Healthcare for illegal immigrants between the ages of 18 and 64 cost American taxpayers $1.1 billion in 2000 -- or about $11 per household -- according to a study released Tuesday by the Rand Corp.
The research, published in the November/December edition of the journal Health Affairs, put the cost in Los Angeles County that year at $204 million.
“There are taxpayer implications to illegal immigration, but healthcare is not one of them,” said Jim Smith, a senior economist with Rand and author of the study. “Why are we talking about healthcare when that’s only $1 billion a year?”
The Federation for American Immigration Reform questioned the study’s conclusions, saying it estimates the total cost of healthcare for illegal immigrants in California alone at $1.4 billion.
“From the studies that we have done, [the Rand study] certainly is a low-ball estimate " said Jack Martin of the federation. “But there are issues other than cost.... In the emergency rooms, it has to do with very finite resources and the fact that those medical facilities end up at times being severely overburdened so that the quality of attention that they can give to U.S. citizens and legal permanent residents is degraded.”
The Rand study, which surveyed Los Angeles County residents about their use of healthcare services and then used national estimates on cost to put a price tag on the care, found that nearly 22% of illegal immigrants have health insurance, which covered about $362 million in costs in 2000. The immigrants themselves paid $321 million out of pocket.
Though other estimates of some healthcare costs for undocumented immigrants exist, it is hard to compare them directly to the Rand findings.
In fiscal year 2004-05, California’s Medi-Cal program covered $946 million in services for impoverished illegal immigrants, including coverage for emergencies, prenatal care, limited cancer treatment, abortions and nursing home care. In 2003, Los Angeles County estimated that it spent $340 million on public hospital and clinic care for illegal immigrants not covered by Medi-Cal.
But those figures include costs for children and the elderly, who were excluded from the Rand study. Also, the Rand data were collected in 2000, and the number of illegal immigrants in California has swelled in the five years since then, as have healthcare costs.
The Rand study also found that illegal immigrants tend to see doctors less frequently than citizens do. In part, that’s because they’re younger, Smith said, and because people with chronic health problems are less likely to cross the border.
Researchers found that 40% of male undocumented immigrants had never received a medical checkup and 23% had never seen a doctor, compared with 21% and 10% respectively of those born here. Among illegal immigrant women, 21% had never received a checkup, compared with 5% of those born in the United States.
The study was based on a 2000 questionnaire completed by 2,543 adults in 65 neighborhoods across Los Angeles County. The questionnaire was not specifically aimed at determining healthcare costs; rather, participants were asked about a wide range of issues to discern whether neighborhoods had an impact on people’s lives.
However, the survey asked about legal status and whether the participants held green cards or other documents authorizing their stay in the country. It also asked them about their use of hospitals and clinics in the prior two years.
In the midst of the current debate over illegal immigration, Smith said, he and his colleagues wanted to use their data to “put some facts” into the discussion.
Smith said the researchers calculated the cost of services, then inflated them by 25% to account for incidental costs.
He acknowledged that relying on questionnaires is not foolproof, and that results are tied to the memory and truthfulness of research subjects. But he stood by the study’s basic conclusions.
“Let’s say I’m wrong and I’ve understated these costs by $1 billion -- which is a lot -- I’d still conclude the same thing: that these are relatively small aggregate costs for the nation,” Smith said.
Margaret Laws, director of public financing and policy for the California HealthCare Foundation, said she welcomed the study as a more scientific look that provides a point of comparison. Until now, she said, the only sources of information on the cost of caring for illegal immigrants have been anecdotal reports.
“Short of hospitals collecting and reporting data in a way they don’t now, there is no other way to measure this,” she said. “It is the best thing we have.”