Health Newsletter: Undocumented Immigrants Are Most Likely to Be Uninsured
Undocumented immigrants are far less likely than any other group to have health insurance, accounting for up to one-third of the growth in the uninsured population in the United States in the past two decades, according to a RAND Corporation study published in the November/December edition of the journal Health Affairs.
Researchers found that 68 percent of the undocumented immigrant adults they studied had no health insurance. This compared with 17 percent of the native-born Americans, 23 percent of immigrants who had become citizens, and 38 percent of immigrants who are permanent legal residents. As a group, four in 10 of those born outside the United States lacked health insurance.
The study provides the most detailed analysis to date of undocumented immigrants and health insurance.
“These findings show that if you want to do something that will have a meaningful impact on the problem of the uninsured, then you must talk about undocumented immigrants,” said James P. Smith, a RAND senior economist and co-author of the study. “There are pros and cons of providing insurance to the undocumented that should be debated openly. Undocumented immigrants make up too much of the issue to be ignored or hidden by polite silence.”
Contrary to a commonly held view, undocumented immigrants in the study were less likely than other groups to be covered by public insurance such as Medicaid. This may be because recent rule changes have make it harder for immigrants to obtain such coverage, according to researchers.
Despite their lower incomes, just 8 percent of undocumented immigrants had public insurance such as Medicaid. This compares with 13 percent among native-born Americans, and 10 percent among both immigrant citizens and permanent residents. Most undocumented immigrants who had health insurance were covered through their employers, according to the RAND study.
The report also found that undocumented immigrants are more likely to be chronically uninsured. About 65 percent of undocumented immigrants in the study said they had no insurance in the past two years. This compares with 12 percent of the native-born, 18 percent of citizen immigrants, and 32 percent of permanent residents.
Health policy experts have assumed that undocumented immigrants account for a large number of the medically uninsured in the United States. But relatively little detailed information about the undocumented and health insurance has been available because survey participants are rarely asked their legal status.
RAND researchers analyzed information from the Los Angeles Family Neighborhood Study (LAFANS), which interviewed nearly 2,400 English- or Spanish-speaking adults throughout Los Angeles County during 2000 and 2001. Los Angeles has the largest immigrant community in the United States.
Undocumented immigration has grown rapidly in recent years. Among those who reported in 2002 that they had resided in the nation for less than five years, almost half are undocumented immigrants, compared with 5 percent in 1970. Meanwhile, the number of adults in the nation who have no health insurance increased by 8.7 million from 1980 to 2000.
RAND researchers say that when they apply the rates found in their study to the nation at large, undocumented immigrants would account for about a third of the total increase in the number of uninsured adults nationally from 1980 to 2000.
“Since the number of undocumented immigrants has been growing rapidly, we can expect that the uninsured population is going to grow rapidly as well,” said Neeraj Sood, a RAND economist and another study co-author.
Researchers say that the foreign-born were more likely to have socio-economic factors linked to a lower rate of medical insurance among all adults: less education, employment in an industry such as agriculture where workers less often receive health coverage, and low incomes.
“Much of the reason for the low rates of insurance among the foreign-born can be explained by their low socio-economic status,” said Dana Goldman, director of health economics at RAND and another author of the study. “But even when factors such as income are considered, it does not fully explain why the rates are so low among the undocumented.”
Funding for the study was provided by the Robert Wood Johnson Foundation through its support of the Economic Research Initiative on the Uninsured.
The study was done through RAND Labor and Population, which examines issues involving U.S. labor markets, the demographics of families and children, social welfare policy, the social and economic functioning of the elderly, and economic and social change in developing countries.
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