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 As U.S. lawmakers continue to tackle immigration reform, knowing
whether immigrants burden or subsidize the nation's healthcare
system could be helpful, researchers write in Health Affairs.
"If we're talking about reform, we need to understand the
consequences of policies put in place and the repercussions on many
parts of our country," said study leader Dr. Leah Zallman, director
of research at the Institute for Community Health in Malden,
Massachusetts.
Recent narratives about immigrants and the healthcare system paint a
picture of packed emergency rooms and patients who can't pay their
bills. But many U.S. immigrants are young, healthy and able to get
employer-provided insurance, and when these people are taken into
account, the insurance premiums they're paying might actually
bolster the healthcare system, Zallman said in a phone interview.
Zallman and colleagues analyzed national data from the Medical
Expenditure Panel Survey to understand private insurers'
expenditures on behalf of enrollees and the premiums paid. They
linked that data with National Health Interview Surveys to determine
citizenship and immigrant status. They also assessed employer
contributions to private insurance by analyzing data collected by
the Census Bureau.
The researchers specifically looked at private insurance outside of
the Affordable Care Act Marketplace.
They found that immigrants accounted for 12.6 percent of premiums
paid to private insurers in 2014 but made up 9.1 percent of the
insurers' expenditures on beneficiaries. Within this group,
undocumented immigrants accounted for 2.4 percent of premiums paid
and 1.3 percent of expenditures. In contrast, people born in the
U.S. accounted for 87.4 percent of premiums paid to insurers and
90.9 percent of expenditures.
Similarly, immigrants' annual premiums exceeded their expenses by
$1,123 per enrollee, or a total of $24.7 billion. In contrast,
U.S.-born beneficiaries' expenses exceeded their premiums by about
$24 billion. The immigrants' contributions therefore offset a
deficit of $163 per U.S.-born enrollee, the study authors write.
Overall, this subsidy persisted even after immigrants had been in
the U.S. for 10 years.
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"We live in a political time that is questioning the costs and
benefits of immigration, and it's a question that's been analyzed
for many decades now," said Arturo Vargas Bustamante of the
University of California, Los Angeles Fielding School of Public
Health, who wasn't involved in the study.
"To have a functional health insurance system, we need the rich to
subsidize the poor, the healthy to subsidize the unhealthy and the
young to subsidize the old," he said in a phone interview. "The
basic question is, 'Who is subsidizing who?'"
Future research should look at what would happen if immigration
reform influenced the health insurance risk pool, particularly if
policies curtailed immigration and reduced the number of people with
private insurance who boost it, Vargas Bustamante said.
"There are many different steps that must be taken next, including
whether these findings hold up for different populations of
immigrants, such as country of origin, and a more detailed
examination of state immigration and healthcare policies," said
James Stimpson of the Drexel University Dornsife School of Public
Health in Philadelphia, who wasn't involved in the study.
"Immigrants may be a net financial benefit to the health care system
and efforts to reduce the number of immigrants could have a negative
impact on health insurance premiums for U.S. natives," he said by
email.
SOURCE: https://bit.ly/2C6PRfC Health Affairs, online October 1,
2018.
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