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Fact check: What is the estimated annual cost of providing health care to undocumented immigrants in the US?
Executive Summary
A consistent body of peer-reviewed analyses estimates that the annual national health-care expenditures attributable to undocumented or unauthorized immigrants in the United States fall in the low billions of dollars, with two independent estimates of $6.4 billion [1] and $4.2 billion [2] and systematic reviews showing per capita spending well below US-born levels [3] [4] [5]. These studies converge on the finding that undocumented immigrants use fewer health services per person and therefore represent a smaller fiscal share of health spending than their population share [3] [4] [5].
1. Why two headline numbers keep appearing — $6.4B and $4.2B, and what they mean
Two headline estimates dominate the cited literature: a $6.4 billion estimate from 2006 and a $4.2 billion aggregate estimate for 2017 [3] [4]. The 2006 figure is framed primarily as the total annual cost of caring for undocumented immigrants, of which only 17% ($1.1 billion) was borne by public sources, implying a large share paid privately or uncompensated [3]. The 2017-derived $4.2 billion comes from a machine-learning model calculating aggregate expenditures for unauthorized immigrants and emphasizes lower mean annual per-person spending among the unauthorized ($1,629) relative to US-born people ($6,088) [4]. Both numbers are consistent in portraying small aggregate fiscal impacts relative to total US health spending.
2. Per-person spending paints a clearer picture than aggregates
Per-capita comparisons in multiple studies show unauthorized immigrants spend far less annually than US-born residents, with figures like $1,629 for unauthorized immigrants versus $6,088 for US-born individuals reported for 2017 [4]. A systematic review covering post-2000 literature found immigrants’ overall expenditures were one-half to two-thirds those of US-born persons, a pattern that persists across age groups and payer types [5]. This lower utilization per person explains why aggregate expenditures for undocumented populations remain modest despite sizable population shares in some localities.
3. Public vs private burden — who actually pays?
The 2006 study highlighted that only 17% of the $6.4 billion estimate was paid by public sources ($1.1 billion), indicating most costs were absorbed by private payers or uncompensated care [3]. The 2017 analysis also implies limited pressure on public budgets because unauthorized immigrants’ lower use of insured services translates into less spending channeled through Medicaid or Medicare, though the analyses note higher out-of-pocket shares among immigrants [4] [5]. This pattern suggests fiscal impacts differ markedly depending on whether policy focus is on public budgetary costs or total societal health spending.
4. Methodological differences explain variation between estimates
Differences in time frame, population definitions, and methods account for the gap between $6.4B [1] and $4.2B [2]. The 2006 study estimated total annual cost at that historical moment and apportioned payer shares [3]. The 2017 figure uses a machine-learning model to impute unauthorized status and estimate expenditures, producing a newer aggregate for 2017 [4]. Systematic review findings synthesize multiple methods and consistently report lower per-capita spending by immigrants, which supports both headline estimates despite methodological variation [5].
5. What these numbers do not capture — important omissions and caveats
The analyses acknowledge important omissions: estimates may not capture preventive care deficits, long-term public health effects, or local uncompensated care burdens in high-immigrant jurisdictions. The systematic review notes undocumented immigrants often make larger out-of-pocket payments and may use emergency care disproportionately, which shifts costs across sectors and years [5]. Neither headline number fully captures non-financial impacts—such as access barriers, delayed care, or downstream costs from untreated conditions—that can alter long-term expenditures and public-health outcomes [3] [5].
6. Competing narratives and potential agendas in interpreting the data
Studies emphasizing small aggregate costs are often cited to argue that undocumented immigrants do not impose large fiscal strains on the health system, while opponents may highlight uncompensated emergency care or local budgetary pressures. The 2006 study’s emphasis on only 17% public payment can be used to argue for limited federal burden, whereas the 2017 per-capita comparisons may be used to argue immigrants contribute less to health-care spending overall [3] [4]. Recognizing these framing incentives is crucial when policymakers use these figures.
7. Bottom line for policymakers and the public
Across multiple peer-reviewed analyses, the best-supported conclusion is that undocumented or unauthorized immigrants account for a few billion dollars annually in US health-care expenditures, with per-person spending substantially lower than US-born residents and most costs not shouldered by public payers in the 2006 estimate [3] [4] [5]. Policymaking that focuses solely on headline totals will miss key trade-offs around local uncompensated care, preventive access, and long-term public-health costs, all of which are acknowledged as limitations in the literature.