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E.g., 04/13/2024
Immigrants and Health Care Reform: What's Really at Stake?
October 2009

Immigrants and Health Care Reform: What's Really at Stake?

This report analyzes 2008 census data, presents statistics about immigrant populations and their health coverage, and discusses these numbers in the context of health care reform proposals that directly affect immigrants and the overall U.S. population. According to the report’s findings, recent Lawful Permanent Residents (LPRs) and unauthorized immigrants are disproportionately less likely to have health insurance coverage compared to U.S. born citizens and naturalized citizens due to their lower incomes, lower rates of employer coverage, and bars on eligibility for public programs.

The report examines policy implications for citizens and noncitizens across several health care reform proposals. Authors predict that the absence of a coverage mandate for all employers would have a significant impact on immigrants, who could face significant burdens if subjected to mandates requiring them to purchase coverage. Furthermore, the report argues that policies that exclude recent LPRs and unauthorized immigrants from insurance subsidies may not be cost effective in the long-run—especially in states with large immigrant populations—since such exclusions will render immigrants dependent on costly treatment at public health facilities, with much of the costs borne by state and local governments, and ultimately taxpayers and health care consumers. Finally, the authors sustain that costly and ineffective verification requirements, such as front-end document checks, could deny or delay benefits for citizens and eligible LPRs, impose significant costs on businesses, and raise the cost of insurance for all Americans.

Table of Contents 

I. Introduction

II. A Snapshot of Immigrant Health Care Coverage

A. LPR and Unauthorized Immigrant Populations

B. Income and Poverty among Immigrant Populations

C. Patterns of Work among Immigrants

D. Employer Coverage of Working-Age Immigrants

E. Variation in Employer Coverage by Employer Size

F. Medicaid/CHIP Coverage

G. The Uninsured

H. Disproportionate Impact on Large Immigrant States

III. Policy Implications

A. Eligibility Rules for Medicaid and Insurance Subsidies

B. Access to Insurance Exchanges

C. Scope of Employer and Individual Mandates

D. Verification Requirements

E. Designing Eligibility Verification for Health Insurance Reform

IV. Conclusion