how will immigration reform impact the medicare trust fund?

8/12/2019 How Will Immigration Reform Impact the Medicare Trust Fund?

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1 Center for American Progress | How Will Immigration Reform Impact the Medicare Trust Fund?

How Will Immigration Reform

Impact the Medicare Trust Fund?By Patrick Oakford and Robert Lynch February 27, 2014

Las year, he Senae passed he hisoric and biparisan Border Securiy, Economic

Opporuniy, and Immigraion Modernizaion Ac, or S. 744. Since hen, he House o

Represenaives has alked a lo abou immigraion reorm bu has ailed o move he

legislaive process orward. Ta inacion carries a hefy cos by delaying he signifi-

can economic and social benefis o enacing immigraion reorm. Te nonparisanCongressional Budge Office, or CBO, and many oher independen economic research-

ers have ound ha comprehensive immigraion reorm would significanly reduce our

naions defici, creae housands o jobs each year, and spur economic growh.1In addi-

ion o broad economic benefis, immigraion reorm would also improve he financial

sabiliy o he Medicare Hospial Insurance, or HI, rus Fund, which pays or many o

he criical healh care services used by he millions o Americans enrolled in Medicare.2

Te HIalso called Par Arus Fund is one o our disinc componens o

Medicare, our naions larges publicly unded healh insurance program. oday, he

rus und finances healh care or more han 50 million Americans enrolled in MedicarePar A, which covers inpaien hospial services, skilled nursing aciliy services, and

home healh care.3Over he coming decades, he number o beneficiaries is only

expeced o increase as Baby Boomers reach age 65.4As a resul o hese demographic

changes and oher acors, such as rising healh care coss, he rus und is projeced o

be depleed by 2026.5

While he rus und has previously been projeced o reach depleion numerous imes,

legislaive adjusmens such as changes in payroll ax raes have ensured ha he rus

und never reached insolvency. Tus, here is litle doub ha he HI rus Fund could

remain solven well pas 2026.

Immigraion reorm, hough, would provide immediae financial relie o he rus

und wihou changing any o he curren parameers o he program. Undocumened

immigrans would pay axes ino he HI rus Fund now beore ever drawing a dollar in

benefis. Te ne-posiive conribuions o undocumened immigrans would exend he

solvency o he program.


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In his brie, we esimae he ne fiscal impacaxes paid ino he program minus ben-

efis receivedo undocumened immigrans on he HI rus Fund. We limi our analy-

sis o only he HI rus Fund, which unds abou 50 percen o oal Medicare expenses,

because his is he only porion o Medicare ha is financed almos exclusively hrough

payroll axes.6Tus, similar o Social Securiy conribuions, individual conribuions o

he HI rus Fund are easily idenifiable over heir lieime, which enables us o esimae

undocumened immigrans ne fiscal impac on he und.

In he analysis below, we assess how immigraion reorm would change he projeced

depleion dae o he rus und. Ta is, i immigraion reorm were o cause expenses

under he rus und o rise aser han addiional ax conribuions made by undocu-

mened immigrans, hen he rus und would be depleed much

sooner han 2026. Conversely, i immigraion reorm leads o higher

payroll ax conribuions han addiional expenses, hen he deple-

ion dae, or solvency o he rus und, will be exended. Our analysis

demonsraes ha undocumened immigrans will pay more in payroll

axes han hey will receive in benefis under he rus und and wouldexend he solvency o he HI rus Fund by our years.

Bu he ne impac o immigraion reorm goes well beyond simply

exending he solvency o he rus und. Assuming changes are made

o he rus und so ha i is viable beyond he curren esimae o

insolvency in 2026, undocumened immigrans would coninue o

provide a ne fiscal conribuion. We esimae he size o his conribu-

ion under wo immigraion reorm scenarios.

Under he firs scenario, we esimae boh he payroll conribuionsmade and he Medicare expenses generaed by undocumened immi-

grans under S. 744 over he nex 20 and 30 years. Under he second

scenario, we esimae wha he ne conribuion would be over he

same ime period i immigrans were graned legal saus bu denied a

pahway o ciizenship.

