Key Facts on Health Care Use and Costs Among Immigrants
Immigrant adults are a diverse population who make up 16% of adults in the United States and play a significant role in the nation’s workforce and communities. Leading up to the 2024 election, there has been an increase in anti-immigrant rhetoric and immigration has been a central talking point for candidates. The Trump campaign has repeatedly described immigrants as a source of crime, a burden for taxpayers, and a drain on government programs like Medicare and Social Security. The Harris campaign has also focused on immigration, emphasizing her tough on crime stance as a former attorney general of a border state, while also highlighting her family’s immigrant roots. Some states have also taken restrictive actions focused on immigrants, including requiring hospitals to collect patient immigration status.
Amid this rhetoric and these recent state actions, data on immigrants’ health care use and costs as well as their contributions to the economy and workforce, including in the health care sector, can be informative. This brief provides key data on these topics drawing on KFF analysis across a range of data sources, including the KFF/LA Times Survey of Immigrants, the largest nationally representative survey of immigrants conducted to date, and other research.
Immigrants are not more likely than U.S.-born citizens to report using government assistance for food, housing, or health care, and undocumented immigrants remain ineligible for federally funded assistance.
The 2023 KFF/LA Times Survey of Immigrants shows that, despite having lower household incomes and facing financial challenges, immigrant adults are no more likely than U.S.-born adults to say that they or someone living with them received government assistance with food, housing, or health care in the past year. Overall, about a quarter (28%) of both immigrant adults and U.S.-born citizen adults say they received this type of assistance in the past 12 months (Figure 1).
Lawfully present immigrants face eligibility restrictions for federal programs, including Medicaid and the Children’s Health Insurance Program (CHIP). In general, lawfully present immigrants must have a “qualified status” to be eligible for Medicaid or CHIP, and many, including most lawful permanent residents or “green card” holders, must wait five years after obtaining qualified status before they may enroll even if they meet other eligibility requirements. Some lawfully present immigrants, such as refugees and asylees, are exempt from the five-year waiting period. States can also expand coverage to lawfully residing immigrant pregnant people and children without a five year wait. Lawfully present immigrants can purchase Affordable Care Act (ACA) Marketplace coverage and receive tax credits to offset the cost of that coverage without a five-year wait. Lawfully present immigrants can also qualify for Medicare but must have sufficient work history. If they do not have this work history, they can purchase Medicare Part A after residing legally in the U.S. for five years continuously.
Undocumented immigrants are not eligible to enroll in federally funded coverage including Medicaid, CHIP, or Medicare, or to purchase coverage through the ACA Marketplaces. Medicaid payments for emergency services may be made to hospitals or other providers on behalf of individuals who are otherwise eligible for Medicaid but for their immigration status. Emergency conditions include those that place an individuals’ health in serious jeopardy or cause serious bodily impairment or dysfunction, although states have discretion to determine what services can be reimbursed through Emergency Medicaid.
Some states have established fully state-funded programs to provide coverage to immigrants regardless of immigration status, although they vary in eligibility and scope of benefits provided. Research suggests that expanding health coverage for immigrants can reduce uninsurance rates, increase health care use, lower costs, and improve health outcomes.
Immigrants, particularly those who are undocumented, use less health care, including emergency room care, than people born in the U.S.
Overall, research shows that immigrants, including lawfully present and undocumented immigrants, use less health care than U.S.-born citizens. Moreover, the KFF/LA Times Survey of Immigrants shows that among immigrant adults, likely undocumented immigrants are less likely than lawfully present immigrants and naturalized citizens to report seeking or receiving care in the U.S. or having a health care visit in the past year. About six in ten (63%) likely undocumented immigrant adults report a health care visit in the past year compared with 74% of lawfully present immigrant adults and 82% of naturalized citizen adults.
Lower use of health care among immigrants likely reflects a combination of them being younger and healthier than their U.S.-born counterparts as well as them facing increased barriers to care, including language access challenges, confusion, and immigration-related fears. Prior KFF analysis found that Trump-era policies amplified these fears and contributed to greater reluctance to access care.
Immigrants have lower health care costs than U.S.- born people.
Reflecting their lower use of health care, immigrants have lower health care expenditures than their U.S.-born counterparts. KFF analysis of 2021 medical expenditure data shows that, on average, annual per capita health care expenditures for immigrants are about two-thirds those of U.S.-born citizens ($4,875 vs. $7,277) (Figure 3). This reflects lower spending for most types of health care, including office-based visits, prescription drugs, inpatient care, outpatient care, and dental care. These findings are consistent with other research which shows that immigrants’ overall health expenditures are one-half to two-thirds of those of U.S.-born individuals, regardless of status, and that per capita expenditures from private and public insurance sources are lower for immigrants, particularly for undocumented immigrants. For example, one study found that undocumented immigrants are more likely to be uninsured and have significantly lower health care expenditures than U.S.-born individuals per year, and that despite differences in the likelihood of being uninsured, there are no significant differences in rates of uncompensated care between undocumented immigrants and U.S.-born individuals.
Immigrants contribute to the economy through their role in the workforce and tax payments, with research showing that they help subsidize health care for U.S.- born people and stabilize Medicare and Social Security.
Immigrants support the nation’s workforce by filling unmet labor market needs, and research suggests that they do not take jobs away from U.S.-born people. They play a disproportionate role filling jobs in essential industries such as construction and agriculture that are at increased risk of adverse health outcomes and injuries, including climate-related health hazards. In addition, immigrants as well as the adult children of immigrants play outsized roles in the health care workforce as physicians, surgeons, nurses, and long-term care workers (Figure 4). As health care workforce shortages are projected to continue and the U.S. 65 and older population grows, immigrants could help mitigate these shortages.
Analysis shows that undocumented immigrants contribute billions in federal, state, and local taxes each year. It is estimated that more than a third of their tax dollars are payroll taxes that fund programs they cannot access, including Social Security, Medicare, and the federal share of unemployment insurance. Research further finds that immigrants pay more into the health care system through taxes and health insurance premiums than they utilize, helping to subsidize health care for U.S.-born citizens. Earlier research found that without the contributions undocumented immigrants make to the Medicare Trust Fund, it would reach insolvency earlier, and that undocumented immigrants result in a net positive effect on the financial status of Social Security.