Illustration by Adrian Forrow
Illustration by Adrian Forrow

Politicians have seldom talked about immigration reform and health-care costs in the same breath. With Congress debating legislation to remake the U.S. immigration system, perhaps it’s time they did.

Since the 1960s, legal immigrants have been able to sponsor the admission of their parents, siblings and adult children under a system of preferences intended to facilitate reunification of extended families.

My analysis of immigrant-admissions data from the Justice and Homeland Security departments shows that these family-reunification policies are having an unintended consequence. At a time when the U.S. population is growing older, a system that fails to restrict late-age migration will only add to the costs of Medicaid and Medicare.

Of course, legal immigrants should be able to bring along their spouses and dependent children. But the rules that also allow them, after they become U.S. citizens, to sponsor their parents have produced a rapid increase, over the past three decades, in the share of legal immigrants who arrive at age 50 or older, especially from countries such as China, India and the Philippines.

Two processes are at work here. For one, the parents of naturalized citizens are exempt from the caps that limit how many immigrants the U.S. accepts each year from a given country. Sponsors are only required to prove that they can support their parents at 1.25 times the poverty level -- hardly enough to guarantee that the parents will have health insurance.

Parents’ Costs

Proponents of family preferences argue that legal immigrants should be allowed to sponsor their parents so that they can help with child care. If the sponsors take responsibility for their parents’ health care, that’s fine; otherwise, taxpayers will end up subsidizing that child care. Nonworking parents who immigrate to the U.S. contribute little to the economy, and in many cases the taxpayers will have to shoulder the burden of their health care as they grow older.

The other process involves siblings and adult children of legal immigrants, who receive preference in admissions decisions but aren’t exempt from the annual country caps. With limits on the number of extended-family relatives who can be admitted each year, siblings and adult children -- once they are approved -- join a huge backlog of extended-family members waiting to come to the U.S.

For immigrants from China, India, Mexico and the Philippines, the wait is extraordinarily long -- 10, 15 or even 20 years. These family members age as they wait for a visa, and they arrive in the U.S. with fewer productive years ahead of them. Unless sponsors are required to purchase health insurance for them, like sponsored parents, many will become a drain on the economy as they suffer the infirmities of age.

The proposed immigration overhaul addresses only part of the problem by imposing an age cap of 30 on married children of U.S citizens. But the legislation doesn’t change the rules for sponsoring parents.

My research shows that every 100 legal immigrants from Asia admitted from 1996 to 2000 sponsored almost 400 relatives by 2009, of whom one-quarter were age 50 or older. The vast majority of immigrant seniors are parents of naturalized citizens. If visas for these people aren’t restricted, then Congress should strengthen enforcement-of-support requirements for sponsored parents by enforcing those requirements currently on the books.

Medicaid Access

The Illegal Immigration Reform and Immigrant Responsibility Act of 1996 required sponsors to sign a legally binding affidavit promising to support their family members so they don’t become public charges. A five-year moratorium on immigrants’ access to means-tested benefits simply delays taxpayers’ liability for publicly funded Medicaid.

Other countries recognize and address the problem explicitly. Australia discourages sponsorship of parents by limiting the annual number of admissions for them; by imposing high visa costs with no guarantee of admission; and by insisting on a $42,000 deposit to help defray social costs for the majority of sponsored parents.

In the formula it uses to weigh potential immigrants against one another, Canada subtracts points for applicants above a certain age.

Congress could adopt one of these solutions, or could require that legal immigrants buy lifelong health insurance for their older extended-family members before they are allowed in the country.

According to a recent study by AARP, almost 9 million adults ages 50-64 lacked health insurance -- an increase of 3.7 million since 2000. If the Affordable Care Act requires citizens to purchase health insurance, it seems only fair that new immigrants should be bound by the same rules.

Particularly in a period of tight fiscal constraints and an aging population, Congress needs to consider whether we can still afford policies designed in the 1960s, at the end of the baby boom, when the newly enacted Medicare and Medicaid programs didn’t cost nearly as much as they do today.

We should base our decisions about family visas on evidence about the costs of late-age migration rather than on sentimental ideas about reuniting extended families.

(Marta Tienda is a professor of sociology and demography in the Woodrow Wilson School of Public and International Affairs at Princeton University. The opinions expressed are her own.)

To contact the writer of this article: Marta Tienda at tienda@princeton.edu.

To contact the editor responsible for this article: Katy Roberts at kroberts29@bloomberg.net.