Trump Says Covering All Immigrants Would Bankrupt Our Healthcare System. That’s A Lie.

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Above Photo: We must confront Trump’s State of the Union lies about immigrants’ healthcare. (Photo by Mark Boster/Los Angeles Times via Getty Images)

Covering undocumented immigrants under Medicare for All isn’t just morally right—it’s also economically sound.

Including immigrants in an insurance system, in other words, makes it more actuarially sound.

During his State of the Union address on Tuesday, President Trump put Medicare for All in the crosshairs. Single-payer healthcare will “bankrupt our nation by providing free taxpayer-funded healthcare to millions of illegal aliens,” he seethed, “forcing taxpayers to subsidize free care for anyone in the world who unlawfully crosses our borders.” Like so many of the other claims in Trump’s speech, this one was demonstrably false. If anything, the evidence suggests that immigrants actually subsidize healthcare systems—and it is time for advocates to push back.

For proponents, the case for single-payer is fundamentally a moral one: Healthcare should be a right, and everybody should be covered. This argument, however, is up against the rancorous rhetoric of the demagogic Right, which is not only advancing dehumanizing narratives of exclusion, but also bolstering those narratives with factual inaccuracies. According to one CNN poll, some 59% of the American public is opposed to providing public coverage to the undocumented. Changing this opinion means overturning the right-wing narrative. To do so, we have to make the case that Trump’s claim—that including all U.S. residents in a single-payer system will bankrupt it—is wrong.

A fundamental fact about financing healthcare for immigrants is that they are, compared to the native-born population, relatively young, and therefore healthy. As a result, immigrants tend to use comparatively less healthcare (indeed, too little) relative to those born in the United States. At the same time, they still pay into the system—even undocumented immigrants. Precise numbers are hard to come by, but as Paul Van De Water of the Center on Budget and Policy Priorities has noted, undocumented immigrants were estimated to have contributed a net $12 billion into the Social Security system via payroll taxes back in 2007. Something similar plays out in healthcare. As two important studies led by my colleague Dr. Leah Zallman at Cambridge Health Alliance and Harvard Medical School make clear, in healthcare, immigrants subsidize the U.S.-born.

In a 2013 study published in Health Affairs, Zallman and colleagues examined how much immigrants pay into the Medicare trust fund, relative to how much Medicare spends on their healthcare. They found that while immigrants paid some $33 billion in Medicare taxes in 2009, they only used $19 billion in health services—in other words, they subsidized the trust fund to the tune of nearly $14 billion. In a second study, also published in Health Affairs, researchers turned to private insurance, and a similar picture emerged. Premium contributions from immigrants (including the undocumented) exceeded plans’ outlays on immigrants’ healthcare. In contrast, U.S.-born enrollees contributed less than what they used in care—a deficit of about $163 per native-born person.

Including immigrants in an insurance system, in other words, makes it more actuarially sound. “Immigrants subsidize US natives in the private health insurance market,” the researchers concluded, “just as they are propping up the Medicare Trust Funds.”

Evidence from abroad—in particular, Spain—similarly strengthens the economic case for covering everyone. Spain’s universal system dates back to the 1980s, but as health researcher Helena Legido-Quigley of the London School of Hygiene and Tropical Medicine described with colleagues in Lancet Public Health, the nation passed a law in 2011 that “gave an explicit right to free health care for all people living in Spain, both Spanish and migrant, irrespective of their legal status, making Spain one of the most migrant-friendly health systems in Europe.” Still, it hasn’t been a straightforward path. In 2012, a newly elected conservative government reversed this expansion. They were met, however, with a wave of resistance, including civil disobedience. Some 1,300 doctors and nurses pledged to defy the law and treat immigrants regardless of documentation status, as the British Medical Journal reported. After elections in 2018, the new left-wing government of Pedro Sanchez restored coverage to all.

In 2018 (the latest year of data available from the OECD), Spain spent some $3,323 per capita on healthcare—compared to more than $10,000 in the United States. It seems unlikely that the 2019 figures will change that overall picture much. As such, the policy of extending universal healthcare to immigrants has not bankrupted Spain’s system.

Legido-Quigley and colleagues, writing in the British Medical Journal last year, cite other evidence of cost-savings from European nations, including a study in German that found that a policy of limiting healthcare access for asylum seekers and refugees actually led to larger healthcare costs down the road.

