Fact Check

Does Lack of Affordable Healthcare Kill More People in America Than Terrorism and Illegal Immigration?

A widely-shared Facebook meme challenged readers to reevaluate their political priorities about immigration and health care.

Published Jan 8, 2019

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Lack of affordable healthcare accounts for a greater number of deaths per year than do terrorist attacks and illegal immigration combined.
What's True

Terrorist acts and homicides committed by undocumented immigrants account for a relatively very small portion of all violent deaths in the United States, and some research has concluded that the lack of affordable healthcare causes many more deaths each year.

What's False

No consensus exists about either the methodology or definitions that should be employed in researching the number of deaths caused each year by lack of access to affordable healthcare, nor about that number itself.

Statistics are a common feature of online political debate, and statistical comparisons can often be a powerful rhetorical tool, especially if they are striking or unexpected -- thereby forming the basis of eye-catching and "shareable" social media memes.

At the end of 2018, one such meme sought to force readers to reevaluate their perception of various risks and harms in American society, arguing that when it comes to sheer fatalities, terrorism and the consequences of illegal immigration pale in comparison to a lack of affordable healthcare. The left-leaning "Teanderthal Party" Facebook page posted a meme which contained the claim that "More Americans die every year from lack of affordable healthcare than from terrorist attacks and illegal immigration combined":

Terrorist attacks

Terrorist attacks are relatively very rare events in the United States and in recent years have resulted in a relatively very small number of fatalities. No single, universally-accepted definition of a terrorist attack exists, but the term's distinguishing characteristic is that, roughly speaking, it describes an attack driven by some cause (e.g., political, religious, environmental) rather than a criminal motive or personal grievance.

Furthermore, except in cases of assassination, the victims of terrorist acts are typically not known or individually targeted in advance. They are either arbitrary (for example the passengers of a commercial jet converted into a weapon by Al-Qaeda operatives and used to destroy the World Trade Center) or part of a group which is symbolically targeted (for example, worshippers at the Sikh Temple of Wisconsin, where a neo-Nazi assailant shot dead six people on the basis of their perceived religious faith, in 2012).

The Federal Bureau of Investigation (FBI) defines terrorist acts as falling into two categories:

International terrorism: Perpetrated by individuals and/or groups inspired by or associated with designated foreign terrorist organizations or nations (state-sponsored)
-- for example, the December 2, 2015 shooting in San Bernardino, CA, that killed 14 people and wounded 22 which involved a married couple who radicalized for some time prior to the attack and were inspired by multiple extremist ideologies and foreign terrorist organizations.

Domestic terrorism: Perpetrated by individuals and/or groups inspired by or associated with primarily U.S.-based movements that espouse extremist ideologies of a political, religious, social, racial, or environmental nature.
-- for example, the June 8, 2014 Las Vegas shooting, during which two police officers inside a restaurant were killed in an ambush-style attack, which was committed by a married couple who held anti-government views and who intended to use the shooting to start a revolution.

A couple of unofficial but robust sources of data on deaths from terrorist attacks in the United States have been active in recent years. The first is the National Consortium for the Study of Terrorism and Responses to Terrorism (START), which is linked to the Department of Homeland Security and led by the University of Maryland.;

According to START figures, between 1995 and 2017 show 3,516 deaths associated with 694 terrorist attacks of all varieties (international and domestic), yielding a mean (average) of 153 deaths per year. However, around 3,000 of those fatalities were associated with a single set of events: the Al-Qaeda attacks of 11 September 2001.

In order to find out what the typical number of deaths per year was during this period, we must calculate the median, a type of average that strips away the impact of outliers such as 9/11. The median (or typical) annual number of terrorism-related deaths in the United States between 1995 and 2017 was four -- a number that makes sense when one considers that in 10 of the 23 years in question the number of deaths was fewer than three.

If we focus in on the five most recent years (2013-2017), we find a clear increase in the number of terrorism-related deaths, with 266 in total and an annual average of 53. The median (typical) number of deaths per year was 54 during this period.

The second source is a major report published in 2016 by the conservative-leaning think thank the Cato Institute. Their "Terrorism and Immigration Risk Analysis" collated data from nine different sources but focused exclusively on terrorist acts perpetrated by foreign-born assailants in the United States.

According to the report, between 1975 and 2015 a total of 2,983 deaths occurred that were related to terrorist attacks perpetrated by non-U.S. born attackers. Unsurprisingly, the overwhelming majority of these resulted from the September 11th attacks.

These numbers work out to an average of 73 deaths related to foreign-perpetrated terrorism, but it's important to note that in 30 out of the 41 years in question not a single such death occurred, and the median (typical) annual number of deaths relating to foreign terrorism was actually zero.

Illegal immigration

It's not made explicit, but the meme's mention of illegal immigration is almost certainly a reference to homicides committed by undocumented immigrants within the United States, something that is often talked up as a threat by those in favor of stricter immigration enforcement and border security, not least of all President Donald Trump.

Several studies have shown that undocumented immigrants actually commit crime in general at a lower rate than native-born Americans. We examined that research in greater depth previously.

