Health care reform

From Wikipedia, the free encyclopedia

Health care reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:

• Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies
• Expand the array of health care providers consumers may choose among
• Improve the access to health care specialists
• Improve the quality of health care
• Give more care to citizens
• Decrease the cost of health care

United States

Maximum Out-of-Pocket Premium as Percentage of Family Income (Source: CRS)

In the United States, the debate regarding health care reform includes questions of a right to health care, access, fairness, sustainability, quality and amounts spent by government. The mixed public-private health care system in the United States is the most expensive in the world, with health care costing more per person than in any other nation, and a greater portion of gross domestic product (GDP) is spent on it than in any other United Nations member state except for East Timor (Timor-Leste). A study of international health care spending levels in the year 2000, published in the health policy journal Health Affairs, found that while the U.S. spends more on health care than other countries in the Organization for Economic Co-operation and Development (OECD), the use of health care services in the U.S. is below the OECD median by most measures. The authors of the study concluded that the prices paid for health care services are much higher in the U.S.

In spite of the amount spent on health care in the U.S., according to a 2008 Commonwealth Fund report, the United States ranks last in the quality of health care among developed countries. The World Health Organization (WHO), in 2000, ranked the US health care system 37th in overall performance and 72nd by overall level of health (among 191 member nations included in the study). International comparisons that could lead to conclusions about the quality of the health care received by Americans are subject to debate. The US pays twice as much yet lags other wealthy nations in such measures as infant mortality and life expectancy, which are among the most widely collected, hence easily compared, international statistics. Many people are underinsured, for example, in Colorado "of those with insurance for a full year, 36.3% were underinsured." About 10.7 million insured Americans spend more than a quarter of their annual paychecks on health care because of the high deductible policies.

The Patient Protection and Affordable Care Act (Public Law 111-148) was signed into law by President Barack Obama on March 23, 2010. Along with the Health Care and Education Reconciliation Act of 2010 (signed March 30), the Act is a product of the health care reform efforts of the Democratic 111th Congress and the Obama administration. The law includes health-related provisions to take effect over the next four years, including expanding Medicaid eligibility for people making up to 133% of the federal poverty level (FPL), subsidizing insurance premiums for people making up to 400% of the FPL ($88,000 for family of 4 in 2010) so their maximum "out-of-pocket" payment for annual premiums will be from 2% to 9.5% of income, providing incentives for businesses to provide health care benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, establishing health insurance exchanges, prohibiting insurers from establishing annual coverage caps, and support for medical research. According to White House and Congressional Budget Office figures, the maximum share of income that enrollees would have to pay for the "silver" healthcare plan would vary depending on their income relative to the federal poverty level, as follows:^[10][12] for families with income 133–150% of FPL will be 3–4% of income, for families with income of 150–200% of FPL will be 4–6.3% of income, for families with income 200–250% of FPL will be 6.3–8.1% of income, for families with income 250–300% of FPL will be 8.1–9.5% of income, for families with income from 300 to 400% of FPL will be 9.5% of income.

The costs of these provisions are offset by a variety of taxes, fees, and cost-saving measures, such as new Medicare taxes for those in high-income brackets, taxes on indoor tanning, cuts to the Medicare Advantage program in favor of traditional Medicare, and fees on medical devices and pharmaceutical companies; there is also a tax penalty for those who do not obtain health insurance, unless they are exempt due to low income or other reasons. The Congressional Budget Office estimates that the net effect of both laws will be a reduction in the federal deficit by $143 billion over the first decade.

The universal health care proposal pending in the U.S. Congress is called the United States National Health Care Act (H.R. 676, formerly the "Medicare for All Act.") The Congressional Budget Office and related government agencies scored the cost of a universal health care system several times since 1991, and have uniformly predicted cost savings, probably because of the 40% cost savings associated with universal preventative care and elimination of insurance company overhead costs.

In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) offered monetary incentives from 2011 to 2015 for adopting EHR technology to decrease the length of time for hospitals and other healthcare facilities to move from paper records to an electronic health record system. The technology, while not without its pitfalls, should allow easier documentation and storage, the ability to access the information from a bedside, and the ability to sync prescriptions with a bar code.

The Affordable Care Act was enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government. Health care providers receive payment more frequently as the number of insured people increases and the number of uninsured patients unable to pay out of pocket declines. Competition between insurers in the new health insurance marketplace has increased pressure on insurance companies to reduce premium rates, leading to reduced compensation rates to providers in some plans.

Many healthcare facilities are struggling to break even since the cost of providing health services has increased, due to wages, technology, and resources. Medicare reimbursement payments to health providers for orthopaedic procedures such as total knee arthroplasty, lumbar spine repair, open rotator cuff repair, and open ankle fracture repair, declined from 1992–2010 which means the providers must rely on self-pay patients and patients with commercial insurances to make up the difference. The changes in regulations regarding risk pool assessment and the inclusion of 10 essential health benefits to every insurance plan have also contributed to the rise in cost of insurance premiums.

Hawaii and Massachusetts

Both Hawaii and Massachusetts have implemented some incremental reforms in health care, but neither state has complete coverage of its citizens. For example, data from the Kaiser Family Foundation shows that 5% of Massachusetts and 8% of Hawaii residents are uninsured. To date, The U.S. Uniform Law Commission, sponsored by the National Conference of Commissioners on Uniform State Laws has not submitted a uniform act or model legislation regarding health care insurance or health care reform.

Health care costs

The United States spends more on health care than any other country in the world, and, yet, has poorer health status by many measures. In 2007, the United States spent $7,290 per capita on health care. The average among peer nations in the Organisation for Economic Cooperation and Development (OECD) is $3075, just 42 percent of U.S. spending. Health spending is concentrated on a few consumers. In 2006, almost half of all health care spending was used to treat just 5 percent of the population, according to the Kaiser Family Foundation. More than half of bankruptcy filings are related to health care expenses, and sixty-eight percent of these cases are filed by people who have health insurance. According to the White House Council of Economic Advisors, the average family income will be $2,600 lower by 2020, if the growth in the cost of health care is not slowed by at least 1.5 percent. The cost of health insurance premiums more than doubled between 1999 and 2008 while workers' earnings stagnated. In 2008, the average annual cost for family insurance coverage was $12,700.

