October 7, 2019
The Trump administration continues to look for ways to restrict authorized immigration to the United States. The latest effort is a new rule, issued in a late-night proclamation, that denies visas to people seeking to relocate to the United States if they cannot prove they will be able to acquire health insurance within a month of arrival - or separately show they can afford any “foreseeable health care costs” out of pocket. From CBS News:
"The administration is on-the-record wanting to cut legal immigration, and particularly wanting to cut legal immigration of lower-skilled, lower-paid immigrants who are probably less likely to have health insurance coverage," said Randy Capps, director of U.S. programs research at the nonpartisan think tank the Migration Policy Institute.
Earlier in the summer, the administration rolled out the final version of a "public charge" regulation, which would make it easier for the government to deny green cards and temporary visas for legal immigrants who use public benefits like food stamps and government-subsidized housing.
Capps told CBS News that Friday's proclamation will go "much further" than the public charge rule in terms of health-based restrictions on people seeking to immigrate to the U.S. The administration is hoping to accomplish this, he added, by rolling out an abrupt executive order that will not be subject to feedback prior to implementation — unlike the public charge rule, which is expected to take effect later this month.
The order itself is framed as denying visas to those who will “financially burden the healthcare system.” The preamble claims that uninsured individuals rely on more expensive emergency health care at hospitals, and that hospitals are often not reimbursed for those costs. From the proclamation:
These costs amount to approximately $7 million on average for each hospital in the United States, and can drive hospitals into insolvency. Beyond uncompensated care costs, the uninsured strain Federal and State government budgets through their reliance on publicly funded programs, which ultimately are financed by taxpayers.
The order then goes on to claim that immigrants are three times more likely to be uninsured - a claim with no reference. The implication being they are three times more likely to access emergency services and be an extra burden on “U.S. taxpayers.” Is this true?
No. Last year the International Journal of Health Services published an article summarizing 188 peer-reviewed articles published over an 18 year period. The findings were quite the opposite of what is claimed here. Authorized immigrants cost the U.S. healthcare system LESS than U.S. born citizens. And, though Trump’s order focused on authorized immigration, it is also worth noting that unauthorized immigrants use even less resources (adjusting for population). From the study:
While annual U.S. medical spending in 2016 was a staggering $3.3 trillion, immigrants accounted for less than 10% of the overall spending – and recent immigrants were responsible for only 1% of total spending. Given these figures, it is unlikely that restrictions on immigration into the United States would result in a meaningful decrease in health care spending. To the contrary, restricting immigration would financially destabilize some parts of the health care economy, as suggested by Zallman and colleagues, who found that immigrants contributed $14 billion more to the Medicare trust fund than they withdrew.
Does the truth matter? That is a whole other question. Politics, as they say, is about perception. And the perception that immigrants - even authorized immigrants - place an inordinate burden on social services is widespread. It is not true - by almost every measure, from crime to healthcare, to access of “welfare” - immigrants cost “the system” less than U.S. born citizens. Nevertheless, people believe the opposite to be true, and that belief is what Trump is playing to. By doing so, he is placing himself in the position of being the one who “finally did something about it.” It doesn’t matter that the “it” is a myth. Hell, Trump might even believe this - I have a hard time imagining him reading peer reviewed health science journals in his free time. But “belief” is not the place one should make policy from. Evidence is.
Setting all that aside - even if Trump is right - the reality is that our healthcare system is a mess already. The problems identified in this order are not created by immigrants. The problems are endemic to the system itself - health care costs are too high, and even post Affordable Healthcare Act many people are still left out of the system. This order only makes sense if you believe that it is the uninsured who drive up the costs of a healthcare system they are too poor to participate in. And that is absurd.
Trump won his election with a minority of the vote by pitching warmed over southern strategy style race-baiting to folks who are nervous about the future. He is governing the same way. Sadly, this means that a simple fact check won’t settle anything. If it did, Trump would have never won a single primary.
I leave you with this: Immigrants actually subsidize U.S. born citizen's healthcare costs. From Modern Healthcare in relation to the same study:
Study co-author Dr. J. Wesley Boyd, an associate professor of psychiatry in Harvard Medical School's Center for Bioethics, said the lower expenditures among insured immigrants seems to indicate that that population makes up a low-risk insurance pool that helps subsidize more frequent healthcare users.
"On average immigrants tend to be younger and healthier than native-born Americans and therefore when they do have health insurance they're contributing more into insurance pools than they're taking out," Boyd said.
Boyd lamented that false preconceptions have informed many substantial policies. (emphasis added).
Trump just added another misinformed policy to the list....