Saturday, February 08, 2020

Debunking some immigration myths

There is a common complaint about immigration that migrants are a drain on the health services of the host nation. Recent conservative governments in the United Kingdom have taken steps to restrict access to the National Health Service to migrants. Migrants rarely bring infections that pose a threat to the host population but denying them treatment may create risks.

 This article disputes this by citing research.

In the USA, Paul Van De Water of the Center on Budget and Policy Priorities has noted, undocumented immigrants were estimated to have contributed a net $12 billion into the Social Security system via payroll taxes back in 2007. Something similar plays out in healthcare. As two important studies led by Dr. Leah Zallman at Cambridge Health Alliance and Harvard Medical School make clear, in healthcare, immigrants subsidize the U.S.-born.

A 2013 study published in Health Affairs, Zallman and colleagues examined how much immigrants pay into the Medicare trust fund, relative to how much Medicare spends on their healthcare. They found that while immigrants paid some $33 billion in Medicare taxes in 2009, they only used $19 billion in health services—in other words, they subsidized the trust fund to the tune of nearly $14 billion. 
In a second study, also published in Health Affairs, researchers turned to private insurance, and a similar picture emerged. Premium contributions from immigrants (including the undocumented) exceeded plans’ outlays on immigrants’ healthcare. In contrast, U.S.-born enrolees contributed less than what they used in care—a deficit of about $163 per native-born person. Including immigrants in an insurance system, in other words, makes it more actuarially sound. “Immigrants subsidize US natives in the private health insurance market,” the researchers concluded, “just as they are propping up the Medicare Trust Funds.”

Evidence from  Spain similarly strengthens the economic case for covering everyone. It passed a law in 2011 that “gave an explicit right to free health care for all people living in Spain, both Spanish and migrant, irrespective of their legal status, making Spain one of the most migrant-friendly health systems in Europe.”  In 2012, a newly elected conservative government reversed this expansion. They were met, however, with a wave of resistance, including civil disobedience. Some 1,300 doctors and nurses pledged to defy the law and treat immigrants regardless of documentation status. After elections in 2018, the new left-wing government of Pedro Sanchez restored coverage to allIn 2018 Spain spent some $3,323 per capita on healthcare—compared to more than $10,000 in the United States. It seems unlikely that the 2019 figures will change that overall picture much. As such, the policy of extending universal healthcare to immigrants has not bankrupted Spain’s system.

A study from Germany that found that a policy of limiting healthcare access for asylum seekers and refugees actually led to larger healthcare costs on the long term.  Furthermore, a study in several European countries found that extending access to primary care achieved large savings in direct medical and non-medical costs. Both studies concluded that inclusion of migrants in health systems reduced the risk of health conditions—which could be treated cheaply—progressing to complex and expensive illnesses. 

In conclusion, migrant inclusive health systems reduce long term health expenditure, help to tackle shortages of workers, especially in the health and social care sectors, boost economic growth, and promote social integration in host countries.

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