Unauthorized immigrants spend less than other immigrants and US natives on health care.

Unauthorized immigrants and other immigrants who have been in the United States for less than five years have few options for accessing health care through public programs. In light of the ongoing national debate about immigration reform and the impact of the Affordable Care Act on immigrants, we examined differences in health care spending by nativity and legal status using Medical Expenditure Panel Survey data for the period 2000-09. We found that unauthorized, legal, and naturalized immigrants together accounted for $96.5 billion in average annual health care spending, compared to slightly more than $1 trillion for US natives. Unauthorized immigrants' share of health care spending was $15.4 billion-the smallest of the groups. Just 7.9 percent of unauthorized immigrants benefited from public-sector health care expenditures (receiving an average of $140 per person per year), compared to 30.1 percent of US natives (who received an average of $1,385). Policy solutions could include extending coverage to unauthorized immigrants for the prevention and treatment of infectious diseases or granting them access to the Affordable Care Act's insurance marketplaces, which start in 2014. The final version of federal immigration reform might also include strategies to expand immigrants' access to health care.