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Fact check: What are the estimated costs of providing healthcare to undocumented immigrants in the US?
Executive Summary
The available analyses do not produce a single, agreed national price tag for providing healthcare to undocumented immigrants; studies repeatedly find lower per-capita healthcare expenditures for immigrants than for US-born adults and localized estimates that are modest relative to state budgets. Evidence shows undocumented populations predominantly access community clinics and emergency departments, face barriers that suppress utilization, and in some contexts contribute more in premiums and taxes than they consume—while state pilot estimates show per-newly insured costs in the low thousands per year [1] [2] [3] [4]. These findings point to complex, state-dependent costs rather than a simple national figure.
1. Why nobody gives a single national price — systemic fragmentation and missing data
No analysis in the provided set attempts a comprehensive national cost estimate, reflecting fragmented state policies and measurement gaps. Recent work mapping state coverage options emphasizes that coverage and costs vary substantially by state choices and by whether immigrants are lawfully present, undocumented, or newly eligible under expansions; this complexity prevents a straightforward aggregation to a U.S.-level dollar amount [5]. Absent a coordinated federal expansion and standardized data collection on undocumented populations’ insurance take-up and utilization, estimates remain piecemeal and sensitive to local policy contexts and modeling assumptions [5].
2. Repeated finding: immigrants use less healthcare per person than US-born adults
Multiple retrospective and cross-sectional analyses conclude that immigrants have lower healthcare expenditures than US-born individuals, often substantially lower on a per-capita basis; one summary indicates the cost to insure immigrants is less than half that for US-born adults [1] [6]. These findings appear across studies from 2022–2023 and are confirmed by analyses of Medicaid expansion impacts, which show increased coverage for immigrants but still lower aggregate expenditure and utilization than among U.S.-born populations [6] [1]. That pattern matters for fiscal calculations: per-capita cost assumptions for the overall population overstate likely costs if applied to immigrant cohorts.
3. Local estimates: Connecticut shows modest state-level budget impacts
A state-level modeling exercise in Connecticut offers a concrete example: expanding Medicaid and subsidy eligibility to undocumented and recent lawfully present immigrants would increase coverage by roughly 21,000–24,000 people and cost the state between $83 million and $121 million, equal to about $3,900–$4,900 per newly insured person [4]. These figures demonstrate how costs scale with the size of the newly covered population and state fiscal choices, and they underline that per-capita expenditures in these models are modest compared with many public programs, though totals still represent meaningful state budget items.
4. The role of emergency care and community clinics in cost dynamics
Studies find undocumented patients rely heavily on community health clinics and emergency departments for care, with many ED visits being preventable or treatable in primary care settings, indicating higher system costs tied to limited access rather than intrinsic utilization preferences [2]. This pattern suggests that policy choices expanding access to primary care and insurance could shift care out of expensive ED settings, potentially lowering net costs while improving health outcomes. The data imply costs are partly endogenous to access; reducing barriers may change utilization—and long-term cost profiles.
5. Contributions versus costs: evidence of a fiscal surplus from immigrants
Analyses indicate immigrants, including undocumented individuals, may pay more in premiums and taxes than they receive in benefits, with one 2017-based estimate finding immigrants paid about $58.3 billion more than they received, driven largely by undocumented contributions [3]. This complicates narratives that expanded access necessarily imposes net fiscal burdens; the balance of payments into systems varies by tax, premium, and benefit structures, and depends on whether short-run programmatic costs are offset by long-run tax and labor contributions.
6. Non-financial barriers shape utilization and thus costs
A body of evidence documents that legal, financial, linguistic, and cultural barriers—plus fear of deportation—suppress timely care-seeking among undocumented people, producing delayed or forgone care and worse outcomes [7] [8]. Those suppressed demands lower measured spending today but risk higher acute-care costs later. Policy changes that reduce barriers—insurance options, provider training, and community interventions—could increase near-term costs while lowering costly emergency use and improving population health, altering long-run fiscal implications [7] [8].
7. Bottom line for policymakers and the public: context matters more than a headline number
The evidence across these studies leads to a nuanced conclusion: there is no single, defensible national cost figure given state policy variability, documented lower per-capita use by immigrants, and offsetting fiscal contributions from taxes and premiums [1] [3] [5]. Where concrete estimates exist—like Connecticut—they show per-person costs in the low thousands annually, while national claims must account for suppressed demand, emergency-care patterns, and the political choices shaping eligibility. Any policymaker seeking a precise number must model local demographics, take-up rates, and program designs explicitly [4] [2] [3].