Medicare and Medicaid Spend More on Native-Born Americans Than Immigrants

Despite anti-immigrant rhetoric, the foreign-born account for nearly 20 percent less public health spending than those born in America.

When immigration opponents make the case for closing the country's borders, one common argument is the costs that immigrants incur. But recent statistics throw cold water on those claims, finding that the foreign-born actually use fewer public health dollars than people born in the U.S.

"Immigrant households have much higher use of…Medicaid (42 percent vs. 23 percent)" than native-born households, according to a 2015 report from the Center for Immigration Studies (CIS).

"Prior research indicates that there are 5.8 million uninsured illegal immigrants in the country in 2019, accounting for a little over one-fifth of the total population without health insurance," CIS Director of Research Steven Camarota told a congressional subcommittee in January. "The costs of providing care to them likely totals some $7 billion annually," though he admitted that number could be lower since "immigrants in general tend to consume somewhat less health care than the U.S.-born, primarily because they are relatively young."

Not so, says the data.

The Medical Expenditure Panel Survey (MEPS) is "a set of large-scale surveys" of Americans and their medical providers that "collects data on the specific health services that Americans use, how frequently they use them, the cost of these services, and how they are paid for," as well as the different ways in which those costs are amortized. MEPS recently released its latest survey, using data from 2022.

"A key feature of the survey is that it reports the actual dollar amounts spent by birthplace, which no other survey does," writes David J. Bier, director of immigration studies at the Cato Institute.

What this allows the survey to demonstrate is that between 2002–2022—with the exceptions of 2004–2006 and 2013, in which no birthplaces were recorded—foreign-born respondents accounted for 18.6 percent less Medicare and Medicaid spending than their native-born counterparts. On average, this amounted to $1,775 per person in 2022 dollars, compared to $2,180 per person among those born in the U.S.

Bier breaks down the numbers even further to demonstrate that this trend holds across each year in the sample for which data was available: In 2022, the most recent year recorded, U.S.-born patients cost the health agencies $2,691 apiece, while foreign-born cost $2,116 each. The closest the two groups ever came to parity was in 2015, when the U.S.-born cost $2,312 and the foreign-born cost $2,233.

"Despite their lower incomes, immigrants are less likely to use publicly funded health care for several reasons," Bier writes. "Most importantly, they are younger, but even controlling for age, immigrants tend to be healthier and participate in fewer high-risk activities. In addition, their eligibility for Medicare and Medicaid is more limited than for the US-born population….Finally, some eligible immigrants also do not enroll in these programs out of ignorance or fear about its immigration effects."

In fairness, the numbers are not as straightforward as comparing immigrants to natural-born citizens: The survey only notes a respondent's birthplace, not their immigration status. So then, Sen. Ted Cruz (R–Texas)—who was born in Canada to American parents but is, legally speaking, a "natural born citizen"—would be counted among the foreign-born, while the U.S.-born children of noncitizens would be counted among the native-born.

Nonetheless, the numbers paint a stark portrait that counters the doomsayers' predictions that increasing the flow of immigrants across our borders would necessarily overwhelm our public health systems.

"Democrats are going to destroy Social Security and Medicare because all of these people, by the millions, they're coming in," former President Donald Trump said in his speech at the 2024 Republican National Convention. "They're going to be on Social Security and Medicare and other things and you're not able to afford it. They are destroying your Social Security and your Medicare."

As president, Trump signed a proclamation in 2019 barring any immigrants from entering the country unless they could provide proof of health insurance. "Immigrants who enter this country should not further saddle our healthcare system, and subsequently American taxpayers, with higher costs," Trump noted. (In May 2021, President Joe Biden revoked the order, after his administration had previously indicated it would no longer enforce the rule.)

To be clear, this is to say nothing of the soundness of these programs as a whole: "The best experimental evidence indicates that Medicaid does not improve health outcomes for participants," Bier notes, and "when Congress eliminated Medicaid eligibility for many immigrants in the 1990s," those immigrants predominantly went out and got jobs that offered health insurance.

But the MEPS study demonstrates that despite anti-immigration rhetoric, the foreign-born are not as much of a drain on public resources as we've been warned—at least, not nearly as much as those of us who were born here.