By Leah Zallman and Steffie Woolhandler
The Huffington Post, May 26, 2016
Throughout the primary season, leading Republican presidential candidates vied over who could bash immigrants the hardest. And they were promising more than border walls. Donald Trump is the most extreme immigrant-blamer; according to his website, âProviding healthcare to illegal immigrants costs us some $11 billion annually. If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.â
As with many of Trumpâs claims, this one is wrong. But unlike some of his other falsehoods, the media has left this one unchallenged. Trumpâs $11 billion figure comes from an obviously biased study thatâs based on outlandish assumptions.
For instance, it counts as âimmigrantsâ millions of U.S. citizens â children who were born in the U.S. of immigrant parents. It also assumes that immigrant families have high health care costs, ignoring a raft of data showing that immigrants use little care. For instance, nearly half (48 percent) of noncitizen immigrant children never see the doctor in the course of a year.
Finally, Trumpâs source assumes that every penny of immigrant kidsâ health care costs are borne by the taxpayers. Yet a recent study in the respected journal Health Affairs found that unauthorized immigrants families pay the vast majority of their own health care bills, either out-of-pocket, or by buying private insurance. Indeed, 40 percent of newly arrived immigrants have private insurance.
Trumpâs numbers donât just exaggerate taxpayersâ costs for immigrantsâ care, they ignore the billions that immigrants pay in taxes. Compared to other Americans, immigrants are younger, healthier and more likely to be male and part of the workforce. That means that an outsized share of immigrants pay the payroll taxes that support Medicare and Social Security, while few are eligible to draw benefits from these programs.
Employers are required to check a Social Security card when hiring a new worker. But they donât have to check that itâs valid. The IRS happily accepts (and passes on to Medicare and Social Security) payments made under invalid Social Security numbers.
Consequently, millions of undocumented immigrants work and pay taxes under fake or borrowed Social Security numbers. The Social Security Administration estimates that undocumented immigrants pay $13 billion annually into the Social Security trust funds. And, in studies we did at Harvard and the City University of New York, we found that undocumented immigrants contribute billions more to Medicare.
Without immigrants â and especially unauthorized immigrants â Medicareâs Trust Fund would be broke. Each year, immigrants pay about $11 billion more in Medicare taxes than Medicare pays for their care. And undocumented immigrants contribute the lionâs share of this subsidy.
And, just like everyone else, unauthorized immigrants pay sales taxes every time they shop and property taxes (indirectly) when they pay their rent, contributing $11 billion annually in state and local taxes.
While unauthorized immigrants contribute billions in taxes, they use shockingly little health care. Most of the federal health programs they help pay for (like Medicare, Medicaid and the ACAâs plans) exclude them. And those who pay for private coverage use very little care, so their premiums effectively subsidize other enrollees with private insurance.
As physicians, we believe that medical care must be available to everyone residing in the U.S. However, if Trump and other politicians are concerned about ârelieving healthcare cost pressures on state and local governmentsâ they should champion fair immigration policies that assure a steady flow of immigrants who come here wanting to work and willing to pay taxes, and donât need much medical care.
Leah Zallman, M.D., M.P.H., is a research scientist at the Institute for Community Health, a primary care doctor at Cambridge Health Alliance, and an instructor of medicine at the Harvard Medical School. She is a health services researcher who focuses on health disparities, with specific areas of focus including immigrant health and access to care for vulnerable populations. Steffie Woolhandler, M.D., M.P.H., is an internist in the South Bronx, professor at the City University of New York School of Public Health at Hunter College, and lecturer in medicine at Harvard Medical School. She co-founded Physicians for a National Health Program.The opinions expressed here do not necessarily reflect the views of the authorsâ institutions.
PNHP note: Physicians for a National Health Program (PNHP) is a nonpartisan educational and research organization. It neither supports nor opposes any candidate for public office.
