Trump’s Anti-Immigrant Claims on Healthcare Aren’t Just Xenophobic—They’re False
Far from draining the nation’s healthcare coffers, immigrants are actually shoring them up. But that reality is inconvenient for Republicans.
Adam Gaffney
Over the course of his marathon-length speech at the Republican National Convention this July, presidential nominee Donald Trump said little about healthcare — a top issue for voters — except as an excuse to scapegoat immigrants over the cost of care. “Democrats are going to destroy Social Security and Medicare because all of these people, by the millions, they’re coming in. They’re going to be on Social Security and Medicare and other things and you’re not able to afford it,” he baselessly asserted. After President Joe Biden’s exit from the race and the emergence of Vice President Kamala Harris (herself the daughter of immigrants) as the presumptive nominee, the line of attack may well intensify.
It is, of course, nothing new. In the June 27 presidential debate, Trump claimed that migrants were “taking over our schools, our hospitals, and they’re going to be taking over Social Security.” The sentiment is also echoed in the GOP’s Trump-endorsed platform, which promises that “Republicans will protect Medicare’s finances from being financially crushed by the Democrat plan to add tens of millions of new illegal immigrants to the rolls of Medicare.”
Yet while assertions about immigrants sapping the nation’s healthcare dollars are nakedly xenophobic, they are also numerically false: numerous studies have conclusively demonstrated that far from undermining the financing of programs like Medicare and Medicaid, immigrants actually shore them up — contributing more in tax dollars (or premium contributions) than they use in services. That’s to say, a central plank of Republicans’ healthcare platform is not just bigoted, it’s also based on bogus math.
Trump’s right-wing healthcare nationalism is part of a broader, and dangerous, transnational agenda — one that threatens the health of immigrant communities globally while undermining the solidaristic core of public health insurance programs like Medicare or universal systems abroad. During his first administration, for instance, Trump implemented rules declaring legal immigrants who use Medicaid — the public insurance program serving many low-income and disabled people — “public charges,” or persona non grata, jeopardizing their ability to advance their residency status and scaring many away from using services. Meanwhile, in France, the far-right National Rally party campaigned on a promise to deny healthcare services to migrants.
Similarly, last year, Republican Florida Gov. Ron DeSantis signed a bill requiring that hospitals collect information on the immigration and legal documentation status of their patients and then forward the results to the state — likely intimidating some from seeking care. The state put this data to propagandistic use in a report issued earlier this year claiming that undocumented immigrants imposed $566 million in healthcare costs on Florida, and asserting that undocumented immigrants’ care “will continue to put a strain on limited health care resources and drive-up healthcare costs.”
The methodology of DeSantis report was beyond dubious: the state didn’t bother to account for a single dollar in payments made by, or on behalf of, any of these individuals for their care, among other errors. But dodgy math was a necessity to reach the conclusion they were after, since scapegoating immigrants for our healthcare woes all but requires fabrication.
A series of seminal studies led by my late colleague Dr. Leah Zallman — a primary care physician at the Cambridge Health Alliance and an Assistant Professor at Harvard Medical School who was killed tragically by a motor vehicle several years ago — established that immigrants’ contributions to health insurance programs exceed spending by these programs for their care. In a 2013 study published in the healthcare policy journal Health Affairs, Zallman and her colleagues found that immigrants contributed $33.1 billion to the Medicare trust fund, but used only $19.3 billion in services.
In a follow-up study, they found that from 2000 to 2011 contributions by undocumented immigrants into the Medicare trust fund were $35.1 billion higher than their withdrawals, such that this population extended the solvency of the Medicare trust fund. Another of their analyses found that immigrants contributed 12.6% of total private health insurance premiums, but received only 9.1% of these plans’ dollars for care — equating to $174.4 billion in “net” contributions from 2008 to 14.
After her death, Zallmans’ colleagues extended her work and looked at the overall healthcare system. They found that while immigrants’ and non-immigrants’ monetary contributions to the U.S. healthcare system were similar to their respective shares of the population, immigrants’ share of U.S. healthcare spending was disproportionately low, particularly for undocumented immigrants. The takeaway: from 2012 to 17, immigrants contributed $184.2 billion more into the healthcare system than they received in care. Immigrants don’t sap the nation’s healthcare dollars. Rather, they subsidize the costs of U.S.-born individuals like me.
Some of this reality reflects simple demographics. Recent immigrants tend to be younger and healthier (and so have lower healthcare needs) than the U.S.-born population, and they tend to have a high labor-force participation rate. Yet it is also a story of inequity. Lack of health coverage, difficulty affording out-of-pocket costs, and language barriers all-too-often deter immigrants from receiving the care they need.
In my clinical work as an ICU physician at a health system that cares for immigrant communities north of Boston, I’ve seen time and again immigrant patients arrive in critical condition due to years of inadequate medical attention. Such injustices are the real scandal — not made-up claims about immigrants’ supposedly draining our healthcare coffers.
Yet right-wing healthcare nationalism remains such a pernicious threat, facts be damned, because it harnesses legitimate concerns about healthcare system costs and access to care, and uses them in service of illegitimate xenophobia. Care is far too often unaffordable and unavailable for both immigrants and U.S.-born individuals alike — for working class Americans of every demographic.
As a result, it’s not enough to push back on Trump’s bigoted claims. Instead, Democrats (including Vice President Harris) should put forth a positive, progressive vision for expanded healthcare for all to confront the exclusionary and ugly healthcare nationalism of the Right.
Disclosure: The views expressed in this article are held by the author. As a 501(c)(3) nonprofit, In These Times does not support or oppose any candidate for public office.
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Adam Gaffney is an Assistant Professor at Harvard Medical School and a pulmonary and critical care physician at the Cambridge Health Alliance.
