With over 11 million undocumented immigrants living and working in the country, it is important for any Single Payer legislation to address if comprehensive health care coverage will be applied to these individuals or if they will not be included in the system. Unfortunately, few state or national Medicare For All programs or studies have addressed undocumented immigrants due to the politics surrounding the issue. However, this may be beginning to change.

During his primary campaign, Bernie Sanders’ Medicare For All plan provided $77 billion towards taking care of the undocumented. The Lewin Group’s 2003 Georgia study clarified that the Georgia plan would cover undocumented immigrants, but provided no details at all on the costs of covering them. California’s 2002 Single Payer proposal states that undocumented immigrants who have resided in the state since 1996 must wait for five more years to receive any coverage, and then it will only be emergency coverage, other restrictions on undocumented immigrant eligibility to the health care system concern income requirements.

Part of the problem is how to estimate undocumented immigrants? A variety of different research institutes estimate that the number of unauthorized immigrants in the United States is around 11 million and about 4.5 million U.S. residents are born to undocumented immigrants. However, it is difficult to account for a population that does not want to be found? The best way is through the education system, schools are required to enroll K-12 students no matter their immigration status. Also, undocumented immigrants are unlikely to have access to insurance leading them to likely visit emergency rooms in obtain health care, which is likely to be partially covered by Medicaid. The Census Bureau also has ways to deal with undercounting and the likely characteristics of those who are missed. In addition to U.S. surveys, some think tanks have cross referenced U.S. data with census data from countries those who are undocumented originally came from. However, there is no way to appropriately estimate how many are undocumented.

Whether or not undocumented immigration would play a large role in planning and implementing a state Single Payer plan depends on the state. For example, California is home to about 2.5 million undocumented while 1.7 million are projected to live in Texas. Alternatively, six states have less than 5,000 unauthorized immigrants, including Maine, Montana, North Dakota, South Dakota, Vermont, and West Virginia.

How would they affect utilization? Most are young and are not very expensive, and could be a better source for funding the system than entailing greater costs, or would they increase utilization more than other populations that are uninsured or underinsured? At the moment, many undocumented immigrants currently receive some support through Medicaid. Although they are primarily barred from being covered by the federal program, about $2 billion a year, less than 1% of the cost of Medicaid, is used to cover emergency services that are disproportionately made up of the undocumented. During the 1980s, Congress approved of a program that requires hospitals to examine and stabilize all patients who need emergency care regardless of their citizenship or insurance status.

Many pro-immigrant researchers argue that providing comprehensive coverage to undocumented immigrants would not greatly increase utilization costs. For example, the emergency services Medicaid they currently receive could be prevented if undocumented immigrants had access to more preventative medical services. For example, if they had access to prenatal care then costly long-term complications to their children could be prevented reducing costs.

There are fears from some anti-immigration groups that providing coverage to the undocumented could incentivize greater undocumented immigration although there is no evidence that access to Emergency Medicaid has encouraged that in the first place. Although Medicaid funding has surged over the last decade, emergency Medicaid has been stable. (How does emergency medicaid funding correlate with increased immigration?) Alternatively, bills that eliminate the uninsured may reduce access to emergency services for those who lack citizenship complicating progressive coalitions made up of immigrant and health care activists.

Summary of what the parameter is, why it’s important.

Overview of what sources different studies use, what assumptions they make, based on what rationale.

If there’s significant difference in methodology: how many studies take which side.

Closing: Bibliography of sources for this topic.