WASHINGTON – Low-income immigrant children are less likely than their U.S.-born citizen counterparts to see a doctor even when they are insured. Similarly, immigrant adults are less likely to use emergency rooms than low-income natives, a new Migration Policy Institute (MPI) report that examines health care coverage and usage among immigrants and the U.S. born finds.
The report, Health Care for Immigrant Families: Current Policies and Issues, finds that low-income immigrant children with private or public health care insurance were significantly less likely to visit a doctor’s office during 2010 than their native-born counterparts – 44 percent versus 69 percent for children with private coverage, and 62 percent versus 71.5 percent for children with public coverage. Overall, whether insured or uninsured, 47 percent of low-income immigrant children reported visiting a doctor’s office during 2010 compared to 69 percent of U.S.-born children.
Regarding adult health care usage, the report finds that immigrant adults had lower rates of doctor’s office and even emergency room visits. Analysis of Medical Expenditure Panel Survey (MEPS) data showed that 8 percent of low-income immigrant adults overall reported an emergency room visit during 2010, compared to 13 percent of their native-born peers; for those who were uninsured, the rate was 6 percent for immigrants and 14 percent of the native born. And for adults with public insurance coverage, the rate was 17 percent for immigrants and 25 percent for their U.S.-born peers.
“While it is commonly believed that immigrants overwhelm emergency rooms, perhaps in part because so many are uninsured and have problems securing care in doctors’ offices, our analysis shows that immigrants – even those who have insurance – use emergency rooms more sparingly than the native born,” said report co-author Leighton Ku, who is director of the Center for Health Policy Research at George Washington University.
Using 2011 Census Bureau Current Population Survey data, the report finds that 44 percent of non-citizen immigrants in the United States are uninsured, compared to 13 percent of native-born citizens. Among low-income households, the lack of insurance coverage is more than twice as high for non-citizen children with non-citizen parents compared to citizen children (38 percent versus 17 percent). And almost twice as many low-income non-citizen adults are uninsured as their citizen peers (62 percent compared to 35 percent). Their lower rates of coverage are due in part to low coverage through their employers – about 40 percent of noncitizen workers are employed in the service and construction industries, which have low rates of insurance offering.
Even as debate continues over health care coverage for immigrants, Ku and co-author Mariellen Malloy Jewers suggest that in some respects immigrant health care coverage has improved in recent years. A significant number of states have expanded coverage for legal permanent resident (LPR) children and pregnant women as a result of a 2009 law allowing states to eliminate a five-year waiting period instituted as part of a 1996 welfare reform law. The Affordable Care Act also expands Medicaid coverage for legal immigrants and offers them better opportunities to buy private health insurance under the law’s new health insurance exchanges.
Coverage for unauthorized immigrants remains far more controversial and has been a significant topic of discussion during the immigration reform debates underway in the Senate and House, with a number of key lawmakers opposing access to health insurance coverage for unauthorized immigrants who would legalize under comprehensive immigration reform legislation.
Still the authors find there are a variety of ways to improve health access for needy immigrants, particularly those admitted legally. Among the options: Encouraging states to waive the bars on Medicaid for legal immigrant children and pregnant women in the country for less than five years, and strengthening non-profit community health centers that often serve as the safety net for the poor and uninsured. They also cite efforts to increase the use of interpreters and other language access services for those who lack English proficiency, saying access to care as well as the quality of health care received can improve as a result.
This report was produced as part of a research initiative, supported with a grant from the Foundation for Child Development, which seeks to offer an evidence-based appraisal of the policies most important to promoting the health, well-being, and academic success of young children of immigrants and reflect broadly on the political climate for policy change. An earlier paper by the Academic Dean of the Harvard Graduate School of Education focused on the policies and programs that reduce developmental risks for children with parents who are unauthorized. A forthcoming report in the series will examine health outcomes for young children of immigrants.
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The Migration Policy Institute (MPI) is an independent, non-partisan, non-profit think tank in Washington, DC dedicated to analysis of the movement of people worldwide. MPI provides analysis, development and evaluation of migration and refugee policies at the local, national and international levels. For more on MPI, please visit www.migrationpolicy.org.