Noncitizens, Lawful Immigrants Much More Likely to Be Uninsured

February 27, 2019 - Non-US citizens, including immigrants lawfully present in the country, are significantly more likely than citizens to be uninsured, according to new data from the Kaiser Family Foundation (KFF).

The uninsured rate for adult undocumented immigrants is nearly five times higher than that of citizens.

Additionally, adult lawfully present immigrants are more than twice as likely as citizens to be uninsured, revealing that eligibility restrictions and enrollment barriers are limiting access to adequate health coverage.

In 2017, there were 22 million noncitizens living in the US, KFF noted, which accounted for about seven percent of the total population.

Of these noncitizens, about six in ten were lawfully present immigrants, or individuals authorized to live in the US either temporarily or permanently. The remaining 40 percent were undocumented immigrants. KFF pointed out that despite the high rates of citizens who don’t have insurance, noncitizens are far more likely to go without coverage.

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“While most of the uninsured are citizens, noncitizens are at significantly higher risk of being uninsured,” KFF stated.

“Among the total nonelderly population, 23 percent of lawfully present immigrants and more than four in ten (45 percent) undocumented immigrants were uninsured, compared to less than one in ten (8 percent) citizens.”

High uninsured rates extend to the children of noncitizens as well. KFF stated that nearly 19 million children, or 25 percent of all children in the US, had an immigrant parent as of 2017, and many of these children were citizens.

About 10 million, or 13 percent, were citizen children with a noncitizen parent. Of these children, seven percent did not have health coverage, compared to four percent of citizen children with citizen parents.

Moreover, 31 percent of undocumented immigrant children were without health coverage, and 19 percent of lawfully present immigrant children were uninsured.

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The data brief added that noncitizens often have limited access to employer-sponsored coverage.

“Nonelderly noncitizens are more likely than nonelderly citizens to live in a family with at least one full-time worker, but they also are more likely to be low-income,” the brief said.

“They have lower incomes because they are often employed in low-wage jobs and industries that are less likely to offer employer-sponsored coverage. Further, given their lower incomes, noncitizens face increased challenges affording employer-sponsored coverage when it is available or through the individual market.”

Noncitizens also face eligibility restrictions for Medicaid, CHIP, and ACA coverage, KFF noted.

“Lawfully present immigrants may qualify for Medicaid and CHIP, but are subject to certain eligibility restrictions,” the organization said. 

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“In general, lawfully present immigrants must have a ‘qualified’ immigration status to be eligible for Medicaid or CHIP and many, including most LPRs or ‘green card’ holders, must wait five years after obtaining qualified status before they may enroll.”

For ACA coverage, lawfully present immigrants can purchase insurance through the ACA marketplace and may receive subsidies for this coverage.

In contrast, undocumented immigrants are not eligible to enroll in Medicaid or CHIP, and cannot purchase coverage through the ACA marketplace.

However, for emergency services, Medicaid may make payments for individuals who are otherwise eligible except for their immigration status. There are also locally-funded programs that will provide coverage or assistance regardless of immigration status.

Although many lawfully present immigrants are eligible for coverage under the ACA, the brief showed that a significant number are still without insurance.

“In 2017, nearly three-quarters of uninsured lawfully present immigrants were eligible for ACA coverage, including 29 percent who were eligible for Medicaid and 43 percent who were eligible for tax credit subsidies,” KFF said.

“Many lawfully present immigrants who are eligible for coverage remain uninsured because immigrant families face a range of enrollment barriers, including fear, confusion about eligibility policies, difficulty navigating the enrollment process, and language and literacy challenges.”

Undocumented immigrants who are uninsured are ineligible for coverage options under the ACA, and often rely on safety net clinics or hospitals, or go without needed care.

Going forward, shifting policies that are restricting immigration may lead to increased fear in the immigrant community, and could result in families turning away from programs and services like Medicaid and CHIP.

In September 2018, the Trump administration proposed changes to rules that govern how public benefits may affect individuals’ ability to enter the US or adjust to legal permanent resident status. KFF stated that these proposed changes would likely lead to more individuals living without insurance.

“Under these changes, officials would newly consider use of certain non-cash programs, including Medicaid, when determining whether someone is a public charge and should be denied a green card or entry into the United States,” KFF concluded.

“The changes would likely lead to broad decreases in participation in Medicaid and other programs among legal immigrant families and their primarily US-born children. Declines in coverage for families would increase barriers to care and financial instability, negatively affecting the growth and healthy development of their children.”