Undocumened immigrans who receive legal saus under immigraion reorm may

become eligible o receive premium-ree Par A benefis afer 10 years.7So he 20-year

analysis under boh reorm scenarios capures undocumened immigrans ne conribu-

ion a decade afer he firs members o he undocumened populaion become eligible

o receive Medicare Par A benefis. In order o more ully evaluae he impac o reorm

on he finances o he rus und, however, we expand he analysis o 30 years, recognizing

ha he undocumened populaion is on average relaively young and will no enroll in

Medicare or decades o come.

FIGURE 1

Medicare contributions from

immigration reform

Net contributions of undocumented immigrants

under two legalization scenarios

Source: Authors' calculations. See the methodology for more information.

Legal status and citizenship

Legal status only

Netcontributions(in

billions)

20 years 30 years0

50

100

150

200

250

$9 billion

$25 billion


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In he firs scenarioenacmen o he Senae billwe ound ha undocumened

immigrans who become ciizens would pay $202 billion more ino he sysem han

hey will receive in benefis over he nex 20 years. Even over 30 years, undocumened

immigrans would conribue a ne $155 billion o he HI rus Fund. Tus, despie

undocumened immigrans receiving an increasing amoun o Par A benefis in he

hird decade, hey will sill conribue more han hey ake ou.

Our resuls under he second scenariopermanen legal saus onlyshow ha

ciizenship creaes addiional posiive impacs or our counrys fiscal healh. Over he

nex 20 years, i immigrans were provided legal saus bu denied ciizenship, he ne

conribuion o he rus und would be $9 billion less han i would be wih ciizenship.

Over he nex 30 years, undocumened immigrans ne conribuion o Medicare would

be $25 billion less.

Conrary o reorm opponens claims, providing legal saus and ciizenship o undocu-

mened immigrans will no urher srain he rus und over he nex hree decades.

Insead, i will susain he rus unds solvency or anoher our years. In ac, he neconribuion o undocumened immigrans will come a he very ime ha Medicare

spending increases due o Baby Boomer reiremens. Tus, i immigraion reorm is

enaced, he Medicare HI rus Fund will have more money han i oherwise would o

und Par A benefis o enrollees over he nex hree decades.

Significanly, his analysis also demonsraes ha providing undocumened immigrans

legal saus bu denying hem ciizenship will no reduce ne expenses under Medicare

Par A. Insead, he increased incomes associaed wih earned ciizenship would be los

hereby diminishing he ne benefis our counry sands o gain.

The current state of the Medicare Par t A Trust Fund

Our counrys Medicare sysem is complex and made up o our parshe larges being

Medicare Par A. Tis par is unded hrough he HI rus Fund and covers inpaien

hospial services, hospice care, home healh services, and says in skilled nursing home

aciliies.8Te HI rus Fund receives mos o is income hrough payroll axes; employ-

ers and employees combined pay 2.9 percen o an employees wages in axes. 9Similar o

Social Securiy, odays workers are unding he benefis o individuals currenly enrolled

in Medicare Par A. Upon urning 65, a person is eligible o enroll in Medicare Par A

wihou having o pay any premiums, as long as hey have paid payroll axes or a leas

10 years and have been lawully presen in he Unied Saes during hose years.

Medicare currenly covers more han 50 million people, and he rusees o he

Medicare rus und esimae ha more han 88 million people will be enrolled in

Medicare Plan A by 2040a rise largely due o aging Baby Boomers.10


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Troughou is hisory, he HI rus Fund has a imes paid ou more in benefis han i

received in income. When his occurred, he asses in he rus und paid or he remain-

ing expendiures. In 2013, he rus und began he year wih $220.4 billion.11Tis

money will be used in par o cover he projeced $22.2 billion shorallhe difference

beween oal income and oal expenses. Te rusees o he Medicare rus und proj-

ec ha by 2026, he rus und will be depleed; in oher words, he rus und will no

longer be able o cover he difference beween oal income and oal expenses.