Even though the United States spends more on health care than any other country in the world, in 2015 the Organization for Economic Co-operation and Development (OECD) reported that about 38.2% of adults in the United States are obese. The obesity rates among American adults is almost triple of any other country on the top ten list of countries spending the most money on health care in the world. The United States is also the only country in the top 10 of health care spending with an average lifespan under 80 years of age. The incredibly high health care expenditures in the United States results from a combination of various factors; medical practitioner salaries, expensive medical procedures, hospital costs, and most of all pharmaceutical products. Drug manufacturers in the United States set their own prices, while also allowing "government-protected monopolies" for certain drug manufacturers by granting sole drug manufacturers patents for 20 years or more.
An estimated 52 million people – more than 15 percent of the people in the United States – are currently without health insurance or access to a government health care program. Nationally, 77 percent of the people who are uninsured are workers or are dependents of someone who works. In 2008, employees of small businesses contributed an average of $4,101 for family coverage, compared to $2,982 paid by employees in large firms. About 59 percent of employees with incomes below the poverty level ($18,310 for a family of three) do not have health insurance. At income levels twice to three times the poverty level, about 34 percent lack insurance. Half as many lack insurance at four times the poverty level.

United Kingdom

Healthcare was reformed in 1948 after the Second World War, broadly along the lines of the 1942 Beveridge Report, with the creation of the National Health Service or NHS. It was originally established as part of a wider reform of social services and funded by a system of National Insurance, though receipt of healthcare was never contingent upon making contributions towards the National Insurance Fund. Private health care was not abolished but had to compete with the NHS. About 15% of all spending on health in the UK is still privately funded but this includes the patient contributions towards NHS provided prescription drugs, so private sector healthcare in the UK is quite small. As part of a wider reform of social provision it was originally thought that the focus would be as much about the prevention of ill-health as it was about curing disease. The NHS for example would distribute baby formula milk fortified with vitamins and minerals in an effort to improve the health of children born in the post war years as well as other supplements such as cod liver oil and malt. Many of the common childhood diseases such as measles, mumps, and chicken pox were mostly eradicated with a national program of vaccinations.

The NHS has been through many reforms since 1974. The Conservative Thatcher administrations attempted to bring competition into the NHS by developing a supplier/buyer role between hospitals as suppliers and health authorities as buyers. This necessitated the detailed costing of activities, something which the NHS had never had to do in such detail, and some felt was unnecessary. The Labour Party generally opposed these changes, although after the party became New Labour, the Blair government retained elements of competition and even extended it, allowing private health care providers to bid for NHS work. Some treatment and diagnostic centres are now run by private enterprise and funded under contract. However, the extent of this privatisation of NHS work is still small, though remains controversial. The administration committed more money to the NHS raising it to almost the same level of funding as the European average and as a result, there was large expansion and modernisation programme and waiting times improved.

The government of Gordon Brown proposed new reforms for care in England. One is to take the NHS back more towards health prevention by tackling issues that are known to cause long term ill health. The biggest of these is obesity and related diseases such as diabetes and cardio-vascular disease. The second reform is to make the NHS a more personal service, and it is negotiating with doctors to provide more services at times more convenient to the patient, such as in the evenings and at weekends. This personal service idea would introduce regular health check-ups so that the population is screened more regularly. Doctors will give more advice on ill-health prevention (for example encouraging and assisting patients to control their weight, diet, exercise more, cease smoking etc.) and so tackle problems before they become more serious. Waiting times, which fell considerably under Blair (median wait time is about 6 weeks for elective non-urgent surgery) are also in focus. A target was set from December 2008, to ensure that no person waits longer than 18 weeks from the date that a patient is referred to the hospital to the time of the operation or treatment. This 18-week period thus includes the time to arrange a first appointment, the time for any investigations or tests to determine the cause of the problem and how it should be treated. An NHS Constitution was published which lays out the legal rights of patients as well as promises (not legally enforceable) the NHS strives to keep in England.

Germany

Numerous healthcare reforms in Germany were legislative interventions to stabilise the public health insurance since 1983. 9 out of 10 citizens are publicly insured, only 8% privately. Health care in Germany, including its industry and all services, is one of the largest sectors of the German economy. The total expenditure in health economics of Germany was about 287.3 billion euro in 2010, equivalent to 11.6 percent of the gross domestic product (GDP) this year and about 3,510 euro per capita. Direct inpatient and outpatient care equal just about a quarter of the entire expenditure - depending on the perspective. Expenditure on pharmaceutical drugs is almost twice the amount of those for the entire hospital sector. Pharmaceutical drug expenditure grew by an annual average of 4.1% between 2004 and 2010.

These developments have caused numerous healthcare reforms since the 1980s. An actual example of 2010 and 2011: First time since 2004 the drug expenditure fell from 30.2 billion euro in 2010, to 29.1 billion Euro in 2011, i. e. minus 1.1 billion Euro or minus 3.6%. That was caused by restructuring the Social Security Code: manufacturer discount 16% instead of 6%, price moratorium, increasing discount contracts, increasing discount by wholesale trade and pharmacies.

The Netherlands

The Netherlands has introduced a new system of health care insurance based on risk equalization through a risk equalization pool. In this way, a compulsory insurance package is available to all citizens at affordable cost without the need for the insured to be assessed for risk by the insurance company. Furthermore, health insurers are now willing to take on high risk individuals because they receive compensation for the higher risks.

A 2008 article in the journal Health Affairs suggested that the Dutch health system, which combines mandatory universal coverage with competing private health plans, could serve as a model for reform in the US.

Russia

Following the collapse of the Soviet Union, Russia embarked on a series of reforms intending to deliver better healthcare by compulsory medical insurance with privately owned providers in addition to the state run institutions. According to the OECD none of 1991-93 reforms worked out as planned and the reforms had in many respects made the system worse. Russia has more physicians, hospitals, and healthcare workers than almost any other country in the world on a per capita basis, but since the collapse of the Soviet Union, the health of the Russian population has declined considerably as a result of social, economic, and lifestyle changes. However, after Putin became president in 2000 there was significant growth in spending for public healthcare and in 2006 it exceed the pre-1991 level in real terms. Also life expectancy increased from 1991-93 levels, infant mortality rate dropped from 18.1 in 1995 to 8.4 in 2008. Russian Prime Minister Vladimir Putin announced a large-scale health care reform in 2011 and pledged to allocate more than 300 billion rubles ($10 billion) in the next few years to improve health care in the country.

Taiwan

Taiwan changed its healthcare system in 1995 to a National Health Insurance model similar to the US Medicare system for seniors. As a result, the 40% of Taiwanese people who had previously been uninsured are now covered. It is said to deliver universal coverage with free choice of doctors and hospitals and no waiting lists. Polls in 2005 are reported to have shown that 72.5% of Taiwanese are happy with the system, and when they are unhappy, it's with the cost of premiums (equivalent to less than US$20 a month).

Employers and the self-employed are legally bound to pay National Health Insurance (NHI) premiums which are similar to social security contributions in other countries. However, the NHI is a pay-as-you-go system. The aim is for the premium income to pay costs. The system is also subsidized by a tobacco tax surcharge and contributions from the national lottery.

