Fact check: What is the estimated annual cost of providing healthcare to undocumented immigrants in the US?

1. Why there’s no single national price tag — methodological fragmentation drives disagreement

Researchers working from different data and assumptions generate very different answers about the fiscal impact of covering undocumented immigrants. One body of work reports per-person expenditure differences—for example, a 2020 study showing $1,629 annual spending per unauthorized immigrant versus $6,088 for U.S.-born individuals—highlighting utilization and access differences rather than projecting a nationwide program cost ^[1]. Other analyses create policy-counterfactual national estimates by assuming varying enrollment rates and program scopes; a frequently cited range in the provided analyses places potential federal costs at roughly $10 billion under conservative take-up assumptions up to $23 billion under higher enrollment scenarios ^[2]. These diverging methods—micro-level utilization comparison versus macro-policy simulation—explain why sources do not state a single consensus number.

2. State-level models show how local policy choices change the arithmetic

Detailed modeling at the state level demonstrates that local policy design matters for fiscal totals. Connecticut’s modeling using a microsimulation framework estimated that expanding Medicaid and subsidy eligibility to undocumented and recently present legally present immigrants would increase coverage by 21,000–24,000 people, producing state budget impacts in the range of $83–$121 million depending on program design and cost-sharing features ^[3]. The same modeling approach underscores that per-capita costs and total price tags vary with population size, baseline access to care, and whether emergency-only benefits or comprehensive coverage are provided, and it shows why national extrapolations must be treated cautiously.

3. Per-capita spending differences reveal utilization and access gaps, not universal cost burdens

Comparisons of per-person health spending expose that unauthorized immigrants tend to have lower annual healthcare expenditures than U.S.-born populations, with one analysis citing $1,629 for unauthorized immigrants versus $6,088 for U.S.-born individuals ^[1]. That difference reflects a complex mix of lower insurance coverage, restricted program eligibility, potential barriers to primary and preventive care, and a reliance on emergency or safety-net services ^{[1] [4]}. While lower per-capita spending suggests limited immediate fiscal exposure if coverage is extended, it also indicates unmet health needs that could raise costs over time if preventive care remains inaccessible.

4. Conservative national price estimates come with clear caveats and contested assumptions

Projections that put a national price tag in the low tens of billions—such as $10–$23 billion per year—are framed by clear assumptions about who enrolls, what benefits are covered, and how federal versus state costs are apportioned ^[2]. Analysts who produce lower estimates often assume limited take-up among eligible undocumented immigrants and continued barriers that suppress utilization. Critics of these projections point out that higher enrollment, broader benefit packages, or expanded state subsidies would push totals upward ^[1]. The available materials therefore show estimates are highly sensitive to enrollment and benefits assumptions, making headline figures unreliable without a full methodological disclosure.

5. Emergency-care-focused systems hide the true demand for comprehensive coverage

Studies of emergency department utilization and emergency Medicaid illustrate that current patterns of care—heavy reliance on emergency services and community clinics—both lower immediate per-person spending and mask unmet preventive needs ^{[4] [5]}. Emergency-only coverage creates episodic cost spikes while failing to produce the longitudinal savings associated with preventive care. State and clinic-level analyses emphasize that improving primary care access could reduce unnecessary ED visits, but such shifts change both the timing and distribution of costs, complicating short-term budget estimates ^[4].

6. What’s missing and why policy debates remain unsettled

The analyses collectively show that a robust national estimate requires: a consistent definition of the population (unauthorized vs. recent legal immigrants), transparent assumptions on take-up and benefit levels, and harmonized accounting of federal versus state responsibilities ^{[1] [3]}. Existing studies offer useful pieces—per-person spending, state pilot costs, and scenario-driven national ranges—but no single study in the provided material produces a definitive nationwide annual cost figure. Policymakers seeking a concrete fiscal number must commission model harmonization or scenario analyses that explicitly disclose enrollment, benefit, and funding assumptions.

7. Bottom line for readers evaluating cost claims

When confronted with a specific cost claim about providing healthcare to undocumented immigrants, scrutinize whether the number is per-person or aggregate, based on utilization comparisons or policy simulations, and what take-up and benefits assumptions underpin it ^{[1] [2] [3]}. The materials show plausible low-end and high-end scenarios—per-capita spending around $1,600 for unauthorized immigrants, state pilot costs like $83–$121 million, and national scenario ranges around $10–$23 billion—but none constitute a definitive national price tag without further methodological harmonization ^{[1] [2] [3]}.