Former President Donald Trump’s bumbling responses on healthcare in his debate with Vice President Kamala Harris last month earned well-deserved mockery. “Concepts of a plan” to replace the Affordable Care Act has become an instant classic of what not to say on national television. Yet Trump does have a plan to reduce healthcare costs. It’s ugly, won’t really save any money, and is based on a 180-degree reversal of reality, but it’s a plan nonetheless: mass deportation.
Trump and the Republican Party insist that millions of undocumented immigrants “have driven up the cost of … Healthcare for American families.” Trump also says Democrats plan to “add tens of millions of new illegal immigrants to the rolls of Medicare” and bankrupt the program that helps elderly and disabled Americans afford medical care. To Donald Trump, healthcare is another reason to round up millions of people and ship them out of the country.
Mr. Trump has it backwards. Outside his cat-eating fantasy world, undocumented immigrants spend large portions of their income subsidizing healthcare for the rest of us, and certainly for elderly and disabled Americans.
Economists from the Institute on Taxation and Economic Policy (ITEP) recently estimated that undocumented immigrants paid $96.7 billion in federal, state and local taxes in 2022—$59.4 billion to the federal government and $37.3 billion to state and local governments.
According to ITEP, about a third went to Social Security and unemployment insurance, which are set aside for specific purposes. Of the rest, my healthcare newsletter Healing and Stealing estimates that—based on the percentage of federal, state, and local government spending that goes to health care—undocumented taxpayers paid $24.2 billion in taxes that governments ultimately spent on health insurance and other healthcare programs in 2022 (more details on this calculation here). That includes $2.2 billion spent in Texas: $921 million paid directly to the state and local governments, along with another $1.3 billion in federal taxes eventually spent in the state. Nearly all of that money was spent on healthcare for anyone and everyone except undocumented immigrants themselves.
$8.8 billion (per Healing and Stealing) in taxes for Medicare? Undocumented elderly and disabled people are ineligible for Medicare.
$2.6 billion in taxes for healthcare for federal, state, and local civilian employees, veterans, and active-duty military? Undocumented immigrants can’t legally work for the government or join the military. Yet they help pay for health insurance for immigration enforcement agents, U.S. military and diplomatic personnel stationed in their home countries, and millions of other government workers.
$5.5 billion for Medicaid, which covers the poorest Americans? Medicaid’s doors are open to undocumented people—but only a crack. By law, state Medicaid programs have to pay for emergency care for anyone who shows up in the emergency room, but most states won’t enroll undocumented immigrants in coverage that pays for doctors, drugs, lab tests, and non-emergency hospitalization.
These restrictions are changing slowly. Federal law allows states to enroll people in Medicaid or similar programs regardless of immigration status, but they must prove they’re only using state-collected funds. Six states and the District of Columbia have programs that cover at least some undocumented residents, but patients have to be poor enough just like everyone else. Meanwhile, undocumented taxpayers pay $3.6 billion in federal taxes for Medicaid for everyone else.
$1.9 billion to subsidize private employment-based health insurance? Although technically barred from work, some undocumented workers do end up with employer-sponsored coverage. But not many.
In surveys by the Kaiser Family Foundation and Los Angeles Times, half of all “likely undocumented” immigrants said they were uninsured, a rate ten times that for citizens.
Although barred from most government healthcare programs, undocumented taxpayers pay more in healthcare taxes than the entire estimated cost of their own healthcare. University of Utah economics professor Fernando Wilson and colleagues found that healthcare for undocumented adults cost, converted to 2022 dollars, $1,880 per person. At that rate, healthcare for the 11 million people living in the U.S. without legal authorization would have cost $20.7 billion that year, $3.5 billion less than undocumented taxpayers paid in taxes for healthcare.
Trump’s claim that Democrats plan to give “tens of millions” of undocumented immigrants “free healthcare” is phony too. The Biden administration did issue a rule allowing people receiving Deferred Action for Childhood Arrivals (DACA) to get subsidies for Obamacare exchange coverage. That’s not free, and it doesn’t cover “millions.”
The Biden administration estimates that the rule will benefit a little more than 100,000 DACA-covered “Dreamers,” all of whom have lived here for years and will have to pay the same Obamacare premiums as citizens.
Of course, the Democrats aren’t really offering anyone much that resembles “free” healthcare. Vice President Harris supported Medicare for All briefly in 2019, but she is running from it faster than a U.S. Olympian sprinting to a French doctor for free care (ditto for her positions on immigration). Her vague promise to “build on the ACA” wasn’t as comical as Trump’s response, but it wasn’t much better substantively. Medicare for All would deliver tax-financed healthcare to every U.S. “resident” without premiums or deductibles, but without White House support it’s going nowhere. Moreover, even Medicare for All punts on undocumented taxpayers: The current bills leave “resident” to be defined in regulations.
In a toxic 2024 political environment, state-level politicians and activists are left fighting to expand Medicaid, including in Texas. Medicaid is an American paradox—a desperately needed lifeline for millions of people and an underfunded nightmare that requires you to prove you’re destitute enough to deserve healthcare, keep proving it every year, struggle to find actual doctors that will take your coverage, fight through the bureaucratic rules set up by the private insurance companies that most states force you to use, and finally rat on yourself and possibly lose coverage if you get a decent raise or better job.
In most states, even Medicaid is too much to offer undocumented taxpayers despite the billions of dollars they pour into government healthcare programs each year.
Mass deportation isn’t a plan to control healthcare costs. Based on a twisted lie, it’s a vicious way to repay guests who have generously paid for their hosts’ healthcare along with their own.