Elsewhere

As evidenced by the large variety of different healthcare systems seen across the world, there are several different pathways that a country could take when thinking about reform. In comparison to the UK, physicians in Germany have more bargaining power through professional organizations (i.e., physician associations); this ability to negotiate affects reform efforts. Germany makes use of sickness funds, which citizens are obliged to join but are able to opt out if they have a very high income (Belien 87). The Netherlands used a similar system but the financial threshold for opting out was lower (Belien 89). The Swiss, on the other hand use more of a privately based health insurance system where citizens are risk-rated by age and sex, among other factors (Belien 90). The United States government provides healthcare to just over 25% of its citizens through various agencies, but otherwise does not employ a system. Healthcare is generally centered around regulated private insurance methods.

One key component to healthcare reform is the reduction of healthcare fraud and abuse. In the U.S. and the EU, it is estimated that as much as 10 percent of all healthcare transactions and expenditures may be fraudulent. See Terry L. Leap, Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to do about It (Cornell University Press, 2011).

"Control knobs" theory

The five control knobs for health-sector reform

In “Getting Health Reform Right: A Guide to Improving Performance and Equity,” Marc Roberts, William Hsiao, Peter Berman, and Michael Reich of the Harvard T.H. Chan School of Public Health aim to provide decision-makers with tools and frameworks for health care system reform. They propose five “control knobs” of health reform: financing, payment, organization, regulation, and behavior. These control knobs refer to the “mechanisms and processes that reformers can adjust to improve system performance”. The authors selected these control knobs as representative of the most important factors upon which a policymaker can act to determine health system outcomes.
Their method emphasizes the importance of “identifying goals explicitly, diagnosing causes of poor performance systematically, and devising reforms that will produce real changes in performance”.  The authors view health care systems as a means to an end. Accordingly, the authors advocate for three intrinsic performance goals of the health system that can be adjusted through the control knobs. These goals include:

1. Health status: This goal refers to the overall health of the target population, assessed by metrics such as life expectancy, disease burden, and/or the distribution of these across population subgroups.
2. Customer satisfaction: This goal is concerned with the degree of satisfaction that the health care system produces among the target population.
3. Financial risk protection: This goal refers to the health system’s ability to protect the target population from the financial burden of poor health or disease.

The authors also propose three intermediate performance measures, which are useful in determining the performance of system goals, but are not final objectives. These include:

1. Efficiency:
   1. Technical efficiency: maximum output per unit cost
   2. Allocative efficiency: a given budget maximises health system user satisfaction or other defined goals
2. Access: effective availability by which patients receive care
3. Quality of care: consideration of both the average quality and distribution of quality

While final performance goals are largely agreed upon, other frameworks suggest alternative intermediate goals to those mentioned here, such as equity, productivity, safety, innovation, and choice.

Alternative frameworks for health care reform

Framework	Intermediate Goals
Control knobs framework	Efficiency Access Quality
Framework for assessing behavioural healthcare	Effectiveness Efficiency Equity
EGIPSS model	Productivity Volume of care and services Quality of care and services
WHO Performance framework	Access Coverage Quality Safety
Commonwealth Fund framework	High-quality care Efficient care Access System and workforce innovation and improvement
WHO Building Blocks Framework	Access Coverage Quality Safety
Systems Thinking	Equity Choice Efficiency Effectiveness

The five proposed control knobs represent the mechanisms and processes that policy-makers can use to design effective health care reforms. These control knobs are not only the most important elements of a healthcare system, but they also represent the aspect that can be deliberately adjusted by reforms to affect change. The five control knobs are:

1. Financing, which encompasses all the mechanisms and activities designed to raise money for the health system. With respect to mechanisms, the financing knob includes health-related taxes, insurance premiums and out-of-pocket expenses among others. Activities refers to the institutional organization that collects and distributes finance to participants in the health sector. In other words, financing is about the resources available to the healthcare system, who controls them and who receives them. The financing knob has clear implications for the health status of the population and particular groups in it, as well as the access to health care and protection from financial risk that these groups, and the population as a whole, have. The financing knob involves numerous potential financing mechanisms and processes that should be selected in accordance with a country’s social values and politics.
2. Payment refers to the mechanisms and processes through which the health system or patients distribute payments to providers, including fees, capitation and budgets on the part of the government and fees paid by patients. Payment is about the distribution of available resources to the providers of health services. Health care reform can implement a variety of incentive schemes for both providers and patients in a way to optimize limited resources.
3. Organization of the health system refers to the structure of providers, their roles, activities and operations. Essentially, organization describes how the health care market is set up: who are the providers, who are the consumers, who are the competitors, and who runs them. Changes in the organization of a healthcare system happen at multiple levels at both the front-line and managerial level.
4. Regulation refers to actions at the state level that modify or alter the behavior of various actors within the health care system. The actors may include health care providers, medical associations, individual consumers, insurance agents, and more. Regulations are only effective when enforced, therefore laws that are “on the books” but are not implemented in practice have little effect on the system as a whole.
5. Behavior of healthcare actors includes actions of both providers (e.g., doctors’ behavior) and patients (e.g., anti-smoking campaigns) and involves “changing individual behavior through population-based interventions”. Healthcare reform with respect to behavior revolves around the behaviors that can be used to improve the outcomes and performance of the health care system. These behaviors include health-seeking behavior, professional/doctors’ behavior, treatment compliance, and lifestyle and prevention behaviors.

The five control knobs of health care reform are not designed to work in isolation; health care reform may require the adjustment of more than one knob or of multiple knobs simultaneously. Further, there is no agreed-upon order of turning control knobs to achieve specific reforms or outcomes. Health care reform varies by setting and reforms from one context may not necessarily apply in another. It is important to note that the knobs interact with cultural and structural factors that are not illustrated within this framework, but which have an important effect on health care reform in a given context.
In summary, the authors of “Getting Health Reform Right: A Guide to Improving Performance and Equity” propose a framework for assessing health systems that guides decision-makers’ understanding of the reform process. Rather than a prescriptive proposal of recommendations, the framework allows users to adapt their analysis and actions based on cultural context and relevance of interventions. As noted above, many frameworks for health care reform exist in the literature. Using a comprehensive yet responsive approach such as the control knobs framework proposed by Roberts, Hsiao, Berman, and Reich allows decision-makers to more precisely determine the “mechanisms and processes” that can be changed in order to achieve improved health status, customer satisfaction, and financial risk protection.

Opposition to immigration

From Wikipedia, the free encyclopedia

 
Opposition to immigration exists in most states with immigration, and has become a significant political issue in many countries. Immigration in the modern sense refers to movement of people from one state or territory to another state or territory where they are not citizens. Illegal immigration is immigration in contravention of a state's immigration laws.

