Immigrants paid $24.7 billion more into private insurance than was spent on their care: Harvard researchers

Study published today in Health Affairs finds that immigrants boost the profits of private insurers, heavily subsidize the benefits of U.S.-born enrollees


Contacts: Leah Zallman, M.D., M.P.H., Institute for Community Health and Harvard Medical School,; Clare Fauke, PNHP communications specialist,

Immigrants pay billions more in private insurance premiums than insurers pay out for their care, according to a new study by researchers from Harvard Medical School and the City University of New York at Hunter College. The study, the first to look at immigrants' role in financing private health insurance, found that immigrants paid $88.7 billion in private insurance premiums but used only $64.0 billion in insurer-paid health care, generating a surplus of $24.7 billion in 2014. Between 2008 and 2014, immigrants generated a cumulative surplus of $174.4 billion.

On a per-enrollee basis, the study found that immigrants provided an average premium-over-payout surplus of $1,123 each, while U.S.-born Americans incurred an average deficit of $163 each. Undocumented immigrants, who generally use little medical care, generated the largest surplus at $1,445 per enrollee. Previous research shows that insurance outlays for immigrants are low because they are relatively young and healthy, and often face linguistic and other barriers to care.

Researchers used data from the Medical Expenditure Panel Survey and the Census Bureau’s Current Population Survey to determine immigrants' premium contributions to private insurance, including premiums that employers paid on their behalf (which economists consider part of employees' earned compensation). Then they tabulated all payments that private insurers made to doctors, hospitals, and other providers for immigrants' care to determine whether immigrants paid more or less into private insurance than they used.

The authors note that since undocumented immigrants or those residing legally in the U.S. for fewer than five years are not eligible for Medicaid and Medicare, private insurance is often immigrants’ only coverage option. Because immigrants are mostly working-age adults with high rates of labor force participation, many enroll in job-based coverage. 

“Almost every day I see immigrant patients who avoid seeking the care they need to stay healthy,” said lead author Dr. Leah Zallman, director of research at the Institute for Community Health, physician at Cambridge Health Alliance, and assistant professor of medicine at Harvard Medical School. “Political leaders have created a climate of fear by blaming immigrants for driving up health care costs. However, this study and our prior research shows that by paying more into the system than they receive, immigrants actually subsidize both private insurance and Medicare for U.S.-born citizens.”

“Immigrants contribute tens of billions to our health economy, and account for 21% of all doctors in the U.S.,” said Dr. Steffie Woolhandler, professor of health policy at Hunter College, City University of New York, and lecturer in medicine at Harvard Medical School. “Reducing immigration could weaken both the private insurance risk pool and the Medicare Trust Fund, making insurance more expensive for everyone else.”


Immigrants Pay More in Private Insurance Premiums Than They Receive in Benefits” Leah Zallman, M.D., M.P.H., Steffie Woolhandler, M.D., M.P.H., Sharon Touw, M.P.H., David Himmelstein, M.D., Karen Finnegan, P.h.D., Health Affairs, Oct. 1, 2018. DOI: 10.1377/hlthaff.2018.0309

A copy of the full study is available to media professionals upon request from Ms. Fauke.

Physicians for a National Health Program ( is a nonprofit research and educational organization of more than 22,000 doctors who support a single-payer national health program. PNHP had no role in funding or otherwise supporting the study above.