Immigrants Contributed An Estimated $115.2 Billion More To The Medicare Trust Fund Than They Took Out In 2002–09
Abstract
Many immigrants in the United States are working-age taxpayers; few are elderly beneficiaries of Medicare. This demographic profile suggests that immigrants may be disproportionately subsidizing the Medicare Trust Fund, which supports payments to hospitals and institutions under Medicare Part A. For immigrants and others, we tabulated Trust Fund contributions and withdrawals (that is, Trust Fund expenditures on their behalf) using multiple years of data from the Current Population Survey and the Medical Expenditure Panel Survey. In 2009 immigrants made 14.7 percent of Trust Fund contributions but accounted for only 7.9 percent of its expenditures—a net surplus of $13.8 billion. In contrast, US-born people generated a $30.9 billion deficit. Immigrants generated surpluses of $11.1–$17.2 billion per year between 2002 and 2009, resulting in a cumulative surplus of $115.2 billion. Most of the surplus from immigrants was contributed by noncitizens and was a result of the high proportion of working-age taxpayers in this group. Policies that restrict immigration may deplete Medicare’s financial resources.
http://content.healthaffairs.org/content/early/2013/05/20/hlthaff.2012.1223.full
For Medicare, Immigrants Offer Surplus, Study Finds
By SABRINA TAVERNISE
Immigrants have contributed billions of dollars more to Medicare in recent years than the program has paid out on their behalf, according to a new study, a pattern that goes against the notion that immigrants are a drain on federal health care spending.
The study, led by researchers at Harvard Medical School, measured immigrants’ contributions to the part of Medicare that pays for hospital care, a trust fund that accounts for nearly half of the federal program’s revenue. It found that immigrants generated surpluses totaling $115 billion from 2002 to 2009. In comparison, the American-born population incurred a deficit of $28 billion over the same period.
The findings shed light on what demographers have long known: Immigrants are crucial in balancing the age structure of American society, providing an infusion of young, working-age adults who support the country’s aging population and help cover the costs of Medicare and Social Security. And with the largest generation in the United States, the baby boomers, now starting to retire, the financial help from immigrants has never been more needed, experts said.
Individual immigrant contributions were roughly the same as those of American citizens, the study found, but immigrants as a group received less than they paid in, largely because they were younger on average than the American-born population and fewer of them were old enough to be eligible for benefits. The median age of Hispanics, whose foreign-born contingent is by far the largest immigrant group, is 27, according to the Brookings Institution. The median age of non-Hispanic whites in the United States is 42.
The study drew on two nationally representative federal surveys, from the Census Bureau and the Department of Health and Human Services. Researchers included the contributions of legal residents who were not citizens, a group that is eligible for Medicare if certain requirements are met; unauthorized immigrants; and citizens who were born abroad.
It was not clear how much of the surplus was made up of earnings by immigrants in the country illegally, who are ineligible for most government programs.
The Census Bureau, whose data was used for the contributions portion of the study, says it attempts to count all immigrants, including those in the country illegally.
The finding “pokes a hole in the widespread assumption that immigrants drain U.S. health care spending dollars,” said Leah Zallman, an instructor of medicine at Harvard Medical School and the lead author of the study
Hospital Caring for an Heiress Pressed Her to Give Lavishly
By ANEMONA HARTOCOLLIS
For the last 20 years of her life, Huguette Clark, a wealthy and reclusive copper heiress, lived in a Manhattan hospital room, shades drawn, door closed. She played with dolls, watched cartoons and followed the Bush v. Gore hanging chad debacle. (She favored Gore.)
Within months of her arrival, the hospital, Beth Israel Medical Center, went after her for an all-out fund-raising campaign. They researched her family history, had officials visit her often in her room and plied her with gifts. The effort, described in court documents, quickly extended to the hospital’s chief executive and even his mother, who watched the Smurfs with Mrs. Clark and talked to her about making a will. After Mrs. Clark donated a Manet to Beth Israel, but it sold for less than expected, the chief executive wrote an e-mail joking that Mrs. Clark “didn’t take the bait and offer a half dozen more.”
That note from July 6, 2001, was among scores of hospital documents filed on Wednesday in Manhattan Surrogate’s Court as part of a battle over Mrs. Clark’s $300 million estate with her distant relatives. She died in 2011 at age 104.
