Immigrants in California, both those with legal status and the undocumented, contributed far more in premiums for private health insurance coverage between 2008 and 2014 than their insurers paid out for their care, according to new research we conducted at the Institute for Community Health. California immigrants were responsible for a net contribution of $27.7 billion to private insurers between 2008 and 2014, or an average of $4 billion per year. In contrast, US-born individuals contributed less in premiums during that period than what insurers paid for their care.
Our findings mirror national data published today in Health Affairs. From 2008 to 2014, immigrants in the US made $174 billion in net contributions to private insurers. Privately insured California immigrants were responsible for 15.8% of this national net contribution.
Much of the national debate over the financing of immigrant medical care has centered on uncompensated care and Medicaid, but a more complete understanding requires examination of private health insurance and Medicare. Previous studies published by the Journal of General Internal Medicine and Health Affairs demonstrate that immigrants contribute more than they withdraw from the Medicare Trust Fund, thus subsidizing Medicare.
One-Quarter of Californians Were Born Outside the US
In California, more than one in four residents — just over 10 million people — are immigrants. Eighty-two percent are working age (18 to 64 years old), and 44% are privately insured, meaning they obtain coverage through their jobs or purchase it directly from private insurers.
We knew from previous studies that immigrants, including undocumented immigrants, use less health care (including emergency care [PDF]) than US-born individuals.
Our new study looks at how much care immigrants in California receive and how much they contribute financially to private health insurance. We explored whether contributions to private health insurance through immigrants’ premiums and employers’ contributions on their behalf exceed the amount spent by private health insurers for their care. We used a previously published methodology that analyzed two nationally representative surveys. We analyzed these data to understand insurers’ expenses as well as individual and employer contributions to private health care coverage for immigrants and US-born individuals residing in California.
Per enrollee, immigrants had similar contributions to US-born individuals but lower expenditures, resulting in an average $795 net contribution per enrollee. In contrast, US-born individuals had a $245 per enrollee deficit.
Immigrants’ net contribution to private health insurance in California likely reflects their relative youth and good health, as well as the reluctance of many to seek care because of fear of deportation, stigma, financial barriers (such as inability to afford out-of-pocket costs), and lack of social capital (such as getting time off of work).
Our findings demonstrate that immigrants’ spending subsidizes the care of US-born Californians in the private insurance market. Our findings also raise the question of whether restricting immigration could worsen the private insurance risk pool and raise the premiums of nonimmigrants.
Authors & Contributors
Leah Zallman
Leah Zallman, MD, is director of research at the Institute for Community Health in Malden, Massachusetts, a primary care physician at Cambridge Health Alliance in Cambridge, Massachusetts, and an assistant professor of medicine at Harvard Medical School. Her work has appeared in Health Affairs and the Journal of General Internal Medicine and has been the subject of reporting in the New York Times, Washington Post, and Los Angeles Times.
Sharon Touw
Sharon Touw is an epidemiologist at the Institute for Community Health in Malden, Massachusetts.
Karen Finnegan
Karen Finnegan, PhD, is an epidemiologist at the Institute for Community Health.
