National Data | RAND Study Concedes Immigrant Health Care Burden—But Not Enough
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A flurry of recent MSM stories proclaimed what we've been reporting on VDARE.COM for years: the celebrated problem of "Americans without health insurance" has a significant immigration dimension—many of these "Americans" are actually immigrants.

(For that matter, I helped Peter Brimelow make an estimate of this phenomenon for his much-denounced immigration book Alien Nation back in 1995).

The stories were triggered by a recent RAND Corporation study that analyzed data from Los Angeles. Its conclusion: Illegal aliens accounted for about a third of the growth of adults without health insurance between 1980 and 2000. [Legal Status And Health Insurance Among Immigrants, Health Affairs, Vol. 24, Issue 6, 1640-1653, Dana P. Goldman, James P. Smith and Neeraj Sood]

But the RAND study also claims that illegals use taxpayer-funded public health programs far less than many of us thought.

RAND researchers found that uninsurance rates vary dramatically by immigration status:

  • 68 percent of  illegals lack health insurance


  • 17 percent of native-born


  • 23 percent of naturalized citizens


  • 38 percent of green-card holders

But the RAND study selects its data and time periods so as to understate the burden imposed by immigrants on the U.S. health care system.

For starters, it focuses on adult illegals, ignoring the fact that their U.S.-born citizen children are eligible for the full gamut of public health benefits. There are approximately three million such "anchor babies" in the country.

And adult illegals, even if ineligible for Medicaid, are routinely treated in hospital emergency rooms. In some hospitals as much as two-thirds of total operating costs are for uncompensated ER care for illegals. [FAIR, "The Sinking Lifeboat: Uncontrolled Immigration and the U.S. Healthcare System."] The RAND study simply ignores this practice.

And, as I reported in an earlier column, ER admissions often result in a "permanent disability" diagnosis, which in turn automatically qualifies individuals for Supplemental Security Insurance—a federally funded cash transfer.

Not the least of the RAND study's artful deceptions results in its low estimate of illegals' Medicaid usage. RAND extrapolates the Los Angeles experience to the rest of the U.S. Only eight percent of the illegal aliens surveyed by RAND participated in Medi-Cal, California's Medicaid program.

But this is hardly representative of the rest of the U.S. In 1994 Californians passed Proposition 187, denying Medicaid (and almost all other types of assistance) to illegal aliens residing in California. Although most of Prop.187's provisions were judicially sabotaged, it did have a chilling effect on immigrant recipiency. Harvard's George Borjas writes: "The relative decline in immigrant participation in welfare at the national level can be attributed entirely to what happened in California." [George J. Borjas, "The Impact of Welfare Reform on Immigrant Welfare Use," CIS, March 2002.]

The Medicaid bottom line: nearly one in four (23.0 percent) of all illegal immigrants in the U.S. participate in Medicaid, according to CIS. That's nearly three times the eight percent rate claimed by RAND.

Furthermore, RAND's assertion that illegals account for only one-third of the growth in the uninsured population over the past two decades (1980-2000) leaves the misleading impression that this figure obtains evenly throughout the period. But not only did illegals enter in far greater numbers in 2000 than in 1980, they were also more likely to be mired in low wage jobs that do not offer health insurance. This is even more the case today.

And legal immigrants are entering the uninsured ranks at even faster rates than illegals, thanks in part to the five-year waiting period for health insurance eligibility imposed by the 1996 welfare reform. This change has pushed the immigrant (legal and illegal) share of uninsured growth from one-third between 1994 to 1998 to 86 percent between 1998 and 2003.  

Nearly ninety percent of recent uninsured growth due to immigration? That may sound fanciful—perhaps an exaggerated claim made by anti-immigration fanatics. But in fact, this figure is from a June 2005 report of the non-partisan Employee Benefit Research Institute.

Final thought: the RAND report's co-author James P. Smith was also responsible for deep-sixing the devastating welfare dependency findings of the 1997 National Academy of Science report The New Americans.

Smith has a track record of unscrupulous immigration enthusiasm. Ask him why.

Edwin S. Rubenstein (email him) is President of ESR Research Economic Consultants in Indianapolis.

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