I is imporan o noe ha oher pars o he Medicare sysemsuch as he

Supplemenary Medical Insurance, or SMI, rus Fund ha finances Par Bdo no

ace he same hrea o insolvency as he HI rus Fund. Te board o rusees o he

Medicare rus unds noes ha he SMI rus Fund is no a risk o being depleed,

because each year is general revenue is adjused o mee expeced expenses.12

Immigrants current contribution to the Medicare trust fund

A recen sudy by researchers a Harvard Universiy looked a boh he expenses

generaed by all immigrans under he Par A rus Fund and he amoun o money

hey conribued o i beween 2002 and 2009. Te sudy ound ha immigrans made

a ne conribuion o $13.8 billion in 2009, whereas he naive-born populaion had

a ne drain o $30.9 billion.13And rom 2002 o 2009, immigrans paid $115.2 billion

more in Medicare axes han hey received in Medicare Par A benefis. Immigrans

made a ne conribuion o he sysem, because hey generally end o be younger and

healhier han he naive-born populaion.14Tus, he expendiures ha immigrans

generae under Medicare Par A are nearly 30 percen less han he expendiures cre-

aed by he naive-born populaion.15

Bu i is no jus he legal immigran populaion ha is already making significan con-

ribuions o he HI rus Fund; undocumened immigrans also provide imporan

financial suppor. Under our curren immigraion sysem, i is unlawul or employers o

knowingly hire undocumened immigrans.16Despie his prohibiion, more han 8 mil-

lion undocumened immigrans are working across our economy, making up 5 percen

o our labor orce.17While many undocumened immigrans work in he inormal or

underground economy, he Social Securiy Adminisraion esimaes ha 37 percen

o undocumened workers are on he books and pay payroll axes.18

Undocumened immigrans collecively paid $13 billion in payroll axes o he Social

Securiy sysem in 2010.19Tis suggess ha undocumened immigrans payroll con-

ribuions o Medicare oal more han $3 billion each year. 20Bu while undocumened

immigrans already make imporan conribuions o he rus und, he conribuions are

ar smaller han hey would be i hese immigrans were given legal saus and ciizenship.


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Immigrants eligibility for Medicare under immigration reform

As discussed above, mos prospecive premium-ree Medicare Par A enrolleesor

heir spousesmus mee a 10-year work and legal immigraion eligibiliy requiremen.

Under S. 744, undocumened immigrans will be able o begin working legally and sar

he 10-year clock oward Medicare eligibiliy.21Given he bills implemenaion imeline,

he earlies ha undocumened immigrans could sar accruing credi or Medicare viapayroll axes would be 2015. Tis means ha he firs year undocumened immigrans

could conceivably enroll in Medicare is in 202510 years afer hey have been legally

working and once hey reach age 65.

I is imporan o noe, however, ha some undocumened immigrans have already

been working and paying payroll axes despie being undocumened.22Tese previous

years o work will no be couned oward he needed 10 years o conribuions under

S. 744. Te consequence o denying credi or previous years o ax conribuions has

serious implicaions or immigrans who are over age 55. Under comprehensive immi-

graion reorm, or example, a 60-year-old immigran who has been in he Unied Saesworking and paying axes or five or more years will no be eligible or Medicare Par A

when hey urn 65, because hey will no have been credied he 10 years o Medicare

payroll ax paymens. Insead, hey would have o work and pay payroll axes unil hey

are 70 i hey wan o receive Par A premium-ree benefis. Tus, while immigrans

who receive legal saus under he bill will be able o play by he same rules as oher

Americans, some will be disadvanaged and only receive Medicare afer age 65 or no a

all i hey ail o acquire enough years o credi.

Immigration reforms impact on the Medicare Part A Trust Fund

Opponens o immigraion reorm ofen claim ha providing legal saus and ciizenship

o undocumened immigrans would creae a fiscal burden on Medicare as immigrans

become eligible o draw benefis. Tere is no dispuing he ac ha i more people

enroll in Medicare, program expenses will increase decades laer as hese people become

eligible or he program. Bu his should no be a reason o deny undocumened immi-

grans benefis or delay he passage o immigraion reorm, because he amoun hey

will pay ino he rus und will more han offse he benefis hey will receive or a leas

he nex hree decades.

Immigraion reorm would srenghen he Medicare Par A rus Fund or wo primary

reasons. Firs, immigraion reorm would increase he number o people working legally

and paying payroll axes. As discussed above, only 3 million undocumened immigrans

are currenly paying payroll axes, meaning more han 5 million undocumened immi-

gransnearly 65 percen o he undocumened workorceare working off he books


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and no conribuing o he Medicare rus und. 23Immigraion reorm such as S. 744

would provide he means or employees and employers o ollow he rules and pay axes.

In shor, immigraion reorm would bring millions o undocumened immigrans ono

he books and ensure ha all employers and workers are paying ino Medicare.