When it comes to the number of homicides attributed to undocumented immigrants, the numbers are less clear, but we do have some indicative data. In 2011, the Government Accountability Office, an objective and non-partisan federal auditing and research agency, published a study on arrests and incarceration among immigrants in the United States.

The study concluded that between 1955 and 2010, a total of 25,064 arrests took place of undocumented immigrants on homicide charges. We don't know what proportion of those arrests advanced to prosecutions, and from there to convictions, but even the highest possible conversion rate of 100 percent would mean there an average of 448 undocumented immigrants per year were convicted of homicides in the United States between 1955 and 2010.

Of course, the actual number is likely to be significantly lower than that, since only some arrests will lead to prosecutions, and only some prosecutions will lead to convictions.

In 2018, the Cato Institute published a report on the rates of arrest and conviction among immigrants in Texas on charges of homicide, sex crimes, and other serious offenses. The report concluded that, in general, legal and undocumented immigrants committed crime at lower rates than native-born Americans.

In particular, the report found that undocumented immigrants accounted for 5.9 percent of homicide convictions in Texas in 2015, despite making up 6.4 percent of the state's population. Legal immigrants accounted for just 3.8 percent of homicide convictions, despite making up 10.6 percent of the state's population. By contrast, native-born Americans accounted for 90.3 percent of homicide convictions in 2015, despite making up 83 percent of the Texas population.

The rate of homicide conviction among undocumented immigrants in Texas in 2015 was 2.6 convictions for every 100,000 immigrants. If one were to extrapolate from that rate on to the national level, it would work out as 286 homicide convictions of undocumented immigrants in the United States, in 2015, based on an estimated undocumented immigrant population of 11 million.

Even if, for some reason, the rate of homicide conviction were remarkably low in Texas -- one third the national rate, for the sake of argument -- that would still equate to fewer than 1,000 homicide convictions (858) of undocumented migrants in the United States in 2015.

If the rate of undocumented-immigrant homicide convictions is the same nationwide as it is in Texas, and if we accept START's annual average of 153 deaths caused by terrorism per year (even though the average in the last five years has been significantly lower at 53), this gives us a combined total of 439 deaths per year caused by terrorism and undocumented-immigrant homicide.

If one allows for the possibility that the rate of undocumented immigrant homicide conviction might be (for the sake of argument) three times higher nationwide than it is in Texas, this yields a combined total of 1,011 deaths per year. The question now is, does that number outstrip the number of deaths caused by a lack of affordable healthcare each year?

Lack of affordable healthcare

Recent debates about healthcare in general, and former president Barack Obama's Affordable Care Act (Obamacare) in particular, have often featured claims about the number of avoidable deaths caused by a lack of affordable healthcare.

The estimates have varied. A 2009 study in the American Journal of Public Health reckoned that 44,789 deaths in the United States in 2005 were associated with a lack of health insurance.

In 2016, the left-leaning web site ThinkProgress calculated that the repeal of Obamacare could cause as many as 36,000 deaths per year, based on an estimate that almost 30 million people would lose their health insurance under such a scenario, and after applying the conclusions of a 2014 study from the Annals of Internal Medicine, which found that the introduction of affordable health insurance in Massachusetts in 2007 prevented one death for every 830 individuals who became insured under the program.

Using the same 2014 study as their basis, President Obama's Council of Economic Advisers estimated in December 2016 that the provisions of the Affordable Care Act were saving around 24,000 lives per year.

Others have pointed out the flaws in such estimates, not least the difficulty in precisely attributing a lack of health insurance as the primary direct cause of a particular individual's death. In particular, a 2009 study in the journal Health Services Research concluded that: "Adjusted for demographic, health status, and health behavior characteristics, the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer‐sponsored group insurance ..." In other words, the study found that lack of health insurance did not cause any otherwise avoidable premature deaths.

However, another study that challenged the methodology of earlier estimates and found them to be excessively high still arrived at the conclusion that those who could not afford private health insurance were 3.7 percent more likely to suffer an avoidable death than those who had private health insurance, a ratio that would equate to a significant number of avoidable deaths per year on a national level.


It does seem unlikely that the unavailability of affordable healthcare to many U.S. residents accounts for fewer than 1,000 deaths each year -- the very high estimate we arrived at as the combined number of deaths attributable to acts of terrorism and homicides perpetrated by undocumented immigrants.

It is also undoubtable that terrorist acts and homicides committed by undocumented immigrants account for a relatively very small portion of all violent deaths in the United States, and certainly a smaller share than might appear to be the case, based on the intense media and political scrutiny they attract.

However, it's unlikely that any research model could arrive at a definitive estimate of the number of people who die premature and avoidable deaths each year as a result of their inability to access health insurance. This is partly due to the inherent complexities and ambiguities involved in that question.

Furthermore, we must take into account the absence of uniformly-accepted estimates on the number of fatalities caused by the lack of affordable healthcare, and the existence of at least one peer-reviewed study which concluded that lacking insurance did not cause any substantive difference in the number of deaths.

For those reasons, we give a mixed verdict to the claim in the meme, that "More Americans die every year from lack of affordable healthcare than from terrorist attacks and illegal immigration combined."


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Dan Mac Guill is a former writer for Snopes.