The case is scheduled for trial in September, but until then, the documents provide a rare look at the inner workings of a nonprofit hospital’s fund-raising operation — one that, as the relatives see it, coerced a woman who did not need constant medical care to give it a piece of her large fortune. In one of the e-mails, which were turned over to the relatives’ lawyer under a judge’s direction, a hospital fund-raising employee wondered whether Beth Israel’s legal department would approve of Mrs. Clark’s residency there.
Admitted in 1991, Mrs. Clark ended up staying until her death, giving the hospital at least $4 million in donations, not counting millions more she paid just to live there and a $1 million bequest in her final, contested will, according to court papers.
“What this is about is not just a will contest, it’s about the accountability of professionals,” John Morken, the lawyer for the relatives, 20 grand and great-grand half-nieces and half-nephews, said.
In previous court filings, the Manhattan public administrator, who has been appointed as temporary administrator of the estate, also has criticized the hospital’s behavior — as well as that of Mrs. Clark’s accountant, lawyer, admitting doctor and a private nurse, all of whom appear in the disputed will as beneficiaries of her estate. In response to those filings, the hospital has defended its actions, saying Mrs. Clark was sharp as a whip — her dolls were “objets d’art” and a sophisticated hobby, she read the newspaper, and she gave every cent willingly.
Joblessness Shortens Lifespan of Least Educated White Women, Research Says
By SABRINA TAVERNISE
Researchers have known for some time that life expectancy is declining for the country’s least educated white women, but they have not been able to explain why. A new study has found that the two factors most strongly associated with higher death rates were smoking and not having a job.
The aim of the study, which is being published Thursday in The Journal of Health and Social Behavior, was to explain the growing gap in mortality between white women without a high school diploma and those with a high school diploma or more.
The study found that the odds of dying for the least educated women were 37 percent greater than for their more educated peers in any given year in the period of 1997 to 2001. The odds had risen to 66 percent by the period of 2002 to 2006. The authors controlled for age.
The researchers used a health survey conducted by the National Center for Health Statistics, drawing on data from about 47,000 women ages 45 to 84. The study weighed more than a dozen factors to see which were causing the divergence in mortality rates. Poverty, obesity, homeownership, marital status and alcohol consumption were among the factors investigated.
But they mattered little. As it turned out, smoking was important, as had long been established, but researchers were surprised that joblessness had a dramatic effect, even after controlling for factors that employment would have generated, like income and health insurance.
“What is it about employment that has this huge impact on mortality, beyond the material resources it brings?” said Jennifer Karas Montez, the study’s lead author, a researcher at the Harvard Center for Population and Development Studies.
UPDATED MAY 29, 2013 5:29 PM
Is Obamacare Too Complicated to Succeed?
Posted May 29, 2013, at 5:32 p.m.
AUGUSTA, Maine — Gov. Paul LePage on Wednesday railed against an expansion of Medicaid eligibility in Maine, calling it a disturbing national trend of damaging federal mandates.
LePage also linked what he called censorship he has experienced in the past two weeks to a pattern of the same at the national level, suggesting that citizens go home and arm themselves if it continues.
“Expanding Medicaid? That’s not being run locally, that’s being run from Washington,” said LePage to reporters Wednesday at the State House, according to a report of the exchange by WCSH. “Are you that naive that you don’t realize who is pulling the strings? This is being run by our congressional delegation. … If I thought it was local, it would be no problem.”
The issue of expanding Medicaid under the federal Affordable Care Act has been simmering in state government for months. Under the law, the federal government will pay 100 percent of the cost of the Medicaid expansion, which would provide health insurance for some 70,000 Mainers, for the first three years. That funding level gradually would recede to 90 percent by 2020.
Legislative Democrats tried to force the expansion this month by linking it to a plan championed by LePage to make a final payment to Maine’s hospitals on hundreds of millions of dollars in past Medicaid debt. LePage vetoed that package last week. The veto was upheld Wednesday in the Senate, and both the governor and Democrats are preparing stand-alone bills to advance the hospital debt payment and Medicaid expansion, respectively.
“This is a national problem and it’s a direction the country is going in that we should be very concerned about,” said LePage.
LePage spokeswoman Adrienne Bennett said later Wednesday that the governor is more concerned about more than 3,000 people who are on waiting lists for social services in Maine.
“Everyone agrees that the hospital debt needs to be paid for,” said Bennett. “The governor’s issue has always been the long-term stability and affordability of a program and ensuring the most needy are covered.”