Second, immigraion reorm would increase conribuions o he rus und, as undocu-

mened immigrans wages will increase afer legalizaion. Research has ound haundocumened immigrans currenly ace subsanial wage dispariies as a resul o

heir legal saus and precarious siuaion. In a sudy ollowing he 1986 legalizaion

program under he Immigraion Reorm and Conrol Ac, he U.S. Deparmen o

Labor concluded ha undocumened immigrans who gained legal saus observed a 15

percen increase in heir earnings.24Bu i is no jus legal saus ha improves economic

oucomes or undocumened immigrans; independen researchers have ound ha he

acquisiion o ciizenship is associaed wih an addiional 10 percen increase in wages.25

Tese wage gains occur because, wih he acquisiion o legal saus and ciizenship,

immigrans are able o work legally, find jobs ha bes mach heir skill se, and inves in

heir educaionall o which enhance heir earnings. Te combined 25 percen increasein earnings would in urn significanly boos undocumened immigrans conribuions

o he Par A rus Fund.

Short-term benefits of immigration reform:

Extending the solvency of the trust fund

Recognizing he poenial impac immigraion reorm could have on Medicare, we

esimaed wha impac undocumened immigrans would have on he solvency o he

Par A rus Fund.

As noed above, he rus und is currenly projeced o be depleed by 2026.

Undocumened immigrans would exend he solvency by our years, because heir

conribuions would significanly reduce he annual difference beween oal income

and oal expendiures. Te shorall, or example, is projeced o be $10.2 billion in

2014, meaning ha he oal income will be $10 billion shy o covering all o he years

expenses.26Bu under immigraion reorm, undocumened immigrans ne conribuion

would reduce he shorall o jus $2 billion, meaning ha he rus unds asses would

only need o cover $2 billion worh o expenses in 2014, and $8 billion would be saved.

Using esimaes on annual income, expenses, and curren asse levels o he rus und,

we projec ha undocumened immigrans would exend he solvency o he HI rus

Fund by our years, demonsraing he financial poenial o undocumened immigrans.

Immigraion reorm would provide Congress wih our more years o ideniy and

implemen oher measures o address Medicares rising coss.


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Long-term benefits of immigration reform:

Three decades of net contributions

Exending he solvency o he Par A rus Fund is jus he ip o he iceberg; immigraion

reorm would provide significan financial suppor o he rus und long pas 2026. o

quaniy he long-erm impac o immigraion reorm on he rus und, we esimaed he

ne conribuions o undocumened immigrans under wo immigraion reorm scenarios.

Te firs scenario assumes a pahway o ciizenship as laid ou in S. 744: Te majoriy o

undocumened immigrans would be given regisered provisional saus wih he abiliy o

adjus o legal permanen residency afer 10 years and become a nauralized ciizen afer

13 years.27Under his scenario, we ound ha undocumened immigrans would conrib-

ue $253 billion in Medicare axes over he nex 20 years, while Medicare is esimaed o

provide only $51 billion in Medicare Par A services. Tus, undocumened immigrans

ne conribuion o he rus und over he nex 20 years would be $202 billion.

Te large ne conribuions over he nex 20 years are no surprising given he age profileo undocumened immigrans. Te average adul undocumened immigran is 36 years

old and hereore will work and pay axes or many more years. 28Accouning or he

ac ha only 18 percen o undocumened immigrans would be over age 65 during he

20-year analysisand o more ully capure he years when Medicare coss will rise due

o he reiremen o he Baby Boomerswe exended our imerame anoher 10 years.

Even afer 30 years, when 43 percen o currenly undocumened immigrans will be

over age 65, he posiive impac on he rus und holds. Over 30 years, i provided legal

saus and ciizenship, undocumened immigrans would conribue a ne $155 billion o

Medicare: $453 billion in Medicare axes versus $298 billion in Medicare Par A benefis.

TABLE 1

Undocumented immigrants contribution to Medicare, over 20 years and 30 years

Undocumented immigrants contribution under two immigration reform scenrios

Scenario 1:

Legal status and citizenship

Scenario 2:

Legal status only

20 years

Contributions $253 billion $244 billion

Benefits received $51 billion $51 billion

Net contributions $202 billion $193 billion

30 years

Contributions $453 billion $428 billion

Benefits received $298 billion $298 billion

Net contributions $155 billion $130 billion

Source: Authors calculations. See the methodology for more information.