Europe, needless to say, faces the same sorts of right-wing populist forces that we contend with in the United States. Recent conservative governments in the United Kingdom, for instance, have taken steps to restrict access to the National Health Service to migrants. Achieving true universal coverage will be no easier here than abroad. But we should see the impediments as political—not economic.

For advocates of Medicare for All, the moral case for universal healthcare will always be paramount. Even if the above realities were not true, we should still include immigrants in universal coverage, on the basis that healthcare is a human right and no one should be left to die because they can’t afford to go to the doctor, regardless of national origin. However, the claim that immigrants would bankrupt the system is an empirical one that can be disproven, and factual inaccuracies should not be allowed to stand, especially when they are used to amplify xenophobic bombast from President Trump and his right-wing backers. The fact that a Medicare for All system that includes immigrants would be economically sound is one of the many data points we can use to make the case to millions of people that it is our moral imperative to build a Medicare for All system that includes everyone.

  • voza0db

    Has the USofT anything that is not bankrupt?!

    The SRF must be laughing ALL THE TIME when looking down at the Herds!

  • Steven Gaylord

    Trump’s swamp is an ever-growing quagmire as his administration, a carry-over of past administrations, will eventually lead to America’s fall. Could the left wing prove itself any better? No! Using the analogy “left wing, right wing, still the same [damned] bird” reveals that the “enemy from within” that some of this nation’s founders warned us about has come to fruition. My fear now is that anything short of revolution, bloody or otherwise, will not or cannot right the wrongs embedded in our society.

  • voza0db

    That tells me that the Herd is packed with 100% dumb voters.

  • To reduce Defense spending we should rename the program Universal Military Coverage, or something to that effect. We can pointedly direct barbs at the illegals for benefiting off the system by not paying their fair share to the country that keeps them safe. (Partial snark)


    IMMIGRANTS WORK AND PAY TAXES. THEY HAVE A RIGHT TO HEALTH CARE AND OTHER SERVICES. How is it possible that the capitalist is able to gain a higher value for the same merchandise? The answer is labor power. What value does labor power have? The value of each merchandise is determined by the amount of labor necessary to produce. Labor power is exercised by real people, including immigrants, who have needs for themselves and their families. The time that is necessary for the production of such resources is what determines the value of labor power. Suppose there is a six hour day. When the capitalist hires the worker, he will pay a full day that expresses six hours of work. The worker works his six hours and is paid for six hours. But this does not make capital out of money, because there is no profit. He who buys the labor power of the worker sees it differently. . The worker works 12 hours instead. The value of the labor force, and the value created by the labor force are two different things. The value that the worker gains for the capitalist is for 6 hours, while the value that the worker gives to the capitalist is the product of 12 hours. The owner of the money pockets the difference . Six hours are not paid for, 6 hours are. There has been a sleight of hand that transforms money into capital. The work that is not paid for is exactly what creates capital. This unpaid labor supports all who do not work in the society, and is used for taxes, the cost of the land, machinery, etc. The salaried worker creates the money necessary for his maintenance during part of the day. This is called necessary work time. The other half is complementary time. The worker with complementary labor creates profit, which is unpaid labor appropriated by the owner, who is not interested in the means of production (raw materials, machinery, capital goods), consumer goods, anything useful for society, but is only interested in the greatest profit possible.

  • chetdude

    Bottom line:

    Leaving the current for-profit, corporate, remedial sick care industry in place (especially the leeches that comprise the “insurance industry) even with “medicare for some” as an alternative ‘semi-privatized’ insurance corporation – WILL COST AT LEAST $50 Trillion** over the next 10 years while leaving tens of millions out in the cold (with a few hundred thousand dead from lack of access) and bankrupt millions of folks.

    HR1384 – Expanded and Improved Single-Payer Medicare for ALL will cost about $30-32 Trillion** over the next 10 years, cover everyone for everything necessary without bankruptcies.

    ** To give you an idea of the trend: Actual 2018 spending on “health care” – $3.4 Trillion, in 2019 – $3.7 Trillion…

  • chetdude

    What would happen if in everyone’s paycheck showed a deduction every month for $900 PER MONTH for “Universal Military Coverage” — the working person’s monthly premium that’s required to finance the USAmerican bloated war machines.

    I wonder if there would be a demand for the Forever War to be ended.