Immigrant adults represent a diverse segment of the population, constituting 16% of adults in the United States and significantly contributing to the nation’s workforce and communities. As we approach the 2024 election, anti-immigrant sentiment has surged, with immigration becoming a focal issue for various candidates. The Trump campaign has frequently labeled immigrants as contributors to crime, a financial burden on taxpayers, and a liability for government programs such as Medicare and Social Security. Meanwhile, the Harris campaign has centered its immigration narrative around her strong law enforcement background as a former attorney general in a border state, while also emphasizing her family’s immigrant heritage. Certain states have enacted restrictive measures aimed at immigrants, including mandates for hospitals to gather patient immigration status.
In light of this rhetoric and recent state actions, information on immigrants’ health care utilization and costs, as well as their economic contributions, particularly in the health care sector, is essential. This brief presents important data on these subjects, utilizing KFF analysis from various sources, including the KFF/LA Times Survey of Immigrants, the largest nationally representative survey of immigrants conducted to date, along with other studies.
Immigrants are no more likely than U.S.-born citizens to report using government assistance for food, housing, or health care; undocumented immigrants remain ineligible for federally funded assistance.
The 2023 KFF/LA Times Survey of Immigrants reveals that, despite experiencing lower household incomes and encountering financial difficulties, immigrant adults are just as likely as U.S.-born adults to state that they or someone in their household received government assistance for food, housing, or health care in the last year. In fact, approximately one-quarter (28%) of both immigrant adults and U.S.-born citizen adults reported receiving such assistance within the past 12 months (Figure 1).
Lawfully present immigrants face eligibility restrictions for federal programs like Medicaid and the Children’s Health Insurance Program (CHIP). Generally, lawfully present immigrants must possess a “qualified status” to access Medicaid or CHIP. Many, including most lawful permanent residents or green card holders, must wait five years after achieving qualified status before enrolling, provided they meet all other eligibility criteria. Some lawfully present immigrants, such as refugees and asylees, are exempt from this five-year waiting period. Additionally, states can expand coverage to lawfully residing immigrant pregnant individuals and children without this waiting period. Lawfully present immigrants can also purchase coverage through the Affordable Care Act (ACA) Marketplace and qualify for tax credits to help lower their costs immediately. Those meeting the work requirements can enroll in Medicare, while others may purchase Medicare Part A after maintaining legal residence in the U.S. for five consecutive years.
Undocumented immigrants cannot enroll in federally funded programs like Medicaid, CHIP, or Medicare, nor can they buy coverage through the ACA Marketplaces. Medicaid can cover emergency services for individuals eligible for Medicaid but for their immigration status. Emergency conditions encompass those that threaten the individual’s health or result in serious bodily impairment, although states hold discretion regarding what services qualify for Emergency Medicaid reimbursement.
Some states have initiated fully state-funded programs to extend coverage to immigrants regardless of status, although the eligibility criteria and benefits provided vary. Studies indicate that expanding health coverage for immigrants can lead to decreased rates of uninsurance, increased health care utilization, reduced costs, and improved health outcomes.
Immigrants, especially undocumented ones, utilize health care services, including emergency care, less than U.S.-born individuals.
Research indicates that immigrants, both lawfully present and undocumented, engage less with health care services than U.S.-born citizens. The KFF/LA Times Survey of Immigrants shows that undocumented immigrants are less likely to seek or receive care in the U.S. compared to lawfully present immigrants and naturalized citizens. Approximately 63% of likely undocumented immigrant adults report having a health care visit in the past year, compared to 74% of lawfully present immigrant adults and 82% of naturalized citizen adults.
This lower health care utilization among immigrants can be attributed to their overall healthier and younger demographics, along with increased barriers such as language access issues, confusion, and fears related to immigration. Analysis from KFF indicated that policies from the Trump administration intensified these fears and led to increased hesitance in seeking care.
Immigrants incur lower health care costs compared to U.S.-born individuals.
Reflecting their reduced health care utilization, immigrants exhibit lower health care expenditures than their U.S.-born counterparts. KFF’s analysis of 2021 medical expenditure data indicates that the average annual per capita health care expenditures for immigrants are about two-thirds that of U.S.-born citizens ($4,875 vs. $7,277) (Figure 3). This includes lower spending across various health care services such as office visits, prescription medications, inpatient and outpatient care, and dental services. These findings support other research revealing that immigrants’ overall health expenditures range from half to two-thirds compared to those of U.S.-born individuals, irrespective of immigration status, with lower per capita expenses noted across private and public insurance sources, especially among undocumented immigrants. A particular study highlighted that undocumented immigrants tend to be uninsured and have significantly reduced yearly health care expenditures compared to U.S.-born individuals, with no substantial differences in rates of uncompensated care between the two groups.
Immigrants bolster the economy through their workforce participation and tax contributions, with evidence suggesting they help subsidize health care for U.S.-born individuals and bolster Medicare and Social Security.
Immigrants play a crucial role in addressing the nation’s labor shortages by occupying unmet manufacturing and service needs, with research indicating they do not displace U.S.-born workers. Their contributions are particularly evident in essential sectors such as construction and agriculture, which are vulnerable to health risks and injuries, including climate-related hazards. Furthermore, immigrants, alongside their adult children, significantly enhance the health care workforce, serving as physicians, surgeons, nurses, and long-term care workers (Figure 4). With ongoing projections of shortages in health care employment and a growing population aged 65 and older, immigrants could be pivotal in alleviating these workforce deficits.
Studies show that undocumented immigrants contribute billions yearly in federal, state, and local taxes, with more than a third attributed to payroll taxes funding programs they cannot access, such as Social Security and Medicare. Additional research indicates that immigrants contribute more to the health care system than they use through taxes and premiums, effectively subsidizing health care for U.S.-born citizens. Earlier studies found that without the input of undocumented immigrants into the Medicare Trust Fund, it would face insolvency sooner, and demonstrably, undocumented immigrants positively impact the financial health of Social Security.