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Denying citizenship forgoes benefits to the trust fund

In recen monhs, some members o Congress have floaed he idea o passing immigra-

ion reorm ha includes legalizaion bu wihholds a pahway o ciizenship or he

naions undocumened immigrans.29In he second scenario, we esimae he impac

ha his ype o approach would have on he Medicare rus und.

We ound ha over he nex 20 years, immigrans would pay $9 billion less ino he Par

A rus Fund i ciizenship were denieda ne $193 billion versus he poenial ne

$202 billion. Similarly, over he nex 30 years as more immigrans urn 65 and can enroll

in Medicare Par A, conribuions would be $25 billion less i hey were no able o nau-

ralize: undocumened immigrans would pay a ne $130 billion in conribuions versus

he poenial ne $155 billion.

Te significan drop in ne conribuions can be explained by he ac ha wihholding

ciizenship would sifle undocumened immigrans economic mobiliy. As discussed

above, he acquisiion o ciizenship is associaed wih a 10 percen increase in wages.Tis means immigrans conribuions o he Medicare rus und hrough payroll axes

afer he acquisiion o ciizenship would also increase. Tus, denying ciizenship would

resul in immigrans paying less ino he und while he expenses ha immigrans gener-

ae would remain he same, since eligibiliy or premium-ree Medicare Par A services is

no coningen upon ciizenship.

Conclusion

Immigraion reorm ha provides legal saus and a pahway o ciizenship would domore han jus fix our broken immigraion sysem. I would also srenghen social pro-

grams such as Medicare. Te analysis in his brie demonsraes ha bringing undocu-

mened immigrans ou o he shadows and allowing hem o paricipae ully in our

sociey and social programs as oher Americans do will lead o a ne conribuion o he

Medicare Par A rus Fund over he nex hree decades.

I immigrans are provided legal saus and ciizenship, hey will conribue a ne $202

billion over 20 years, or a ne $155 billion o he rus und over he nex 30 years. More

imporanly, his analysis proves ha wihholding ciizenship would significanly decrease

immigrans conribuions; over he nex 30 years, ne conribuion o he Medicare Par

A rus Fund would be $25 billion less i immigrans are denied ciizenship.

As he House coninues o consider immigraion reorm, policymakers and Americans

need o recognize he economic boos and fiscal suppor ha undocumened immi-

grans could give he counry i hey were provided legal saus and ciizenship. Te

posiive impac ha undocumened immigrans can make on Medicares Par A rus

Fund is significan, bu i requires Congress o ac now.


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Undocumened immigrans are younger, and hey have grea poenial o work or many

years and conribue o he Medicare Par A rus Fund. Congress canno afford o le

his opporuniy pass by.

Parick Oakford is a Research Associae on he Economic and Immigraion Policy eams

a he Cener for American Progress. Rober Lynch is a Senior Fellow a he Cener and he

Everet E. Nutle professor of economics a Washingon College.

Tis sudy was made possible by he generous suppor of he JBP Foundaion. Te views

expressed are hose of he auhors and no necessarily of he JBP Foundaion.

Appendix

Methodology

Te calculaions in his repor uilize he ollowing daa ses: he March 2012 Curren

Populaion Survey, or CPS; Pew Research Ceners esimaes on he age profile o he

undocumened populaion; he Migraion Policy Insiues esimaes on he age profile

o undocumened immigrans who came o he Unied Saes beore age 16; and esi-

maes o annual Medicare expendiures by immigrans as calculaed by researchers a

Harvard Universiy.30

Medicare contributions

Medicare conribuions are esimaed by summing he Medicare payroll ax conribu-

ions ha each age cohor will make over heir lieime. We assume ha individuals

ener he workorce and begin paying payroll axes a age 18. For age cohors older

han 67, we applied curren and projeced labor-orce paricipaion raes as esimaed

by Dowell Myers, Seven Levy, and John Pikin.31We applied he sandard 2.9 percen

Medicare ax rae o he esimaed earnings or each cohor, which were calculaed using

he March 2012 CPS. Based on previous sudies, we assumed ha legalizaion would

increase he earnings o undocumened immigrans by 15 percen, and he acquisiion

o ciizenship would resul in an addiional 10 percen increase.32We increased he aver-

age earnings each year by 3.8 percen as esimaed by CBO.

