What types of health insurance do immigrants currently qualify for?
Undocumented immigrants are generally ineligible for federal healthcare programs due to immigration status regulations and public charge rules. Additionally, even immigrants who are “lawfully present” face barriers to accessing federal healthcare programs such as Medicaid and the Children’s Health Insurance Program (CHIP), which are state-administered and federally funded to provide coverage to low-income individuals. They are also excluded from the Health Insurance Marketplace, a federal service that offers tax cuts and subsidies to make insurance more affordable.
Undocumented immigrants in the U.S. are eligible for emergency medical care under the Emergency Medical Treatment and Labor Act (EMTALA), funded through Medicaid. Beyond emergency care, their options are limited to private insurance through employers or primary care at community health clinics. Many rely primarily on EMTALA-covered emergency services, with a high likelihood of not having access to regular medical care or a doctor’s visit in the past year.
The combination of eligibility restrictions for federal programs, limited access to private insurance due to employment in low-benefit jobs, and barriers like fear and language differences makes undocumented immigrants more likely to be uninsured compared to lawfully present immigrants and U.S.-born citizens.
Background on undocumented immigrants in the US
In recent years, several states have started expanding health coverage to undocumented immigrants to improve healthcare access and reduce financial strain on hospitals treating uninsured patients. On the federal level, there was a move towards expansion with the introduction of the Health Equity and Access under Law (HEAL) for Immigrant Families Act in 2023, aimed at eliminating healthcare barriers for all immigrants, regardless of status. Despite these efforts, challenges persist. For example, Illinois had to scale back on enrollments due to budget underestimations, affecting about 6,000 people’s insurance coverage. Moreover, with unauthorized crossings at the US-Mexico border hitting a record 2.4 million in 2023, cities like New York City have been overwhelmed, committing $2.4 billion in 2024 to address the costs related to the large influx of migrants.
The Cost of Providing Care
Proponents of expanding healthcare coverage to undocumented immigrants argue that it would not result in excessive costs and could actually lead to savings in other areas. They point out that providing regular preventative primary care to undocumented immigrants would reduce the need for more costly emergency department (ED) visits, which often arise from lack of insurance. Cost analyses support this view, showing that regular primary care is less expensive than ED services that could have been avoided. Furthermore, the lack of preventative care can lead to advanced chronic diseases, which are significantly more costly, imposing an estimated economic burden of $4 trillion a year. It’s estimated that preventing unnecessary ED visits could save approximately $4.4 billion annually.
Supporters of expanding health coverage to undocumented immigrants say that there is a widely held misconception that immigrants use more healthcare than those born in the U.S. and “drain” medical resources. One systematic review indicates that both private and public health insurance expenditures are lower per capita for immigrants, particularly undocumented ones. Additionally, immigrants tend to pay more in out-of-pocket expenses, contributing more to medical costs than they receive in services.
Opponents of expanding health coverage to undocumented immigrants argue that such programs are financially unsustainable, pointing to significant costs associated with existing state initiatives. For instance, California’s Medi-Cal program, which was the first to extend coverage to all undocumented immigrants, is projected to cost over $2 billion annually. This comes at a time when California faces a budget deficit of approximately $73 billion, according to estimates by the state’s legislative analyst. Critics believe that simply providing universal coverage is not cost-effective and suggest alternative solutions to improve healthcare access. They advocate for policies like lifting bans on the sale of short-term health plans, which are less expensive, and expanding private insurance options as more sustainable approaches to delivering affordable care.
Illinois recently had to pause its health insurance program for undocumented immigrants due to higher-than-expected costs. Since its launch in 2020, the program expanded twice and was projected to cost $1.1 billion. However, in 2023, the state allocated only $550 million and capped enrollment at 16,500 participants. The governor’s spokesperson attributed the underestimation of costs to unreliable metrics from the U.S. Census, indicating challenges in accurately predicting financial needs for such programs.
How does expanding healthcare access relate to the migrant crisis?
Advocates for expanding health coverage to undocumented immigrants argue that it will improve the overall health of the nation. With an estimated 10.5 million undocumented immigrants in the U.S., proponents suggest that broader access to healthcare could significantly boost public health by increasing care availability and vaccination rates among this population. They point to outbreaks of vaccine-preventable diseases, such as measles, poliovirus, and Covid-19, which have been linked in part to vaccine hesitancy among immigrant groups and low immunization rates. A systematic review indicated that barriers like limited access to medical care and infrequent doctor visits contribute to vaccine hesitancy. Therefore, supporters of healthcare expansion believe that improving access to care for undocumented immigrants will help reduce the spread of preventable diseases.
Opponents of expanding health benefits for undocumented immigrants argue that such policies could incentivize more immigration to the U.S. They cite studies suggesting that immigrants are drawn to areas with generous welfare benefits, including healthcare. Critics also highlight the strain on hospital resources due to increased immigration. For example, Colorado hospitals have seen a significant increase in migrant patients, with a 69% rise in new patients over a three-month period, totaling around 6,000 migrant visits. This surge has led to overcrowded emergency departments, impeding access for other patients and forcing some hospitals to turn patients away. Dr. Richard Zane, chair of the Department of Emergency Medicine for UCHealth, expressed concerns, stating, “We will not deny emergency care. But at some point, access is impeded for everyone.”
Takeaways from the debate: Cost analysis and the effect of coverage expansion on the US population
The debate over expanding healthcare to undocumented immigrants is complex, entangled with concerns about costs, program sustainability, and the ongoing migrant crisis. Proponents of expansion argue that it could lead to modest costs by reducing unnecessary emergency department visits and would significantly benefit public health by increasing healthcare access for the large undocumented population in the U.S. However, opponents contend that evidence from state programs and healthcare systems points to substantial costs associated with such expansions. Additionally, they argue that the growing number of undocumented immigrants, exacerbated by the migrant crisis, will further strain city, state, and federal budgets.
