Immigration Issues

Illegal Immigration and Public Health (2009)

The impact of immigration on our public health is often overlooked. Although millions of visitors for tourism and business come every year, the foreign population of special concern is illegal residents, who come most often from countries with endemic health problems and less developed health care. They are of greatest consequence because they are responsible for a disproportionate share of serious public health problems, are living among us for extended periods of time, and often are dependent on U.S. health care services.

Public Health Risks

Because illegal immigrants, unlike those who are legally admitted for permanent residence, undergo no medical screening to assure that they are not bearing contagious diseases, the rapidly swelling population of illegal aliens in our country has also set off a resurgence of contagious diseases that had been totally or nearly eradicated by our public health system.

According to Dr. Laurence Nickey, director of the El Paso heath district “Contagious diseases that are generally considered to have been controlled in the United States are readily evident along the border ... The incidence of tuberculosis in El Paso County is twice that of the U.S. rate. Dr. Nickey also states that leprosy, which is considered by most Americans to be a disease of the Third World, is readily evident along the U.S.-Mexico border and that dysentery is several times the U.S. rate ... People have come to the border for economic opportunities, but the necessary sewage treatment facilities, public water systems, environmental enforcement, and medical care have not been made available to them, causing a severe risk to health and well being of people on both sides of the border.”1

A June, 2009 article in the New England Journal of Medicine noted that a majority (57.8%) of all new cases of tuberculosis in the United States in 2007 were diagnosed in foreign-born persons. The TB infection rate among foreign-born persons was 9.8 times as high as that among U.S.-born persons.2 The article documents the medical testing process for TB required of immigrants and refugees, and this points to foreigners who are unscreened, especially the illegal alien population as the logical source of this disproportionate rate of TB incidence. It should also be kept in mind that among U.S. citizens who contract TB their exposure to the disease may well have come from exposure to a non-U.S. citizen.

“The pork tapeworm, which thrives in Latin America and Mexico, is showing up along the U.S. border, threatening to ravage victims with symptoms ranging from seizures to death. ... The same [Mexican] underclass has migrated north to find jobs on the border, bringing the parasite and the sickness—cysticercosis—its eggs can cause[.] Cysts that form around the larvae usually lodge in the brain and destroy tissue, causing hallucinations, speech and vision problems, severe headaches, strokes, epileptic seizures, and in rare cases death.”3

The problem, however, is not confined to the border region, as illegal immigrants have rapidly spread across the country into many new economic sectors such as food processing, construction, and hospitality services.

Typhoid struck Silver Spring, Maryland, in 1992 when an immigrant from the Third World (who had been working in food service in the United States for almost two years) transmitted the bacteria through food at the McDonald’s where she worked. River blindness, malaria, and guinea worm, have all been brought to Northern Virginia by immigration.4

"We're running an H.M.O. for illegal immigrants and if we keep it up, we're going to bankrupt the county."

-Los Angeles County supervisor Michael D. Antonovich, New York Times, May 21, 2003

“What is unseen is their [illegal aliens’] free medical care that has degraded and closed some of America’s finest emergency medical facilities, and caused hospital bankruptcies: 84 California hospitals are closing their doors.”

-Madeleine Peiner Cosman, Ph.D., Esq. “Illegal Aliens and American Medicine,” Journal of American Physicians and Surgeons, Spring 2005

Contrary to common belief, tuberculosis (TB) has not been wiped out in the United States, mostly due to illegal migration. In 1995, there was an outbreak of TB in an Alexandria high school, when 36 high-school students caught the disease from a foreign student.5 The four greatest immigrant magnet states have over half the TB cases in the U.S.6 In 1992, 27 percent of the TB cases in the United States were among the foreign-born; in California, it was 61 percent of the cases; in Hawaii, 83 percent; and in Washington state, 46 percent. The Queens, New York, health department attributed 81 percent of new TB cases in 2001 to immigrants.

Costs of Medical Care

Immigrants are often uninsured and underinsured. Forty-three percent of noncitizens under 65 have no health insurance. That means there are 9.4 million uninsured immigrants, a majority of whom are in the country illegally, constituting 15 percent of the total uninsured in the nation in the mid-1990s.7 The cost of the medical care of these uninsured immigrants is passed onto the taxpayer, and strains the financial stability of the health care community.

Another problem is immigrants’ use of hospital and emergency services rather than preventative medical care. For example, utilization rate of hospitals and clinics by illegal aliens (29 percent) is more than twice the rate of the overall U.S. population (11 percent).8

As a result, the costs of medical care for immigrants are staggering. The estimated cost of unreimbursed medical care in 2004 in California was about $1.4 billion per year. In Texas, the estimated cost was about $.85 billion, and in Arizona the comparable estimate was $.4 billion per year.9

One of the frequent costs to U.S. taxpayers is delivery of babies to illegal alien mothers. A California study put the number of these anchor baby deliveries in the state in 1994 at 74,987, at a cost of $215 million. At that time, those births constituted 36 percent of all Medi-Cal births, and they have grown now to substantially more than half or the annual Medi-Cal budget. In 2003, 70 percent of the 2,300 babies born in San Joaquin General Hospital’s maternity ward were anchor babies. Medical in 2003 had 760,000 illegal alien beneficiaries, up from 2002, when there were 470,000.10

Updated 2009




  1. Statement on behalf of the American Medical Association to the Committee on Public Works and Transportation, U.S. House of Representatives, May 7, 1991.
  2. Liu, Yecai, et al., “Oveseas Screening for Tuberculosis in U.S.-Bound Immigrants and Refugees,” New England Journal of Medicine, June 4, 2009.
  3. Houston Chronicle, November 3, 1992.
  4. Influx of Exotic Diseases Keep Doctors Hopping,” Fairfax Journal, May 8, 1992.
  5. "Health officials say there is a correlation between increases in tuberculosis cases in recent years and the influx of residents from countries where disease prevention is substandard.” “36 Students in Alexandria Test Positive for TB Exposure,” Washington Post, June 8, 1995.
  6. "Taking it to the Streets" Los Angeles Times, October 2, 1993.
  7. Employee Benefit Research Group study, January 1995. “The study suggests the very high degree to which that population [illegal aliens] is contributing to uncompensated costs.” EBRI President Dallas Salisbury, Washington Post, January 25, 1995.
  8. Assessment of Potential Impact of Undocumented Person on National Health Reform, National Health Foundation, April 14, 1993.
  9. See FAIR publications.
  10. Madeleine Peiner Cosman, Ph.D., Esq. “Illegal Aliens and American Medicine,” Journal of American Physicians and Surgeons, Spring 2005.