Immigrant Status and Its Impact on Access to Health Care

Abstract

This paper explores disparities in health care access for undocumented immigrants in the United States. Using the case of California, we find that less than half of undocumented immigrants in this state report having health insurance. Additionally, our estimates show that, among the insured, US-born and naturalized citizens are significantly more likely to have a doctor visit in the previous year when compared to undocumented immigrants (aOR = 1.53%; 95% CI 1.15 -2.04, aOR = 1.40%; 95% CI 1.05 -1.87, respectively). Further, we find that US-born citizens are significantly more likely to use the ER in the previous year than undocumented immigrants, independent of insurance status. Our findings suggest that undocumented immigrants not only face barriers to obtain health insurance, but even with health insurance they face barriers to access health care services.

Legal status and health disparities: An examination of health insurance coverage among the foreign-born

“…Our findings using the statistical matching approach are largely consistent with results from studies with geographically limited samples (Goldman, Smith, and Sood 2005;Navarro, Ibarra, and Anglemyer 2017;Ortega et al 2018) and work using the restricted SIPP (Ro and Van Hook 2021). While our analysis revealed that 21% of naturalized citizens, 45% of LPRs, and 66% of unauthorized immigrants were uninsured, Goldman, Smith, and Sood (2005) found that 23% of naturalized citizens, 38% of permanent residents, and 68% of unauthorized immigrant adults in Los Angeles were uninsured.…”

“…While our analysis revealed that 21% of naturalized citizens, 45% of LPRs, and 66% of unauthorized immigrants were uninsured, Goldman, Smith, and Sood (2005) found that 23% of naturalized citizens, 38% of permanent residents, and 68% of unauthorized immigrant adults in Los Angeles were uninsured. In California, 52% of the unauthorized were uninsured, compared to 14% and 16% of US-born citizens and naturalized citizens, respectively (Navarro, Ibarra, and Anglemyer 2017). Among Hispanics, we find that 32% of naturalized citizens, 60% of LPRs, and 74% of unauthorized immigrants lack insurance coverage, similar to estimates made by Ro and Van Hook (2021) using restricted SIPP; they show that 31% of naturalized, 58% of LPR, and 77% of unauthorized immigrant Hispanic adults were uninsured.…”

“…We find some differences in coverage rates for particular groups (Goldman, Smith, and Sood 2005;Navarro, Ibarra, and Anglemyer 2017;Prentice, Pebley, and Sastry 2005). Compared to studies in Los Angeles County and California, legal nonimmigrants in our sample have lower uninsured rates and public insurance coverage rates (Goldman, Smith, and Sood 2005), whereas lawful permanent residents have higher uninsured rates (Prentice, Pebley, and Sastry 2005) and lower rates of private and public health insurance coverage (Navarro, Ibarra, and Anglemyer 2017). Unauthorized immigrants in California have also been found to have higher private coverage rates (34.7%) than those in our sample (22.2%; Navarro, Ibarra, and Anglemyer 2017).…”

“…While much of the focus of national-level research concerning the foreign-born is on differences by citizenship status (whether an immigrant has become a naturalized US citizen or not), current evidence linking migration status (the visa status of noncitizens) with health insurance coverage is restricted primarily to small, geographically specific samples or ethnographic studies. Geographically specific analyses show that unauthorized immigrant adults are less likely to be insured (Chavez 2012;Chavez et al 1997;Goldman, Smith, and Sood 2005;Marshall et al 2005;Montealegre and Selwyn 2014;Nandi et al 2008;Navarro, Ibarra, and Anglemyer 2017;Ortega et al 2018;Prentice, Pebley, and Sastry 2005;Ybarra, Ha, and Chang 2017) and have less access to health care (Marshall et al 2005;Montealegre and Selwyn 2014;Nandi et al 2008;Navarro, Ibarra, and Anglemyer 2017;Ortega et al 2018) compared to US citizens and other legally resident immigrant groups. In California in 2011-2012, for example, 16% of naturalized citizens, 28% of lawful permanent residents, and 52% of unauthorized immigrants were uninsured (Navarro, Ibarra, and Anglemyer 2017).…”

“…Geographically specific analyses show that unauthorized immigrant adults are less likely to be insured (Chavez 2012;Chavez et al 1997;Goldman, Smith, and Sood 2005;Marshall et al 2005;Montealegre and Selwyn 2014;Nandi et al 2008;Navarro, Ibarra, and Anglemyer 2017;Ortega et al 2018;Prentice, Pebley, and Sastry 2005;Ybarra, Ha, and Chang 2017) and have less access to health care (Marshall et al 2005;Montealegre and Selwyn 2014;Nandi et al 2008;Navarro, Ibarra, and Anglemyer 2017;Ortega et al 2018) compared to US citizens and other legally resident immigrant groups. In California in 2011-2012, for example, 16% of naturalized citizens, 28% of lawful permanent residents, and 52% of unauthorized immigrants were uninsured (Navarro, Ibarra, and Anglemyer 2017). Similarly, among California's Hispanic population, 21% of naturalized citizens, 32% of lawful permanent residents, and 53% of unauthorized immigrants were uninsured (Ortega et al 2018).…”