In the United States, opponents of immigration typically focus on perceived adverse effects, such as economic costs (job competition and burdens on education and social services); negative environmental impact from accelerated population growth; increased crime rates, and in the long run, changes in traditional identities and values. In Spain, surveys show "in descending order, jobs, crime and housing" as the primary concerns for citizens opposed to immigration.

Opposition to immigration ranges from calls for various immigration reforms to proposals to completely restrict immigration to one's nation; these often also include measures to combat emigration of existing citizens.

Anti-immigration arguments

National identity

Some critics of immigration argue that the presence of immigrants may distort the national identity of the native population. That means that the native population opposes immigration because they fear they may lose their sense of belonging to their own nation, as represented by distinctive traditions, culture, language and politics.

National identity can be an important factor for social peace in cases where there are intra-national divides. For example, a 2015 study showed that the educational content of Suharto's Indonesia emphasizing the national unity of Indonesia was an important cause of improved inter-ethnic and inter-religious relationships.

Isolation, separation and stability

Immigrants may isolate themselves in their own communities, forming self-organized communities, ghettos or parallel societies where they live according to their own culture, rather than assimilating to the native culture with a reduced or minimal spatial, social and cultural contact with the majority society into which they have immigrated. Such ethnic enclaves can be the result of humans naturally liking to be around people like themselves. They might not learn the local language and might eventually undermine the national unity, as well as the cultural and religious unity of the native country. Research by Jennifer Neal of Michigan State University suggests that ethnic enclaves promote social cohesion at the cost of decreasing tolerance between groups and that their size, autonomy and proximity are factors. Some also suggest to devolve more power to local communities.

Immigration may adversely affect social and political stability.

Increased competition

Economic arguments concentrate on competition for employment, and the higher burdens that some groups of immigrants may impose on social welfare systems, health systems, housing and public schools of the native state. For example, Denmark's strict immigration law reform has saved the country 6.7 billion euros compared to previous more permissive approach, according to a 2011 report from the Danish Integration Ministry.

Environmental space, quality and resource scarcity

The following are more an argument against overpopulation than against immigration, but sometimes overpopulation is caused by immigration. Some people think there is a certain size of land needed to provide for a population ("environmental space"), e.g., to provide for the population's consumption, including absorption of waste products. Immigrants, in this logic, such as a new born child, reduce the per capita size of land of the native country. This idea dates back to Robert Malthus who claimed this in a similar way in the early 19th century.

Some are concerned about urban sprawl and congestion, alterations in the wildlife and natural environment of the state, and an expansive carbon footprint due to immigration. Furthermore, some are concerned over a state's scarce resources, dwindling water reserves, energy, pauperized soils and solid waste.

Diseases

Immigrants (and cross-border movements in general) can bring infectious diseases uncommon to the native population from their home countries which some perceive as a threat of significance in opposition to immigration.

Some point out that this threat is often overstated by opponents.

Immigrant crime

Opponents of immigration often claim that immigrants contribute to higher crime rates. However, research suggests that people tend to overestimate the relationship between immigration and criminality. The academic literature provides mixed findings for the relationship between immigration and crime worldwide, but finds for the United States that immigration either has no impact on the crime rate or that it reduces the crime rate.

Military unity

Some concerns regarding immigration can be found in perceived military loyalty, especially if the country of emigration becomes involved in a war with the country of immigration. Particularly if a country finds itself in the need of drafting.

Dangerous journeys

Many people make dangerous migration journeys on which many have died. Harshly restricting immigration and making these restrictions known to potential emigrants may prevent them from taking such dangerous journeys.

Import of culture

Immigrants bring their culture with them. The immigrants' thinking, their norms, practices, customs and values shape, extend and influence the native country's culture (Leitkultur). Some such extensions and influences might not be desired by parts of the native population, for reasons that may include practises considered less civilized, restrictions as well as collisions with the native country's norms, laws and values in general.

Welfare costs

Opponents of immigration often state that immigrants have a net negative effect on public coffers mainly due to the provisioning of medical care and welfare.

Various factors influence the impact of immigrants to a nation's public coffers and their use of welfare. While immigrants can improve a state's welfare system by for example counteracting trends of aging populations their net economic impact might also be negative. George Borjas, economics professor at Harvard's Kennedy School of Government, states that "the more unskilled the immigrant, the more likely the immigrant will be a fiscal burden". High-skilled immigrants have better labor market prospects than those admitted based on kinship ties or for humanitarian reasons. It also depends on the tenures, wages and ages of the immigrants and the country's integration system.

Damage to migrants' home countries

Some opponents of immigration argue that emigration of highly skilled or well-educated individuals may hurt their home countries – which could otherwise benefit from them and build up their economy and improve their social and political system (i.e. brain drain). However, the notion of a "brain drain" remains largely unsupported in the academic literature. According to economist Michael Clemens, it has not been shown that restrictions on high-skill emigration reduce shortages in the countries of origin. According to development economist Justin Sandefur, "there is no study out there... showing any empirical evidence that migration restrictions have contributed to development." Hein de Haas, Professor of Sociology at the University of Amsterdam, describes the brain drain as a "myth". Research suggests that emigration (both low-and high-skilled) is beneficial both to the sending countries in terms of economy, education, and liberal democracy.

No solution to underlying problems

Immigration may be the outcome of problems in the migrants' countries of origin. Open immigration policies and efforts do not address these problems. However, just keeping borders closed does not address them either.

Jeanne Park of the Council on Foreign Relations recommends European leaders to address the root causes of migration such as helping to broker an end to Syria's civil war, restoring stability to Libya, and upping aid to sub-Saharan Africa. According to her barring a political solution to these regional crises, Europe will continue to struggle with migrant inflows. Concerning the migratory and refugee movements in and from the Horn of Africa Günther Schröder notes that greater efforts are needed to deal with its causes. A report by the German Caritasverband states that only a long-term strategy that differentiates between combating the causes for migration in the countries of origin and the development of an EU migration policy will be able to find solutions. Responding to the root causes of illegal migration flows involves cooperation with third countries, including migrants' countries of origin and transit and might manifest itself in conflict prevention / peacekeeping and state building. It has been suggested that safe havens be created within the country of origin. It can be argued that immigration means that people "flee" of their country's problems instead of organizing, building up pressure, being involved in constructive foreign aid programs or otherwise addressing them.

Causes of anti-immigration views

A 2017 study drawn from 18,000 interviews across eleven countries found that "higher-skilled immigrants are preferred to their lower-skilled counterparts at all levels of native socio-economic status (SES). There is little support for the Labor Market Competition hypothesis, since respondents are not more opposed to immigrants in their own SES stratum. While skin tone itself has little effect in any country, immigrants from Muslim-majority countries do elicit significantly lower levels of support, and racial animus remains a powerful force." A 2018 paper found that an influx of high-skilled immigration was associated with declines in nationalist voting, but that an influx in low-skilled immigration was associated with increases in nationalist voting.

