Immigration, Health and Welfare

The Right consistently opposes immigrants' use of public benefits, including health care, welfare and education. Many of their arguments focus on the economic cost of providing these services, which they argue falls more heavily on specific communities. Anti-immigrant groups have created the climate in which education, welfare and health care are not seen as human rights, but as privileges of citizenship. Through the Proposition 187 campaign in California, the Right laid the groundwork for Welfare Reform, which took away many of these public benefits from noncitizens.

The Right similarly ignores that these benefits are public goods that benefit the community as a whole. If one segment of the population is denied these rights, the entire community suffers from the loss of human potential and other long-term repercussions. This is evident in the issue of public health. Rather than advocate for access to health care for all immigrants, the Right paints immigrants as a diseased population that should be screened or kept out altogether.

Immigrants as "Freeloaders"

What the Anti-Immigrant Right Says

Anti-immigrant groups often claim that immigrants come to this country to take advantage of the "generous" public benefits and get a "free ride" at the taxpayers' expense. They say:

• Undocumented pregnant women are sneaking across the border to have citizen children through whom they can collect welfare benefits.
• Studies report that immigrants use more in public services than they contribute in tax money.
• Increased poverty rates are a result of immigration. Immigrants tend to be poorer than the general population.
• Immigration should be curtailed and immigration policies should favor immigrants with skills or wealth.

Response

Over the last decade competing studies have argued about the exact usage of public benefits by immigrants. A 1994 Urban Institute report that looked at many of the studies "documenting" immigrants' drain on the economy found consistent misrepresentation of the costs and contributions of immigrants. It concluded that parallel data on U.S.-born individuals drew the same conclusions: that U.S.-born individuals also cost the state in benefits. A 1999 Urban Institute study found that "among poor households with children, immigrants have lower use rates for welfare, food stamps, and Medicaid both before and after welfare reform."¹ In another study, they found that immigrants "pay more in taxes than receive in public services."²

In fact on a federal level most immigrants, especially recent immigrants, are no longer eligible for many of the benefits the Right claims they are "abusing." Undocumented immigrants are ineligible for all federal benefits. Almost all documented immigrants arriving after August 1996 are ineligible for Supplemental Security Income (SSI), Food Stamps, Temporary Assistance for Needy Families (TANF) and Medicaid for at least five years. In general the eligibility of all noncitizens for SSI and Food Stamps is very limited, and states can choose to not offer TANF or Medicaid.

The fact that there has been no decrease in immigration since the passage of the 1996 laws shows that immigrants do not come to this country to access public benefits. Even in states where some benefits have been maintained, eligible immigrants tend not to enroll because of misconceptions and legitimate fears. For example, they fear being reported to INS, barred from citizenship or forced to pay back benefits they receive. The Right rarely mentions that immigrants pay taxes, just as citizens do, that help fund the programs from which they can be barred. Also, they don't acknowledge that many recent immigrants work multiple jobs, pay out of pocket for health care costs and provide childcare within extended family structures. Policies like Welfare Reform make immigrants more vulnerable to exploitation and abject poverty, exactly the circumstances that public benefits are intended to prevent.

Immigrants today are being screened out on the basis of wealth, just as the Right has advocated. Sponsors must sign Affidavits of Support and meet certain income requirements when attempting to bring family members to the United States. Rich immigrants can pay to upgrade to a "priority" application. The result is a two-tiered system where immigrants with money can find legal routes for entering the country and poor immigrants must enter without authorization.

Immigrants as a Health Threat

What the Anti-Immigrant Right Says

Many anti-immigrant groups argue that a disproportionate number of immigrants to the United States carry dangerous, communicable diseases and therefore "mass immigration" poses a grave public health threat. They say:

• Many "Third World" diseases are now entering the United States through immigrants. These include leprosy, dysentery, tapeworm, typhoid, malaria, river blindness and guinea worm.
• The increase in tuberculosis (TB) incidence in this country since the early 1980s is attributable to immigration. One-third of the world population is infected with TB, often carrying a dormant form that can become active later.
• HIV infection rate in many countries is much higher than in the United States.
• Because of language and cultural barriers and lack of health insurance, many immigrants won't seek treatment when they need it. This increases the public health threat.
• Since many immigrants lack health insurance, taxpayers must pay for their health care costs.
• The United States should screen out immigrants with these diseases and make sure immigrants admitted arrive with the resources to cover health care costs.