Under S. 744, undocumened immigrans who enered he counry beore age 16 and

have me a series o requiremens, such as graduaing rom high school or having a GED,

are pu on a aser pahway o ciizenship. Tis means hey would experience he 10


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percen increase in heir earnings sooner han hose on he 13-year pahway o ciizen-

ship and subsequenly conribue more o Medicare sooner. Tus, in our esimaes, we

calculaed his cohorsknown as he DREAMersuure conribuions separaely

rom he larger undocumened immigran populaion. Afer calculaing each age cohor

and he DREAMers conribuion o Medicare over he nex 30 years, we summed each

age group o come o a oal conribuion or he populaion.

Medicare benefits

o esimae undocumened immigrans uure benefis, we used esimaes o individual

Medicare Par A expendiures o legal immigrans under Medicare in 2009. We assumed

ha immigrans receive $3,923 in Par A benefis on average each year. We increased he

amoun o annual benefis received by annual growh raes in Par A spending per ben-

eficiary as esimaed by CBO hrough 2023. We hen used CBOs projeced 4.3 percen

increase or each subsequen year.

We esimaed uure benefis no only by age cohor bu also by gender o accoun or

varying lie expecancies. Te model assumes ha everyone sars enrolling in Medicare

Par A a he age o 65. Medicare allows eligible individuals o enroll in Medicare a

age 65, even i an enrollee is sill working and covered by employer-provided healh

insurance. When an enrolleeor heir spouseis sill working or an employer wih

20 or more employees and covered by privae healh insurance, Medicare becomes he

secondary insurance, and coss covered by Medicare will decline. Our model does no

accoun or savings in expenses due o enrollees having employer-based healh insur-

ance. Tus, our model overesimaes he benefis received by immigrans who are sil l

working beyond age 65.

Based off o Social Securiy lie-expecancy projecions, we assumed ha men will

receive benefis or 21 years and women will receive benefis or 23 years.


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Endnotes

1 See Letter from Douglas W. Elmendorf to the Honorable Pat-rick J. Leahy, July 3, 2013, available at http://www.cbo.gov/sites/default/files/cbofiles/attachments/s744aspassed.pdf;Robert Lynch and Patrick Oakford, The Economic Effects ofGranting Legal Status and Citizenship to Undocumented Im-migrants (Washington: Center for American Progress, 2013),available at http://www.americanprogress.org/issues/im-

migration/report/2013/03/20/57351/the-economic-effects-of-granting-legal-status-and-citizenship-to-undocumented-immigrants;Bipartisan Polic y Center, Immigration Reform:Implication for Growth, Budgets and Housing (2013),available at http://bipartisanpolicy.org/library/report/immi-gration-reform-implications-growth-budgets-and-housing.

2 For a discussion of immigration reforms impact on Social Se-curity, see Adriana Kugler, Robert Lynch, and Patrick Oakford,Improving Lives, Strengthening Finances: The Benefits of Im-migration Reform to Social Security ( Washington: Center forAmerican Progress, 2013), available athttp://www.american-progress.org/issues/immigration/report/2013/06/14/66543/improving-lives-strengthening-finances-the-benefits-of-immigration-reform-to-social-security.

3 Jacob J. Lew and others, 2013 Annual Report of the Boardsof Trustees of the Federal Hospital Insurance and FederalSupplementary Medical I nsurance Trust Funds (2013), avail-able at http://downloads.cms.gov/files/TR2013.pdf.

4 Ibid.

5 Ibid.

6 Ibid.

7 National Immigration Law Center, Do Aspiring CitizensHave Access to Affordable Health Care & Benefits UnderS.744?, available at http://www.nilc.org/hlthcarebensS744.html(last accessed December 2013).

8 Medicare.gov, What does Medicare Plan A cover?, availablehttp://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html(last accessed November 2013).

9 Social Security Administration, Social Security andMedicare tax rates; maximu m taxable earnings, availableathttp://ssa-custhelp.ssa.gov/app/answers/detail/a_id/240(last accessed November 2013).

10 Lew and others, 2013 Annual Report of the Boards ofTrustees of the Federal Hospital Insurance and FederalSupplementary Medical Insurance Trust Funds.

11 Ibid.

12 Ibid.

13 Leah Zallman and others, Immigrants Contributed AnEstimated $115.2 Billion More To The Medicare Trust FundThen They Took Out in 200209,Health Affairs32 (6) (2013):11531160.