Age

Older people tend to hold more negative views of immigration.

Country of origin

A study of Europe found that immigrants themselves tend to hold more favorable views of immigration. The same study found no evidence that the native-born children of immigrants hold more favorable views of immigration.

Economic status

A 2014 review study in the Annual Review of Political Science found that "there is little accumulated evidence that citizens primarily form attitudes about immigration based on its effects on their personal economic situation. This pattern has held in both North America and Western Europe, in both observational and experimental studies." A study of Europe found the unemployed hold less favorable views towards immigration than the employed.

Education and knowledge

Levels of education are one of the best predictors of support for anti-immigration policies and parties. A 2016 study published in the European Economic Review found, on the basis of European survey data in the period 2002-2012, that "higher levels of education lead to a more positive reported attitude toward immigrants". The authors suggest that this is explained by weaker economic competition between immigrants and educated natives, a higher aversion to discrimination among the educated, and a greater belief in the positive effects of immigration among the educated. A 2013 study in the American Journal of Political Science lends some support to the economic competition theory, as highly educated Americans who exhibit lower levels of xenophobia tend to support reductions in the number of highly skilled immigrants. A 2007 study in International Organization found that "people with higher levels of education and occupational skills are more likely to favor immigration regardless of the skill attributes of the immigrants in question. Across Europe, higher education and higher skills mean more support for all types of immigrants. These relationships are almost identical among individuals in the labor force, that is, those competing for jobs! and those not in the labor force." One paper finds "that each additional year of secondary schooling reduces opposition to immigration, and the belief that immigration erodes a country’s quality of life, by around ten percentage points."

One study of Japan found that exposure to information about the benefits of immigration substantially increased support for a more open immigration policy.

A study by Alexander Janus investigated whether social desirability pressures may partially explain reduced opposition to immigration amongst the highly educated. Using an unobtrusive questioning technique, Janus found that anti-immigration sentiments amongst American college graduates were far higher than subjects were willing to state. This indicates that support for immigration amongst the better educated may reflect expression of socially desirable views rather than actual beliefs. Further evidence for this was found in a study by Creighton et al., where amongst the college educated, it was found the stated support for immigration was higher than the actual pro-immigrant sentiment. This was true for other education levels. The study also found that the 2008 economic crisis did not significantly increase anti-immigration attitudes but rather there was a greater expression of opposition to immigration, with underlying attitudes changing little before and after the crisis.

Geographic proximity to immigrants

Some research suggests that geographic proximity to immigrants drives anti-immigration views, while other research shows the reverse. Other research suggests that it is the perception of proximity, not actual proximity, that drives these views.

A 2017 study finds that "more rapid ethnic changes increase opposition to immigration and support for UKIP" in the United Kingdom. A 2018 study found that increases in local ethnic diversity in Denmark caused "rightward shifts in election outcomes by shifting electoral support away from traditional “big government” left‐wing parties and towards anti‐immigrant nationalist parties."

Intergenerational transmission

Some research suggests that anti-immigration views are transmitted from older generations to younger generations. A 2017 study of Germany found "high association between fathers’ and sons’ right-wing extremist attitudes". A 2015 study found that British communities that were more acceptant of Jews in medieval times show much more tolerance towards 20th century immigrants (chiefly Caribbean and South Asian immigrants) and 21st century immigrants (chiefly Eastern European), and less support for the far right.

Perspective-taking

A 2017 study in the American Political Science Review found that prejudice towards marginalized groups, such as refugees, could be explained by a failure to take the perspective of the marginalized group. The study found that young Hungarian adults who played a perspective-taking game (a game intended to reduce prejudice towards marginalized groups by having players assume the role of a member of a marginalized group) showed reduced prejudice towards Romani people and refugees, as well as reduced their vote intentions for Hungary's overtly racist, far right party by 10%.

Religion

A 2017 study found that by emphasizing shared religion can produce more supportive attitudes toward refugees.

Sociopsychological explanations

A 2014 review study in the Annual Review of Political Science found that there is substantial evidence in support of sociopsychological explanations for anti-immigration views. A 2007 study in International Organization found that "the link between education and attitudes toward immigrants is driven by differences among individuals in cultural values and beliefs. More educated respondents are significantly less racist and place greater value on cultural diversity than do their counterparts; they are also more likely to believe that immigration generates benefits for the host economy as a whole."

A 2017 study in the American Political Science Review argued that hostility towards immigrants is driven by disgust and can be explained as a psychological mechanism designed to protect humans from disease.

Research suggests that the perception that there is a positive causal link between immigration and crime leads to greater support for anti-immigration policies or parties. Research also suggests that bigotry and immigrant alienation could exacerbate immigrant criminality and bigotry. For instance, University of California, San Diego political scientist Claire Adida, Stanford University political scientist David Laitin and Sorbonne University economist Marie-Anne Valfort argue "fear-based policies that target groups of people according to their religion or region of origin are counter-productive. Our own research, which explains the failed integration of Muslim immigrants in France, suggests that such policies can feed into a vicious cycle that damages national security. French Islamophobia—a response to cultural difference—has encouraged Muslim immigrants to withdraw from French society, which then feeds back into French Islamophobia, thus further exacerbating Muslims’ alienation, and so on. Indeed, the failure of French security in 2015 was likely due to police tactics that intimidated rather than welcomed the children of immigrants—an approach that makes it hard to obtain crucial information from community members about potential threats."

A study of the long-run effects of the 9/11 terrorist attacks in the United States found that the post-9/11 increase in hate crimes against Muslims decreased assimilation by Muslim immigrants. Controlling for relevant factors, the authors found that "Muslim immigrants living in states with the sharpest increase in hate crimes also exhibit: greater chances of marrying within their own ethnic group; higher fertility; lower female labour force participation; and lower English proficiency." A study of Germans found that the 9/11 terror attacks contributed to greater anti-immigrant sentiments. States that experience terrorist acts on their own soil or against their own citizens are more likely to adopt stricter restrictions on asylum recognition.

Opposition to immigration by country or region

Australia

Pauline Hanson, in her maiden speech in 1996, said that Australia "was in danger of being swamped by Asians".

The impact of Europeans was profoundly disruptive to Aboriginal life and, though the extent of violence is debated, there was considerable conflict on the frontier. At the same time, some settlers were quite aware they were usurping the Aborigines place in Australia. In 1845, settler Charles Griffiths sought to justify this, writing; "The question comes to this; which has the better right – the savage, born in a country, which he runs over but can scarcely be said to occupy ... or the civilized man, who comes to introduce into this ... unproductive country, the industry which supports life." Many events illustrate violence and resistance as Aborigines sought to protect their lands from invasion and as settlers and pastoralists attempted to establish their presence. In May 1804, at Risdon Cove, Van Diemen's Land, perhaps 60 Aborigines were killed when they approached the town.