The governor also continued his criticism of Democrats for what he called “censorship” stemming from a May 19 Appropriations Committee meeting at which LePage arrived unannounced and was not allowed to speak by the committee chairwoman, Sen. Dawn Hill, D-York.
LePage’s claims of censorship continued last week when he was asked to remove a television he had placed outside his office, despite the fact Democrats invited him to take the issue to the Legislative Council, which has authority over alterations to the State House. In protest, LePage worked from the Blaine House late last week and early this week before returning to his office Wednesday.
Maine Senate upholds LePage veto of bill linking Medicaid expansion to hospital repayment
Posted May 29, 2013, at 12:44 p.m.
AUGUSTA, Maine — Democrats’ first effort to link Medicaid expansion with a plan to repay Medicaid debt to Maine hospitals died officially on Wednesday when the Senate failed to override Gov. Paul LePage’s veto of a bill that would do so.
Mirroring all previous votes on a bill that linked the two, the Senate voted 20-15 to override the veto, falling short of the two-thirds needed for an override. Democrats and independent Richard Woodbury voted for the override. All Republicans voted to sustain LePage’s veto. Only Senate Democratic Leader Seth Goodall of Richmond and Senate Republican Leader Michael Thibodeau of Winterport spoke before Wednesday’s veto vote. They reiterated past party arguments.
The provisions within LD 1546, “An Act to Strengthen Maine’s Hospitals, Increase Access to Health Care and Provide for a New Spirits Contract,” have been under debate since January but weren’t included in a single bill until earlier this month. Democrats on the Legislature’s Health and Human Services Committee attached an expansion of Medicaid under the federal Affordable Care Act to Gov. Paul LePage’s plan to repay Medicaid debt to hospitals with the proceeds of a renegotiated state liquor contract.
That angered LePage, who last week held a press conference and made a show of vetoing the bill before it had even arrived on his desk and minutes before Democrats held their own press conference on the issue. The governor said he would introduce a new bill that proposes repaying the hospitals without linking to Medicaid expansion.
As an incentive to lawmakers, LePage wrote in his veto letter to the Legislature that he has directed State Treasurer Neria Douglass to ready $105 million in voter-approved bonds to be released if lawmakers pass his hospital debt repayment plan, which is a promise the governor has voiced since January.
“The sad part of this veto is the simple fact that all of us have agreed paying our bills is the fiscally responsible thing to do,” LePage’s veto letter reads. “Additionally, the bipartisan work of the committees has recognized my original plan is the best way to do it.”
At issue is $484 million in state and federal funding that is owed to 39 Maine hospitals. Under LePage’s plan, the state’s $181 million would be covered by renegotiating a better deal for the state on the nearly 10-year-old state liquor contract and purchasing a revenue bond with the proceeds.
The arguments for and against the veto were brief Wednesday morning in the Senate and similar to the hours of testimony and legislative debate that have already centered around the question.
“Make no mistake about it. If we vote today and do not override this veto, you’re voting against paying back the hospitals,” Goodall said. “You’re voting against providing health care to 70,000 Mainers. Our resolve if we are not successful here today in overriding this veto will not be slowed down in a fashion.”
Under the federal health care reform law, the federal government covers 100 percent of costs for newly eligible Medicaid recipients for three years. That 100 percent rate gradually drops to 90 percent by 2020, when the state would make up the rest. Proponents of the expansion say it would cover almost 70,000 Mainers.
In Maine, about 50,000 adults without children would gain Medicaid coverage if the state opts to expand, according to the Legislature’s nonpartisan Office of Fiscal and Program Review. If the state chooses not to expand, about 25,000 childless adults and parents would lose their Medicaid coverage on Jan. 1, 2014.
| Maine House Rejects Bill to Ban Medicaid Coverage for Opiate Addiction Treatment | |||||||||
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The Maine House of Representatives today voted to reject a bill that would prohibit Medicaid coverage for medications such as methadone and Suboxone, used to treat opiate addiction. With one of the highest rates in the country of people seeking treatment, Maine, opponents argued, is in no position to pull the rug out from those who want and need help. Susan Sharon has more.
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The emotional, hour-long debate was kicked off by Republican Rep. Lawrence Lockman, of Amherst, who confessed to being what he called "a heretic" for not subscribing to the prevailing orthodoxy that drug addiction is a disease. Lockman is the sponsor of the bill that would terminate MaineCare coverage for methadone treatment, effective in January of 2015.
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