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How American Citizens Finance $18.5 Billion In Health Care For Unauthorized Immigrants





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A map of Mexico as it was in 1794 is displayed as young immigrants and their supporters rally in support of Deferred Action for Childhood Arrivals (DACA) in Los Angeles, California on September 1, 2017. A decision is expected in coming days on whether US President Trump will end the program by his predecessor, former President Obama, on DACA which has protected some 800,000 undocumented immigrants, also known as Dreamers, since 2012. / AFP PHOTO / FREDERIC J. BROWN (Photo credit should read FREDERIC J. BROWN/AFP/Getty Images)

I recently did an interesting interview with Dan Gorenstein, a health care reporter with station WHYY and NPR’s radio business show Marketplace on the issue of tax-financed health care for unauthorized immigrants [1]. The piece that aired did not include any of my remarks, but I thought it would be useful to give readers my perspective on this knotty policy question based on both background research I did to prepare for the interview and follow-on research I did in light of the questions posed in the interview.

Current federal policy is to prohibit federal tax funding of health care to unauthorized immigrants through either Medicaid or Obamacare. Nevertheless, rough estimates suggest that the nation’s 3.9 million uninsured immigrants who are unauthorized likely receive about $4.6 billion in health services paid for by federal taxes, $2.8 billion in health services financed by state and local taxpayers, another $3.0 bankrolled through “cost-shifting” i.e., higher payments by insured patients to cover hospital uncompensated care losses, and roughly $1.5 billion in physician charity care. In addition to these amounts, unauthorized immigrants likely benefit from at least $0.9 billion in implicit federal subsidies due to the tax exemption for nonprofit hospitals and another $5.7 billion in tax expenditures from the employer tax exclusion.

All told, Americans cross-subsidize health care for unauthorized immigrants to the tune of $18.5 billion a year . Of this total, federal taxpayers provided $11.2 billion in subsidized care to unauthorized immigrants in 2016 .

In this post, I describe in more detail current policy, current sources of funding for health care of unauthorized immigrants. In a follow-on post, I will offer four independent reasons federal tax funding for such care is a bad idea (that is, a reader need only accept one, not all, in order to conclude we should dispense with such funding).

Current Policy Regarding Federal Funding of Health Care for Undocumented Immigrants

The purported intent of federal policy is to prevent federal tax dollars from being used to fund health care for unauthorized immigrants except in extreme circumstances. Notwithstanding express prohibitions contained in the statutes related to Medicaid and Obamacare, there also are companion federal programs that permit federal funding to be used for health care of unauthorized immigrants indirectly.

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