A sparsely-populated continental nation with a predominantly European population, Australia has long feared being overwhelmed by the heavily populated Asian countries to its north. The standard policy after 1900 was "White Australia" which encouraged immigration from Britain, was suspicious of immigrants from Germany and elsewhere in Europe, and which was quite hostile to immigrants from Asia or the Pacific islands. After World War II, most Australians agreed that the country must "populate or perish". Immigration brought people from traditional sources such as the British Isles along with, for the first time, large numbers of Southern and Central Europeans. The abolition of the so-called 'White Australia policy' during the early 1970s led to a significant increase in immigration from Asian and other non-European countries.

Prime Minister John Curtin supported White Australia policy, saying "This country shall remain forever the home of the descendants of those people who came here in peace in order to establish in the South Seas an outpost of the British race."

Prime Minister Stanley Bruce was a supporter of the White Australia Policy, and made it an issue in his campaign for the 1925 Australian Federal election.

It is necessary that we should determine what are the ideals towards which every Australian would desire to strive. I think those ideals might well be stated as being to secure our national safety, and to ensure the maintenance of our White Australia Policy to continue as an integral portion of the British Empire. We intend to keep this country white and not allow its people to be faced with the problems that at present are practically insoluble in many parts of the world.

labor leader (1951-1960) H. V. Evatt was a defender of the White Australia Policy. There was a strong view in Australia that any softening of the White Australia stance might result in cheaper labour being imported from overseas. Another prevailing sentiment was that multiculturalism resulted in instability. Evatt, opposing resolutions which could have led to more Asian immigration to Australia, told the Chinese delegation at San Francisco:

You have always insisted on the right to determine the composition of your own people. Australia wants that right now. What you are attempting to do now, Japan attempted after the last war [the First World War] and was prevented by Australia. Had we opened New Guinea and Australia to Japanese immigration then the Pacific War by now might have ended disastrously and we might have had another shambles like that experienced in Malaya.

An other (ALP) Leader of the Labor Party from 1960-1967 Arthur Calwell supported the White European Australia policy. This is reflected by Calwell's comments in his 1972 memoirs, Be Just and Fear Not, in which he made it clear that he maintained his view that non-European people should not be allowed to settle in Australia. He wrote:

I am proud of my white skin, just as a Chinese is proud of his yellow skin, a Japanese of his brown skin, and the Indians of their various hues from black to coffee-coloured. Anybody who is not proud of his race is not a man at all. And any man who tries to stigmatize the Australian community as racist because they want to preserve this country for the white race is doing our nation great harm... I reject, in conscience, the idea that Australia should or ever can become a multi-racial society and survive.

It was the high-profile historian Geoffrey Blainey, however, who first achieved mainstream recognition for the anti-multiculturalist cause when he wrote that multiculturalism threatened to transform Australia into a "cluster of tribes". In his 1984 book All for Australia, Blainey criticised multiculturalism for tending to "emphasise the rights of ethnic minorities at the expense of the majority of Australians" and also for tending to be "anti-British", even though "people from the United Kingdom and Ireland form the dominant class of pre-war immigrants and the largest single group of post-war immigrants."

According to Blainey, such a policy, with its "emphasis on what is different and on the rights of the new minority rather than the old majority," was unnecessarily creating division and threatened national cohesion. He argued that "the evidence is clear that many multicultural societies have failed and that the human cost of the failure has been high" and warned that "we should think very carefully about the perils of converting Australia into a giant multicultural laboratory for the assumed benefit of the peoples of the world."

In one of his numerous criticisms of multiculturalism, Blainey wrote:

For the millions of Australians who have no other nation to fall back upon, multiculturalism is almost an insult. It is divisive. It threatens social cohesion. It could, in the long-term, also endanger Australia's military security because it sets up enclaves which in a crisis could appeal to their own homelands for help.

Blainey remained a persistent critic of multiculturalism into the 1990s, denouncing multiculturalism as "morally, intellectually and economically ... a sham".

In the 1996 election Pauline Hanson was elected to the federal seat of Oxley. In her controversial maiden speech to the House of Representatives, she expressed her belief that Australia "was in danger of being swamped by Asians". Hanson went on to form the One Nation Party, which initially won nearly one quarter of the vote in Queensland state elections before entering a period of decline due to internal disputes. The name "One Nation" was meant to signify national unity, in contrast to what Hanson claimed to see as an increasing division in Australian society caused by government policies favouring migrants (multiculturalism) and indigenous Australians.

Some Australians reacted angrily to One Nation, as Hanson was subjected to water balloons filled with urine at public speeches, ridiculed in the media, and received so many death threats she filmed a "good-bye video" in the case of her assassination. She was imprisoned by the government on political corruption charges, which were dropped after her imprisonment. In recent years the rise of other anti-immigrant parties such as the Australian Liberty Alliance and groups such as the United Patriot Front indicates that anti-immigration sentiment may be becoming mainstream.

Europe

Opposition to high levels of legal immigration has been associated with certain right-wing parties in the EU. The issue flared up with the European migrant crisis in 2015 with large numbers of refugees from the Middle East and Africa making dangerous trips to Europe and many deaths en route. With high levels of unemployment and partly unassimilated non-European immigrant populations already within the EU, parties opposed to immigration have improved their position in polls and elections. Right-wing parties critical to immigration have entered the government in Austria, Denmark, Italy, The Netherlands, Norway, Poland and Slovakia, and have become major factors in English, Swedish, German and French politics.

Immigration is one of the central political issues in many European countries, and increasingly also at European Union level. The anti-immigration perspective is predominantly nationalist, cultural and economic. A new index measuring the level of perceived threat from immigrants has been recently proposed and applied to a data set covering 47 European countries and regions. The results show that Malta and Cyprus have the strongest perception of socio-economic threat from immigrants, followed by Austria, Great Britain (in particular England), Northern Ireland and Hungary, and that the countries/regions with the weakest perception of threat are Armenia, Sweden, Romania and Northern Cyprus. European nationalists see unassimilated immigrants as threatening their historic cultures and a violation of their rights of a land for their own peoples. The fears are compounded the fact that many immigrants in western Europe are poor, working class Muslims from the Middle East and Northern Africa. Prominent European opponents of immigration include Jean-Marie Le Pen, Thilo Sarrazin, Fjordman, the late Jörg Haider and the assassinated Pim Fortuyn. In France, the National Front opposes immigration. In the 1988 elections, 75% of supporters of its leader Jean-Marie Le Pen believed France has too many immigrants (as opposed to 35% of all voters.)

