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Are undocumented residents a major drain on public and private health care resources?


What’s Behind It?

Recent immigrants comprise a growing share of California's population. Some members of these groups, though not all, are undocumented. Under federal law, emergency rooms cannot turn patients away based on citizenship status. Many community clinics and other safety-net providers also treat patients regardless of their documentation status. Linking demographic shifts to increasing demands on emergency rooms and the safety net, some suggest that the undocumented are a major drain on California's health care providers and on budgets for public health care programs.


The Broader Picture

Undocumented residents represent a relatively small share of California's immigrant, Latino, and uninsured populations. While almost one third of California residents are Latino and one in four residents is foreign born, only about 7% of the state's total population is undocumented. While precise counts are impossible, some studies estimate that about one in five uninsured Californians is an undocumented immigrant.

Undocumented immigrants use fewer health services than citizens and documented residents. A recent study conducted by experts from the UCLA School of Public Health analyzed data from over 40,000 participants and concluded that undocumented immigrants from Mexico and Latin America are 50% less likely than US born Latinos to use emergency rooms in California. The same study found that after accounting for age, health status, insurance status, and poverty level, undocumented immigrants still made fewer visits to physicians and were 30% less likely than U.S.-born Latinos to have a consistent source of health care. There are at least two likely reasons that undocumented immigrants are disproportionately low users of health care services.

  • Undocumented immigrants tend to be younger and healthier than the average Californian. Research from the Pew Hispanic Center estimates that one in six undocumented immigrants is a child and that only 11% are age 40 or older. A RAND survey in Los Angeles County -- one of the few formal studies to gather reliable data on documentation status -- found that just 19% of undocumented immigrants reported having a chronic health condition, compared to 38% of the native residents.
  • Some undocumented immigrants avoid using the health care system. In addition to being less reliant on the health care system because of better health status, some undocumented immigrants avoid seeking health services even when they do need care. They may avoid interacting with the health care system because they lack insurance or other means to pay, because they are unfamiliar with the U.S. health system, or because they are concerned they might be queried about their citizenship status. Among male undocumented residents, 40% had never received a check-up, compared to 19% of male citizens.

When they use health services, undocumented immigrants are less reliant on public funds to pay for their care. RAND found that both documented and undocumented immigrants are more likely than native Californians to pay health care costs out of pocket rather than rely on public funds. For example, undocumented immigrants pay, on average, 36% of their medical costs out of pocket and 23% of their medical costs are paid with public funds. Native born Californians pay about 20% of their health care costs out of pocket and 28% of their medical costs are paid with public funds.


The Bottom Line

Undocumented Californians comprise a smaller share of the uninsured than some assume. Further, the undocumented use fewer health care services and, when they do access care, are more likely than citizens and documented residents to pay their own way rather than rely on public funds.

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