By Carolyn Crist

(Reuters Health) – The roughly 50 percent of immigrants in the U.S. who have private health insurance coverage contribute more to the risk pool than they receive in benefits, a new study suggests.

As U.S. lawmakers continue to tackle immigration reform, knowing whether immigrants burden or subsidize the nation’s healthcare system could be helpful, researchers write in Health Affairs.

“If we’re talking about reform, we need to understand the consequences of policies put in place and the repercussions on many parts of our country,” said study leader Dr. Leah Zallman, director of research at the Institute for Community Health in Malden, Massachusetts.

Recent narratives about immigrants and the healthcare system paint a picture of packed emergency rooms and patients who can’t pay their bills. But many U.S. immigrants are young, healthy and able to get employer-provided insurance, and when these people are taken into account, the insurance premiums they’re paying might actually bolster the healthcare system, Zallman said in a phone interview.

Zallman and colleagues analyzed national data from the Medical Expenditure Panel Survey to understand private insurers’ expenditures on behalf of enrollees and the premiums paid. They linked that data with National Health Interview Surveys to determine citizenship and immigrant status. They also assessed employer contributions to private insurance by analyzing data collected by the Census Bureau.

The researchers specifically looked at private insurance outside of the Affordable Care Act Marketplace.

They found that immigrants accounted for 12.6 percent of premiums paid to private insurers in 2014 but made up 9.1 percent of the insurers’ expenditures on beneficiaries. Within this group, undocumented immigrants accounted for 2.4 percent of premiums paid and 1.3 percent of expenditures. In contrast, people born in the U.S. accounted for 87.4 percent of premiums paid to insurers and 90.9 percent of expenditures.

Similarly, immigrants’ annual premiums exceeded their expenses by $1,123 per enrollee, or a total of $24.7 billion. In contrast, U.S.-born beneficiaries’ expenses exceeded their premiums by about $24 billion. The immigrants’ contributions therefore offset a deficit of $163 per U.S.-born enrollee, the study authors write. Overall, this subsidy persisted even after immigrants had been in the U.S. for 10 years.

“We live in a political time that is questioning the costs and benefits of immigration, and it’s a question that’s been analyzed for many decades now,” said Arturo Vargas Bustamante of the University of California, Los Angeles Fielding School of Public Health, who wasn’t involved in the study.

“To have a functional health insurance system, we need the rich to subsidize the poor, the healthy to subsidize the unhealthy and the young to subsidize the old,” he said in a phone interview. “The basic question is, ‘Who is subsidizing who?'”

Future research should look at what would happen if immigration reform influenced the health insurance risk pool, particularly if policies curtailed immigration and reduced the number of people with private insurance who boost it, Vargas Bustamante said.

“There are many different steps that must be taken next, including whether these findings hold up for different populations of immigrants, such as country of origin, and a more detailed examination of state immigration and healthcare policies,” said James Stimpson of the Drexel University Dornsife School of Public Health in Philadelphia, who wasn’t involved in the study.

“Immigrants may be a net financial benefit to the health care system and efforts to reduce the number of immigrants could have a negative impact on health insurance premiums for U.S. natives,” he said by email.

SOURCE: Health Affairs, online October 1, 2018.