Ackording to a Yougov poll in 2018, majorities in all seven polled countries were opposed to accepting more migrants: Germany (72%), Denmark (65%), Finland (64%), Sweden (60%), United Kingdom (58%), France (58%) and Norway (52%).

Spain

A January 2004 survey by Spanish newspaper El País showed that the "majority" of Spaniards believe immigration was too high. Small Neo-fascist parties, such as Movimiento Social Español, openly campaign using nationalist or anti-immigrant rhetoric as do other small far-right parties such as National Democracy (Spain) and España 2000. These parties have never won national or regional parliamentary seats.

Portugal

Portugal had little immigration until a sudden influx in the 1970s, as ex-colonists returned. Today there are Lisbon-born Africans. Rural areas have just recently begun to see many new arrivals. The country has one far-right party that supports curbs in immigration. Any resident of a Portuguese-speaking country is free to live and work in Portugal, and vice versa. In recent years, the growth of the Portuguese far-right "National Renewal Party", known as PNR, has targeted the immigration and ethnic minorities issues after years of growing support—0.09% 4,712 2002, 0.16% 9,374 2005, 0.20% 11,503 2009, 0.31% 17,548 2011—managed 0.50% 27,269 of the electorate in the 2015

United Kingdom

In the UK the British National Party made opposition to immigration one of their central policies in the 2010 general election. The anti-mass-immigration party, UKIP, have proposed setting up a Migration Control Commission, tasked with bringing down net migration. The Conservative Party pledged to bring immigration from the EU and rest of the world down to the "tens of thousands", with a range of welfare restrictions and housing restrictions.

The vote for the UK to leave the EU was successful in Britain, with a number of commentators suggesting that populist concern over immigration from the EU was a major feature of the public debate. British Prime Minister David Cameron resigned over the vote. In 2006, Cameron dismissed UKIP supporters as "fruitcakes, loonies and closet racists, mostly" though later conceded to hold a vote on leaving the EU, due in part to the Conservative party losing votes to UKIP.

The current Prime Minister Theresa May introduced an Immigration Skills Charge in April 2017, on companies who employ skilled non-EU immigrants, of £1000 per immigrant employee; small or charitable organizations pay a reduced amount of £364. The money is to be used to help fund apprenticeships and skills training for people from the UK and EU. In her 2017 UK General Election manifesto, the Prime Minister promised to double the Immigration Skills Charge to £2000 per employee, if re-elected. EU law prevents the charge being applied in relation to immigrants from the EU (or limiting the apprenticeships to people from the UK); the prime minister has promised that after Brexit there will also be restrictions on migration from the EU.

Asia

India

India has anti-immigrant parties at the state level. The most common anti-immigrant parties are there in the state of Maharashtra, where the two main anti-immigrant parties are Shiv Sena and the Maharashtra Navnirman Sena. Both parties share the idea of migrants from North India stealing jobs from the native Marathi people in Maharashtra. They even have a history of attacking immigrants, who they accuse of being involved in crimes around Mumbai. Shiv Sena also has a history of threatening the Pakistani cricket team from coming to Mumbai and also threatening Australian cricket players in the Indian Premier League cricket competition following the racist attacks on India students in Australia in 2009.

Even in the last few decades, there has been a rise in the anti-Immigrant attitudes in the North East Indian states like Assam, which has received illegal immigrants from neighboring Bangladesh. Riots have occurred between the native tribes of Assam who are Hindus and the illegal immigrants from Bangladesh, who are predominantly Muslims.

Japan

The movement for Japanese cultural isolation, sakoku (鎖 国), arose in Edo period Japan, in response to the strong influence of Western culture, especially Slavery in Portugal. The study of (ancient) Japanese literature and culture was called kokugaku (国 学, "country study").

Americas

Canada

In L'Express, the French news magazine, Canadian academic, and environmental activist David Suzuki called Canada's immigration policy "disgusting" (We "plunder southern countries to deprive them of their future leaders, and wish to increase our population to support economic growth") and insisted that "Canada is full" ("Our useful area is reduced"), even though Canada has one of the smallest population densities in the world. In a 2017 poll, the majority of Canadians indicated that they agree that Canada should accept fewer immigrants and refugees.

Costa Rica

Anti-immigrant feelings date back to late 19th century and early 20th century with the country's first waves of migrations from places like China, Lebanon and Poland. Non-Polish European migration dates back to practically the independence from Spain but was generally well received. Polish migration was mostly Jewish thus the backlash was due to anti-Semitism. Records of the time show Chinese migrants as the most affected by prejudice especially from government official and the first anti-Chinese laws were enacted as far back as the 1910s. In 1903 President Ascensión Esquivel Ibarra enacted one of the first decrees forbidding non-White immigration and explicitly stating that migration from Asians, Blacks, Gypsies, Arabs and Turks was not allowed. Although this laws were common in Latin America at the time, and Costa Rica’s government eventually became the lead force in its abolishment.

Polish, Chinese and Lebanese migrants would integrate fully into Costa Rican society with time to the point that many prominent Costa Ricans from industry, politics, arts, academy, etc. are of those descents. Latin American migrants became the next source of mistrust and opposition, especially Nicaraguan and Colombian migrants. During the second half of the 20th century and to this date Costa Rica receives numerous waves of Latin American migrants from all the region, but Nicaraguans are by far the higher group among immigrant population encompassing 74.6% of the immigrant population, followed by Colombians and Americans (immigrants in general are 9% of the population) making ethnic Nicaraguans and binational Nicaraguan-Costa Rican citizens one of the most notorious ethnic minorities in Costa Rica outnumbering other groups like African-Costa Ricans. This caused debate in the country with some voices claiming for harder regulations and border control. The issue was one of the main topics of the 2002's political campaign, and was again important for the 2018's campaign with right-wing politicians like Otto Guevara quoting Donald Trump as an inspiration and calling for harsher migratory laws and eliminating the citizenship by birth in the Constitution. The Migration Law was reform globally in 2005 hardening some of the requirements for entering, staying and working on the country which was criticized as excessive, but further reforms, the last one in 2009, reduce some of the impact of the more controversial parts of the law. Far-right ultra-convervative National Restoration Party that held an important role in the most recent presidential election also holds anti-migration positions.

Mexico

In Mexico, during the first eight months of 2005, more than 120,000 people from Central America were deported to their countries of origin. This is a much higher number than the people deported in the same period in 2002, when only 1 person was deported in the entire year. Many women from countries in the Commonwealth of Independent States (most of former USSR), Asia and Central and South America are offered jobs at table dance establishments in large cities throughout the country, causing the National Institute of Migration (INM) in Mexico to raid strip clubs and deport foreigners who work without the proper documentation.

