The Cost of Insuring Illegal Aliens: $10-20 Billion Per Year

Immigrants from Central America reach the border in Tijuana, Mexico, to seek asylum in the United States on April 29, 2018. (Kyodo via AP)

Most of the Democratic candidates running for president have proposed covering illegal aliens under the Affordable Care Act. None of them have yet estimated an annual cost of adding illegals to the subsidized rolls of ACA coverage — probably because they know it won’t be cheap.


It won’t be. The Center for Immigration Studies issued a report today that estimates the costs of covering illegals using Obamacare, as well as Medicaid-ACA hybrid coverage.

  • Consistent with other research, we estimate that there are 4.9 million uninsured illegal immigrants with incomes low enough (less than 400 percent of the poverty threshold) to qualify for subsidies under the ACA.
  • Given their age and income, the average cost of providing an ACA subsidy for an illegal immigrant would be about $4,600 each year.
  • The total cost of providing ACA subsidies to illegal immigrants could be $22.6 billion annually if they all enrolled. The total cost assuming a more realistic enrollment rate is $10.4 billion per year.
  • While the overall cost would be large, the average subsidy illegal immigrants would receive is still smaller than the average ACA subsidy. This is primarily because illegal immigrants are a relatively young population.
  • Although we consider an ACA-only approach the most likely, we also estimate the costs of a hybrid ACA-Medicaid scenario, in which the lowest-income illegal immigrants (about half of the illegal population) are given Medicaid, while those with higher incomes still receive ACA subsidies.
  • Compared to an ACA-only approach, the total cost of the ACA-Medicaid hybrid would be similar — $19.6 billion when assuming 100 percent enrollment, and $10.7 billion assuming a more realistic enrollment rate in both programs.
  • We do not attempt to estimate indirect or second-level costs, such as the possibility that offering government health benefits could incentivize more illegal immigration.

Last week, the White House announced that only immigrants who had health insurance or could prove they had the means to pay for health care would be allowed into the United States. The policy exempts refugees, but could save the health care system $35 billion a year.

Much of the non-reimbursed health care costs in the country comes from illegal aliens with no insurance. CIS put out another report that addresses that issue.

National Review:

The other report explores the cost of expanding health insurance for illegal immigrants. It estimates that if you made our roughly 4.9 million uninsured, low-income illegal immigrants eligible for Obamacare subsidies, it would cost about $10 billion a year. This works out to about $80 per household in the country — but it might be a bit high, e.g. because it assumes that Obamacare-eligible illegal immigrants would have the same enrollment rate (46 percent) that everyone else has, which strikes me as unlikely, especially because the individual mandate expired this year and the report takes its baseline from last year’s enrollment.

If you want to take your own guess of how many would sign up, multiply it by $4,637 to get the total cost. That’s actually less than the typical native enrollee costs, mainly because illegal immigrants tend to be younger.


We all know what would happen if illegals were insured: we’d get more illegals. There might even be people coming here illegally just to be able to check into a modern American hospital, rather than endure the third-world health care in their own countries.

This is not the way to address the problem of illegal aliens. And Democrats are crazy if their plans come to fruition.


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