Fact check: How does the cost of providing healthcare to undocumented immigrants compare to other US healthcare expenditures?

1. Why the headline numbers look small — immigrants’ per-person costs versus US-born costs

Research comparing per-person spending finds immigrants cost less on average than US-born adults: a JAMA Network Open analysis estimated roughly $3,800 per immigrant per year versus $9,428 for US-born adults, implying immigrants use fewer or lower-cost services ^[1]. That same literature shows Medicaid expansions affected utilization differently by nativity, but overall public insurance per-person spending remained lower for immigrant adults in the period studied, suggesting per-capita health spending differences, not absolute cost absolution, are driving the headline gap ^[5]. These figures do not directly isolate undocumented immigrants, but they frame why aggregate costs tied to immigrant care look modest compared with native-born per-person spending ^{[1] [5]}.

2. Undocumented patients rely on different parts of the system — community clinics and EDs dominate

Clinical and policy analyses report undocumented immigrants disproportionately use community health centers and emergency departments because routine insurance coverage is limited; this shifts costs toward safety-net providers and uncompensated care rather than traditional payer flows ^[6]. The reliance on clinics and EDs concentrates spending in settings that already operate on tighter margins or public subsidies, which explains both the lower per-person spending observed and concentrated fiscal impacts at state and local levels that do not necessarily show up in national third-party payer tallies ^{[6] [7]}. That pattern matters for policy because it shapes who pays and where savings or costs appear.

3. Fiscal balance: immigrants’ contributions may exceed what public payers spend

Analyses estimating fiscal flows find immigrants — including many unauthorized immigrants — may contribute more in premiums, payroll taxes, and other payments than they consume in third-party-funded care, with one estimate of a $58.3 billion net contribution to the financing system ^[3]. This claim frames immigrants as a net subsidy to broader healthcare financing, contrasting narratives that portray them as a fiscal drain. However, the measure counts broad tax and premium flows and does not equate to immediate local uncompensated care burdens, so contribution estimates coexist with localized cost pressures ^{[3] [7]}.

4. State experiments show coverage changes shift costs and access

Several states have created state-funded coverage programs irrespective of immigration status, and pilots suggest these programs lower uninsured rates and improve access, with potential to reduce emergency-only care usage ^[4]. These findings indicate that expanding coverage at the state level can reconfigure costs — reducing expensive ED care while increasing preventive and primary care spending — and that policy choices determine whether undocumented care costs are concentrated in uncompensated emergency care or spread across insured, preventive services ^{[4] [6]}.

5. Context: undocumented care is small compared with US national health spending

Even if undocumented care were fully covered, the numbers remain small relative to national health expenditures: $4.9 trillion in 2023 with rapid growth projected ^{[2] [8]}. The studies show undocumented or unauthorized immigrants account for a small share of public-sector health spending (reported 7.9% in one analysis) and overall healthcare spending dynamics are driven by population aging, prices, and utilization growth across the entire system ^{[7] [9]}. Thus, policy debates linking undocumented care to runaway national healthcare spending overstate the relative magnitude ^{[2] [7]}.

6. What’s missing or ambiguous — data gaps that shape disagreement

Key uncertainties remain: most analyses do not isolate undocumented-only per-person spending precisely, estimates vary by methodology and which payers are counted, and time windows differ across studies ^{[1] [3] [7]}. Some studies measure net fiscal contributions including taxes and premiums, while others measure public-sector spending or uncompensated care; these differing scopes produce divergent policy implications, and partisan narratives can cherry-pick one metric to support broader claims. Future research should consistently separate undocumented from authorized immigrants and track payer-level impacts to resolve these ambiguities ^{[5] [7]}.

7. Bottom line for policymakers and the public

The evidence converges on three facts: per-capita healthcare spending for immigrants is lower than for US-born adults, undocumented immigrants account for a small share of total health expenditures, and state-level policy choices significantly shape where costs fall — emergency care versus insured primary care ^{[1] [7] [4]}. Debates that treat undocumented healthcare as a major driver of national spending ignore both the small relative share and the role of coverage design; policymakers should weigh local uncompensated-care pressures, immigrants’ fiscal contributions, and the trade-offs between emergency-driven costs and investments in primary care when crafting reforms ^{[3] [6]}.