Mexico has very strict laws pertaining to both illegal and legal immigrants. The Mexican constitution restricts non-citizens or foreign-born persons from participating in politics, holding office, acting as a member of the clergy, or serving on the crews of Mexican-flagged ships or airplanes. Certain legal rights are waived, such as the right to a deportation hearing or other legal motions. In cases of flagrante delicto, any person may make a citizen's arrest on the offender and his accomplices, turning them over without delay to the nearest authorities.

Many immigration restrictionists in the United States have accused the Mexican government of hypocrisy in its immigration policy, noting that while the Government of Mexico and Mexican Americans are demanding looser immigration laws in the United States and oppose the 2010 Arizona Immigration Bill, at the same time Mexico is imposing even tighter restrictions on immigration into Mexico from Central America and other places than the Arizona law. However Mexico started enforcing those laws which they previously ignored at the direct request of the United State's which saw a surge of Central American immigraiton during the Bush years; the newly elected president of Mexico has stated he's desire to be more open, and would not deport Central Americas on their way to the United States or those who wish to remain in Mexico.

United States

Donald Trump campaigned for president in 2016 by promising to build a wall on the border of Mexico and the United States "as the centerpiece of his immigration plan".

 

Anti-illegal immigrant car sticker in Colorado

In countries where the majority of the population is of immigrant descent, such as the United States, opposition to immigration sometimes takes the form of nativism.

In the United States, opposition to immigration has a long history, starting in the late 1790s, in reaction to an influx of political refugees from France and Ireland. The Alien and Sedition Acts of 1798 restricted the rights of immigrants. Nativism first gained a name and affected politics in the mid-19th century United States because of the large inflows of immigrants from cultures that were markedly different from the existing Protestant culture. Nativists objected primarily to Roman Catholics, especially Irish Americans. Nativist movements included the American Party of the mid-19th Century (formed by members of the Know-Nothing movement), the Immigration Restriction League of the early 20th Century, and the anti-Asian movements in the West, resulting in the Chinese Exclusion Act and the so-called "Gentlemen's Agreement" which was aimed at the Japanese. Major restrictions became law in the 1920s and sharply cut the inflow until 1965, when they ended. The federal government took charge of finding and deporting illegal aliens, which it still does.

Immigration again became a major issue from the 1990s onward, with burgeoning illegal immigration, particularly by Mexicans crossing the Southern border, and others who overstayed their visitor visas. The Immigration Reform and Control Act of 1986 provided an amnesty which was described as the amnesty to end all amnesties but it had no lasting impact on the flow of illegal immigrants.

By 2014, the Tea Party movement narrowed its focus away from economic issues, spending and Obamacare to President Barack Obama's immigration policies. They see his immigration policies as threatening to transform American society. They tried but failed to defeat leading Republicans who supported immigration programs, such as Senator John McCain. A typical slogan appeared in the Tea Party Tribune: “Amnesty for Millions, Tyranny for All.” The New York Times reported:

What started five years ago as a groundswell of conservatives committed to curtailing the reach of the federal government, cutting the deficit and countering the Wall Street wing of the Republican Party has become a movement largely against immigration overhaul. The politicians, intellectual leaders and activists who consider themselves part of the Tea Party movement have redirected their energy from fiscal austerity and small government to stopping any changes that would legitimize people who are here illegally, either through granting them citizenship or legal status.

As of 2014, there were over 42.4 million immigrants living in the United States. This was about 13.3% of the entire United States population at that time.

Labor unions

The American Federation of Labor (AFL), a coalition of labor unions formed in the 1880s, vigorously opposed unrestricted immigration from Europe for moral, cultural, and racial reasons. The issue unified the workers who feared that an influx of new workers would flood the labor market and lower wages. Nativism was not a factor because upwards of half the union members were themselves immigrants or the sons of immigrants from Ireland, Germany and Britain. However, nativism was a factor when the AFL even more strenuously opposed all immigration from Asia because it represented (to its Euro-American members) an alien culture that could not be assimilated into American society. The AFL intensified its opposition after 1906 and was instrumental in passing immigration restriction bills from the 1890s to the 1920s, such as the 1921 Emergency Quota Act and the Immigration Act of 1924, and seeing that they were strictly enforced.

Mink (1986) concludes that the link between the AFL and the Democratic Party rested in part on immigration issues, noting the large corporations, which supported the Republicans, wanted more immigration to augment their labor force.

United Farm Workers during Cesar Chavez tenure was committed to restricting immigration. Chavez and Dolores Huerta, cofounder and president of the UFW, fought the Bracero Program that existed from 1942 to 1964. Their opposition stemmed from their belief that the program undermined U.S. workers and exploited the migrant workers. Since the Bracero Program ensured a constant supply of cheap immigrant labor for growers, immigrants could not protest any infringement of their rights, lest they be fired and replaced. Their efforts contributed to Congress ending the Bracero Program in 1964. In 1973, the UFW was one of the first labor unions to oppose proposed employer sanctions that would have prohibited hiring illegal immigrants.

On a few occasions, concerns that illegal immigrant labor would undermine UFW strike campaigns led to a number of controversial events, which the UFW describes as anti-strikebreaking events, but which have also been interpreted as being anti-immigrant. In 1969, Chavez and members of the UFW marched through the Imperial and Coachella Valleys to the border of Mexico to protest growers' use of illegal immigrants as strikebreakers. Joining him on the march were Reverend Ralph Abernathy and U.S. Senator Walter Mondale. In its early years, the UFW and Chavez went so far as to report illegal immigrants who served as strikebreaking replacement workers (as well as those who refused to unionize) to the Immigration and Naturalization Service.

In 1973, the United Farm Workers set up a "wet line" along the United States-Mexico border to prevent Mexican immigrants from entering the United States illegally and potentially undermining the UFW's unionization efforts. During one such event, in which Chavez was not involved, some UFW members, under the guidance of Chavez's cousin Manuel, physically attacked the strikebreakers after peaceful attempts to persuade them not to cross the border failed.

Bernie Sanders opposes guest worker programs and is also skeptical about skilled immigrant (H-1B) visas, saying, "Last year, the top 10 employers of H-1B guest workers were all offshore outsourcing companies. These firms are responsible for shipping large numbers of American information technology jobs to India and other countries." In an interview with Vox he stated his opposition to an open borders immigration policy, describing it as:

...a right-wing proposal, which says essentially there is no United States...you're doing away with the concept of a nation-state. What right-wing people in this country would love is an open-border policy. Bring in all kinds of people, work for $2 or $3 an hour, that would be great for them. I don’t believe in that. I think we have to raise wages in this country, I think we have to do everything we can to create millions of jobs.

Africa

South Africa

Several periods of violent riots against migrants have occurred in South Africa in the past decade, some resulting in fatalities. Countries from which the migrants targeted originated include Malawi, Mozambique and Zimbabwe.