little effect on the growth in uninsured people.

The U.S. Census Bureau estimated that in 2003, 88 percent of the U.S. residents were native born, 5 percent were foreign-born immigrants who became U.S. citizens, and 8 percent were documented or undocumented immigrants.

The proposed constitutional amendment to prohibit services for undocumented immigrants will not save the state money or reduce health care costs.

Colorado does not pay for non-emergency health services for immigrants. And because the federal government mandates emergency medical care, it is exempted under the proposed amendment.

The real problem with health care costs, which the proposal fails to solve, is that more and more people -- native or foreign born -- can't afford health care.

The proposed amendment relies on fear tactics and false assumptions. It certainly won't fix the U.S. health care crisis, but it blames hard-working immigrants who can't defend themselves against unfair charges and bad information.


Robin Baker, Ph.D., is a senior analyst for Bell Policy Center, a nonpartisan progressive think tank working on social public policy issues in Colorado. Contact her at baker@thebell.org.