14 Research has found, however, that the immigrants healthadvantages begin to lessen over time. The longer im-migrants reside in the United States, the more their healthoutcomes begin to look the same as those of Americans. Formore information, see Heather Antecol and Kelly B edard,Unhealthy Assimilation: Why Do Immigrants Converge toAmerican Health Status Levels?, Demography43 (2) (2006):

337360. Despite the similar health outcomes of immigrantsand native-born people over time, immigrants who collectMedicare benefits still have lower expenditures than thenative-born population. This difference in expenditures isnot likely due to the immigrant health advantage. Using CPS2012 data, we have identified that immigrants over the ageof 65 who collect Medicare benefits have been in the UnitedStates for more than 15 years on average.

15 Zallman and others, Immigrants Contributed An Estimated$115.2 Billion More To The Medic are Trust Fund Then TheyTook Out in 200209.

16 8 U.S.C. 1324a.

17 Jeffrey S. Passel and DVera Cohn, Unauthorized Immigrants

Population: National and State Trends, 2010 (Washington:Pew Research Center, 2011), available at http://www.pewhis-panic.org/2011/02/01/unauthorized-immigrant-population-brnational-and-state-trends-2010.

18 Stephen Goss and others, Effects of Unauthorized Im-migration on the Actuarial Status of the Social Security TrustFunds (Washington: Social Security Administration, 2013),available athttp://www.socialsecurity.gov/OACT/NOTES/pdf_notes/note151.pdf.

19 Ibid.

20 The Social Security payroll tax rate for employees andemployers combined is 12.4 percent. The Social SecurityAdministration estimated that, at this tax rate and with 3million undocumented immigrants paying taxes, immigrantscontributed $13 billion to Social Security. This suggests thatthis same group of undocumented immi grants and theiremployers contributed $3 billion in Medica re payroll taxes at

a combined 2.9 percent tax rate.

21 National Immigration Law Center, Do Aspiring CitizensHave Access to Affordable Health Care & Benefits UnderS.744?.

22 Goss and others, Effects of Unauthorized Immigration onthe Actuarial Status of the Social Security Trust Funds.

23 Ibid.

24 Audrey Singer, Roger Kramer, and Shirley Smith, Character-istics and Labor Market Behavior of the Legalized PopulationFive Years Following Legalization(Washington: U.S. Depart-ment of Labor, 1996).

25 Lynch and Oakford, The Economic Effects of Granting LegalStatus and Citizenship to Undocumented Immigrants.

26 Lew and others, 2013 Annual Report of the Boards ofTrustees of the Federal Hospital Insurance and Federal

Supplementary Medical Insurance Trust Funds.

27 Border Security, Economic Opportunity, and Immigration Mod-ernization Act, S. 744, 113 Cong. 1 sess. (Government PrintingOffice, 2013).

28 Paul Taylor and others, Unauthorized Immigrants: Lengthof Residency, Patterns of Parenthood (Washington: PewResearch Center, 2011), available athttp://www.pewhis-panic.org/2011/12/01/unauthorized-immigrants-length-of-residency-patterns-of-parenthood.

29 For a discussion of immigration reform proposals in theHouse, including plans that would offer legalization but nota pathway to citizenship, see Ann Garcia, Making Senseof the Senate and Houses Vision of Immigration Reform(Washington: Center for American Progress, 2013), availableat http://www.americanprogress.org/issues/immigration/report/2013/12/09/80652/making-sense-of-the-senate-and-houses-visions-of-immigration-reform.
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ial-securityhttp://www.americanprogress.org/issues/immigration/report/2013/06/14/66543/improving-lives-strengthening-finances-the-benefits-of-immigration-reform-to-social-securityhttp://www.americanprogress.org/issues/immigration/report/2013/06/14/66543/improving-lives-strengthening-finances-the-benefits-of-immigration-reform-to-social-securityhttp://bipartisanpolicy.org/library/report/immigration-reform-implications-growth-budgets-and-housinghttp://bipartisanpolicy.org/library/report/immigration-reform-implications-growth-budgets-and-housinghttp://www.americanprogress.org/issues/immigration/report/2013/03/20/57351/the-economic-effects-of-granting-legal-status-and-citizenship-to-undocumented-immigrantshttp://www.americanprogress.org/issues/immigration/report/2013/03/20/57351/the-economic-effects-of-granting-legal-status-and-citizenship-to-undocumented-immigrantshttp://www.americanprogress.org/issues/immigration/report/2013/03/20/57351/the-economic-effects-of-granting-legal-status-and-citizenship-to-undocumented-immigrantshttp://www.americanprogress.org/issues/immigration/report/2013/03/20/57351/the-economic-effects-of-granting-legal-status-and-citizenship-to-undocumented-immigrantshttp://www.cbo.gov/sites/default/files/cbofiles/attachments/s744aspassed.pdfhttp://www.cbo.gov/sites/default/files/cbofiles/attachments/s744aspassed.pdf