Response

The anti-immigrant Right paints a frightening picture of immigrants bringing in strange and exotic diseases. But it fails to provide all the facts about the real causes or true threat of the examples it gives. In reality, studies have shown that immigrants as a whole tend to be healthier than the general U.S. population. This is probably because ill people are less likely to migrate. All international travelers, including U.S. citizens and military personnel, are at higher risk for certain diseases. Unless all international travel is ceased, the United States will always have some incidence of the diseases listed above. Still the Centers for Disease Control (CDC) says that in the United States there is no or very low risk of contraction of almost all these diseases. In fact, in 1991 the Department of Health and Human Services recommended that infectious tuberculosis be the only communicable disease used to exclude foreign visitors. It said that leprosy and six sexually transmitted diseases (including HIV) are not communicable enough to warrant exclusion.³

While it is true that in the last twenty years there has been a significant increase in the incidence of TB in the United States, this is not primarily because of cases among immigrants. The CDC reports that other significant factors are 1) the HIV epidemic which has made many people more susceptible to the disease, 2) the increase in transmission in institutions (such as prisons and hospitals) where high-risk populations are concentrated, 3) the presence of new drug-resistant strains of TB, and 4) the deterioration of the public health infrastructure with respect to the diagnosis and treatment of TB.

Most public health officials agree that the best way to prevent the spread of disease is by educating the public and making sure that all populations have access to health care. Instead, the Right's policies have discouraged or prevented immigrants from seeking care. The 1996 Welfare Reform law barred from Medicaid all undocumented immigrants and, for five years, documented immigrants arriving after 1996. This law has also led immigrants to not seek any health care out of fear that they will later be denied a Green Card or citizenship. Another consequence of this law is increased health care costs because those who lack insurance can often only access medical treatment through more expensive emergency care. Many immigrants are uninsured because they tend to be concentrated in industries that do not provide health insurance. Rather than seeking to expand access to health care for all people, anti-immigrant groups choose to stigmatize immigrants as a group and put the public health of the entire community at risk.

Immigrants Disproportionately Using the Resources of Local Communities

What the Anti-Immigrant Right Says

Many anti-immigrant advocates claim that current federal immigration policies place a disproportionate burden on states' and local communities' individual economies. They say:

• California, New York, Texas, New Jersey, Illinois, and Florida account for 75 percent of the immigrant population but only 38 percent of the U.S. population. This results in a disproportionate drain on these states' coffers.
• The federal government should take responsibility for the repercussions of federal immigration policies and pay state and local governments for the costs incurred.

Response

Some states and local municipalities do experience a disproportionate demand for certain services such as education and health care due to a large immigrant population. Nevertheless, it is unfair to blame immigrants for the problem of how resources are distributed on the federal, state and local levels. Inequalities in public benefits are a result of these services being funded at local and state levels. Wealthier communities benefit from this system, while poorer communities, where immigrants tend to be concentrated, cannot adequately cover the costs of such necessities.

Anti-immigrant groups are correct in demanding that funds be distributed more equitably. However they use this issue to recruit members and increase anti-immigrant sentiment within communities that have large immigrant populations. In general, the Right has opposed distributing resources from the federal level and has sought to dismantle such federal programs. The Right rarely mentions that immigrants also pay taxes towards these services and that they contribute significantly to the vitality of the community in other ways. The economies of cities such as New York, Miami, and Los Angeles would collapse without immigrant labor. Reports in 2001 found that undocumented immigrants filled many of the jobs created by the new economy, helping to fuel it. In fact, some communities with declining populations, such as Pittsburgh, Louisville, Albuquerque, and parts of Iowa, have worked to increase their attractiveness to new immigrants.

End Notes

1.Michael Fix and Jeffrey S. Passel, Trends in Noncitizens and Citizens use of public benefits following Welfare Reform 1994-1997, (Washington, DC: Urban Institute, March 1999). http://www.urban.org/immig/trends.html (January 10, 2002).

2.Michael Fix and Jeffrey S. Passel, Immigration and Immigrants: Setting the Record Straight, (Washington, DC: Urban Institute, May 1994). http://www.urban.org/pubs/immig/immig.htm#V (January 10, 2002).

3. Department of Health and Human Services, "Communicable Diseases and Foreign Visitors," January 1, 1991. http://www.os.dhhs.gov/news/press/pre1995pres/910125.txt (January 10, 2002).

This article first appeared in Defending Immigrant Rights: An Activist Resource Kit, published by Political Research Associates, © 2002.