May
29, 2013
http://www.nytimes.com/2013/05/30/health/immigrants-give-more-to-medicare-than-they-receive-a-study-finds.html?pagewanted=all&_r=0
Immigrants have contributed billions of dollars more to Medicare in recent years than the program has paid out on their behalf, according to a new study, a pattern that goes against the notion that immigrants are a drain on federal health care spending.
The
study, led by researchers
at Harvard Medical School, measured immigrants’ contributions to the part of
Medicare that pays for hospital care, a trust fund that accounts for nearly
half of the federal program’s revenue. It found that immigrants generated
surpluses totaling $115 billion from 2002 to 2009. In comparison, the
American-born population incurred a deficit of $28 billion over the same
period. Immigrants have contributed billions of dollars more to Medicare in recent years than the program has paid out on their behalf, according to a new study, a pattern that goes against the notion that immigrants are a drain on federal health care spending.
The
findings shed light what demographers have long known: Immigrants are crucial
in balancing the age structure of American society, providing an infusion of
young, working-age adults who support the country’s aging population and help
cover the costs of Medicare and Social Security. And with the largest
generation in the United States, the baby boomers, now starting to retire, the
financial help from immigrants has never been more needed, experts said.
Individual
immigrant contributions were roughly the same as those of American citizens,
the study found, but immigrants as a group received less than they paid in,
largely because they were younger on average than the American-born population
and fewer of them were old enough to be eligible for benefits. The median age
of Hispanics, whose foreign-born contingent is by far the largest immigrant
group, is 27, according to the Brookings Institution. The median age of whites
in the United States is 42.
The
study, which was published on the Web site of the journal Health Affairs on
Wednesday, comes as Congress considers legislation that would eventually give
legal status to the country’s 11 million unauthorized immigrants. The
legislation has sparked a vigorous debate about whether immigrants ultimately
contribute more than they receive from the federal budget. One of the sticking
points has been whether immigrants should be eligible for government programs,
including health benefits, before they qualify for citizenship, but while they
are on the path to getting it.
The
study was concerned only with Medicare, the federal program that accounts for
about a fifth of all American health care expenditures. Experts said that the
study’s findings served as a useful reminder that immigrants, at least for now,
are extending the life of the beleaguered program, not hastening its demise.
“There’s
this strong belief that immigrants are takers,” said Leighton Ku, the director
of the Center for Health Policy Research
at George Washington University. “This shows they are contributing hugely.
Without immigrants, the Medicare trust fund would be in trouble sooner.” The
belief prevails, for example, among some opponents of immigration reform.
The
study did not grapple with the health care costs of immigrants over their full
lifetimes, a calculation that economists say is critical to understanding their
long-term impact on the federal budget.
“It’s
just a snapshot of a point in time,” said Paul Van de Water, a visiting fellow at
the liberal-leaning Center on Budget and Policy Priorities.
The
study drew on two nationally representative federal surveys from the Census
Bureau and the Department of Health and Human Services. Researchers included
the contributions of legal residents who were not citizens, a group that is
eligible for Medicare if certain requirements are met; unauthorized immigrants;
and citizens who were born abroad.
It
was not clear how much of the surplus was made up of earnings by immigrants in
the country illegally, who are ineligible for most government programs.
The
finding “pokes a hole in the widespread assumption that immigrants drain U.S.
health care spending dollars,” said Leah Zallman, an instructor of medicine at
Harvard Medical School and the lead author of the study.
Similar
calculations have been made for Social Security. The chief actuary of the
Social Security Administration, Stephen C. Goss, estimated that immigrants
in the country illegally, some of whom assume fake Social Security numbers to
provide cover for employers, generated a surplus of about $12 billion for the
Social Security Trust Fund in 2010.
But
that equation would change if unauthorized immigrants were to gain legal status
under a new law and eventually began collecting Social Security once they were
of retirement age. One major policy question is how much that might cost,
experts said.
The
Heritage Foundation, a conservative institute, estimated that the
legislation’s changes, if implemented, could cost taxpayers more than $6
trillion. Critics of that calculation said it did not take into account the
economic benefits that would arise from taking millions of people out of the
shadow economy.
Mr.
Goss, in a letter this month to
Senator Marco Rubio, a Florida Republican, said that the legislation’s effect
on the long-term health of Social Security would be positive in the long term.
Immigrants
tend to be healthier than American-born citizens, and have lower mortality
rates, research has found. Dr. Ku said there was evidence that individual
immigrants actually use less health care than native-born Americans. He has calculated, for example, that immigrants’ medical
costs were 14 percent to 20 percent less than those who were born in the United
States, even after controlling for other factors such as emergency room visits
and insurance coverage, which fewer immigrants have.
The
study found that average expenditures among immigrant Medicare enrollees in
2009 were $3,923, lower than the average $5,388 expenditure among the
American-born. The difference, however, was just shy of statistical
significance, because of wide variations in medical expenditures and the small
numbers of immigrant enrollees, which made the study’s margin of error wide.
Robert Rector, a senior research fellow at the
Heritage Foundation, who is an author of the institute’s report earlier this
month, said that looking at Medicare alone was not very useful, as it was just
one slice of the entire entitlement pie. And the large immigrant youth
population, which the study spends most of its time on, is familiar, he said.
“It’s
a yawner of a study,” he said. “Young people don’t get Medicare. We don’t need
several Ph.D.s to tell us that.”
Others
defended the findings, saying that they showed immigrants were helping prop up
the country’s retirement funds at the critical point when baby boomers were
starting to retire.
“They’ll
be paying into the system at the very time it is most strained,” said Patrick
Oakford, a researcher on economic and immigration policy at the Center for
American Progress, a liberal-leaning institute. He estimated that the average
undocumented immigrant was 34 and therefore would not retire until 2046.