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30 U.S. Census Bureau, 2012 March Current Population Survey(U.S. Department of Commerce, 2012); Jeffery S. Passel andDVera Cohn, A Portrait of Unauthorized Immigrants in theUnited States (Washington: Pew Research Center, 2009),available at http://www.pewhispanic.org/2009/04/14/a-portrait-of-unauthorized-immigrants-in-the-united-states;Jeanne Batalova and Margie McHugh, DREAM vs. Reality:An Analysis of Potential DREAM Act Beneficiaries (Wash-ington: Migration Policy Institute, 2010), available at http://www.migrationpolicy.org/pubs/dream-insight-july2010.pdf;Zallman and others Immigrants Contributed An Estimated$115.2 Billion More To The Medic are Trust Fund Then TheyTook Out in 200209.

31 Dowell Myers, Steve Levy, and John Pitkin, TheContributions of Immigrants and Their Children to theAmerican Workforce and Jobs of the Future (Washing-ton: Center for American Progress, 2013), available athttp://www.americanprogress.org/issues/immigration/report/2013/06/19/66891/the-contributions-of-immigrants-and-their-children-to-the-american-workforce-and-jobs-of-the-future.

32 Lynch and Oakford, The Economic Effects of GrantingLegal Status and Citizenship to Undocumented Immigrants.
http://www.pewhispanic.org/2009/04/14/a-portrait-of-unauthorized-immigrants-in-the-united-stateshttp://www.pewhispanic.org/2009/04/14/a-portrait-of-unauthorized-immigrants-in-the-united-stateshttp://www.migrationpolicy.org/pubs/dream-insight-july2010.pdfhttp://www.migrationpolicy.org/pubs/dream-insight-july2010.pdfhttp://www.americanprogress.org/issues/immigration/report/2013/06/19/66891/the-contributions-of-immigrants-and-their-children-to-the-american-workforce-and-jobs-of-the-futurehttp://www.americanprogress.org/issues/immigration/report/2013/06/19/66891/the-contributions-of-immigrants-and-their-children-to-the-american-workforce-and-jobs-of-the-futurehttp://www.americanprogress.org/issues/immigration/report/2013/06/19/66891/the-contributions-of-immigrants-and-their-children-to-the-american-workforce-and-jobs-of-the-futurehttp://www.americanprogress.org/issues/immigration/report/2013/06/19/66891/the-contributions-of-immigrants-and-their-children-to-the-american-workforce-and-jobs-of-the-futurehttp://www.americanprogress.org/issues/immigration/report/2013/06/19/66891/the-contributions-of-immigrants-and-their-children-to-the-american-workforce-and-jobs-of-the-futurehttp://www.americanprogress.org/issues/immigration/report/2013/06/19/66891/the-contributions-of-immigrants-and-their-children-to-the-american-workforce-and-jobs-of-the-futurehttp://www.americanprogress.org/issues/immigration/report/2013/06/19/66891/the-contributions-of-immigrants-and-their-children-to-the-american-workforce-and-jobs-of-the-futurehttp://www.americanprogress.org/issues/immigration/report/2013/06/19/66891/the-contributions-of-immigrants-and-their-children-to-the-american-workforce-and-jobs-of-the-futurehttp://www.migrationpolicy.org/pubs/dream-insight-july2010.pdfhttp://www.migrationpolicy.org/pubs/dream-insight-july2010.pdfhttp://www.pewhispanic.org/2009/04/14/a-portrait-of-unauthorized-immigrants-in-the-united-stateshttp://www.pewhispanic.org/2009/04/14/a-portrait-of-unauthorized-immigrants-in-the-united-states

how will immigration reform impact the medicare trust fund?

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