Bold claim: undocumented immigrants pay into the system and deserve access to health care just like everyone else. But here’s where it gets controversial... the question isn’t whether they contribute tax money, but whether fairness requires expanding health coverage to include them.
A real-life story helps ground the issue. Last month, a kindergarten student I counsel as a social work intern was out most of the week. She missed Tuesday through Friday because she was sick. On Friday, her teacher called the mother to check in. The mother couldn’t get her child to a doctor or obtain the necessary medication because money was tight—and Medicaid was out of reach because they were undocumented.
Without federal health insurance, financial constraints blocked access to medical care and prescription medications for the child. This situation illustrates a broader problem: when health care is out of reach for families, illness can go untreated and consequences ripple through schools and communities.
Tax data from the Institute on Taxation and Economic Policy show that in 2022 undocumented immigrants contributed $96.7 billion in federal, state, and local taxes. They represent about 27 percent of the immigrant population in the United States. In other words, roughly 14 million people in the country paid nearly $97 billion in taxes while receiving little or no direct benefits in return. Of that amount, $59.4 billion went to federal taxes and $37.3 billion to state and local taxes.
A common misconception persists: undocumented immigrants receive federal assistance. In reality, welfare programs are largely excluding them due to the welfare reform law enacted in 1996. Eligibility for most welfare benefits typically requires a valid Social Security number, and in practice only certain categories of “qualified aliens”—such as lawful permanent residents, asylees, and refugees—qualify for federal benefits. Many others are deemed not eligible under the law.
Record-keeping and research indicate that despite contributing billions in federal taxes, undocumented immigrants are barred from accessing many of the programs funded by those taxes. At best, they can access emergency Medicaid, which covers urgent, short-term needs like labor and delivery, with some states extending coverage to dialysis or cancer treatment. In states with large undocumented populations, emergency Medicaid spending accounts for less than 1 percent of total state Medicaid budgets.
Further, more than a third of the taxes paid by undocumented immigrants go toward payroll taxes that fund programs they cannot access. In 2022, undocumented workers paid roughly $25.7 billion in Social Security taxes, $6.4 billion in Medicare taxes, and $1.8 billion in unemployment insurance taxes—taxes that support systems they cannot utilize.
If policy changed to grant work authorization to all undocumented immigrants, their tax contributions would rise as wages and tax compliance increase. Under a modeled scenario, granting work authorization could boost total tax contributions by about $40.2 billion annually, bringing the combined federal, state, and local tax total to roughly $136.9 billion. The majority of this increase—about $33.1 billion—would go to the federal government, with around $7.1 billion allocated to state and local governments.
The central question remains: should Congress amend welfare reform to at least allow Medicaid access for undocumented immigrants? Expanding health coverage would enable more people to see doctors, manage chronic conditions, and receive preventive care. A healthier workforce supports stronger productivity, higher output, and broader economic gains. In this framework, who benefits? The undocumented workers themselves, the businesses that hire them, and the overall economy.
Dustin Hopkins is a Master’s student in Social Work at Fort Hays State University and an elementary school social work intern.
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