Health Coverage and Care for Immigrants
Immigrants, particularly those who are not citizens, historically have faced disproportionate barriers to accessing health coverage and care. The ACA offers new options to increase coverage for naturalized citizens and lawfully present immigrants, but undocumented immigrants remain ineligible for assistance. This brief provides an overview of the noncitizen immigrant population and their health coverage and access to care. It shows:
- As of 2014, there were 42.2 million immigrants residing in the United States, accounting for 13% of the total population. This group includes an estimated 19.7 million naturalized citizens, 9.9 million lawfully present immigrants, and 12.5 million undocumented immigrants.
- Noncitizen immigrants are significantly more likely than citizens to be uninsured. Among the nonelderly population, nearly a quarter (23%) of lawfully present immigrants and four in ten (40%) undocumented immigrants are uninsured compared to one in ten (10%) U.S. born and naturalized citizens.
- Two-thirds (66%) of uninsured lawfully present immigrants are eligible for assistance under the ACA, but undocumented immigrants are excluded from coverage options. Although lawfully present immigrants may qualify for the ACA Medicaid expansion, they remain subject to certain Medicaid eligibility restrictions. Undocumented immigrants remain ineligible for Medicaid and are prohibited from purchasing Marketplace coverage.
- Noncitizens fare worse than citizens on measures of access to care and generally report lower utilization of services relative to citizens. These patterns persist among noncitizens with coverage, suggesting they face additional barriers to accessing and utilizing care beyond their higher uninsured rates.
Overall, these findings show that noncitizens continue to face barriers to accessing health coverage and care. The ACA increased coverage options for lawfully present immigrants, but targeted outreach and enrollment efforts will be important for enrolling eligible immigrants in coverage. However, coverage alone will not overcome the barriers to care faced by many noncitizens. Additional efforts will be needed to address their gaps in care. In the absence of coverage options, undocumented immigrants will likely continue to have a high uninsured rate and face significant barriers to care. As such, safety-net providers and resources continue to be important for meeting the needs of this population. Some states also are exploring options to expand coverage for immigrants who remain ineligible for the ACA coverage options due to their immigration status.Issue Brief