Health and Health Care Experiences of Uninsured Immigrants
Introduction
As of 2024, there were about 50 million immigrants residing in the U.S. Within this group, there were 24 million noncitizen immigrants, including lawfully present and undocumented immigrants, and 26 million naturalized citizens, who accounted for about 7% and 8% of the total population, respectively. Actions taken by the Trump administration and Congress will likely have major impacts on health and health care for immigrant families, including increasing the number of uninsured immigrants.
While undocumented immigrants have been ineligible for federally-funded health coverage programs under longstanding policy, the 2025 reconciliation law includes new eligibility restrictions for many lawfully present immigrants, including refugees and asylees, to access Medicaid and the Children’s Health Insurance Program (CHIP), subsidized Affordable Care Act (ACA) Marketplace, and Medicare coverage. The CBO estimates that 1.4 million lawfully present immigrants could lose health coverage by 2034 due to the law’s eligibility changes. Research shows that having insurance makes a difference in whether and when people access needed care. Those who are uninsured often delay or go without needed care, which can lead to worse health outcomes over the long-term that may ultimately be more complex and expensive to treat.
This brief provides data on health and health care experiences of uninsured immigrant adults based on a KFF survey of immigrant adults ages 18 and older conducted in partnership with The New York Times in Fall 2025. The data provide insight into how the projected coverage losses under the 2025 reconciliation law may impact health and health care for immigrant families as more lawfully present immigrants become uninsured. Key takeaways include the following:
Compared to those with insurance coverage, uninsured immigrant adults are more likely to not have a usual source of care and to delay or go without health care. Half of uninsured immigrant adults say that they do not have a usual source of health care other than the emergency room compared to about one in six (16%) of their insured counterparts. Further, half of uninsured immigrant adults report skipping or postponing care, twice the share of those with coverage (50% vs. 26%). Nearly one in five (18%) of all uninsured immigrant adults said their health got worse as a result of skipping or postponing health care.
Cost or lack of coverage is the primary reason uninsured immigrant adults cite for skipping or postponing care, reflecting the role insurance plays in facilitating access to care. Almost half (46%) of uninsured immigrant adults say they delayed or went without care because of cost or lack of insurance compared to 14% of insured immigrant adults. Overall, about seven in ten (69%) uninsured immigrant adults say they have had problems paying for health care (62%), housing (41%), or food (36%) in the past 12 months. In comparison, over four in ten (44%) insured immigrant adults report problems paying for health care (31%), housing (29%), or food (26%) in the past 12 months.
Consistent with other research demonstrating that parental coverage affects children’s health coverage and access to care, uninsured immigrant parents are three times as likely as those with insurance coverage (32% vs. 10%) to say they have at least one child who is uninsured. Further, over four in ten (44%) uninsured immigrant parents say any of their children delayed or skipped health care in the past 12 months compared to about a quarter (26%) of those with insurance coverage.
Findings
Characteristics of Uninsured Immigrants
About one in seven (15%) immigrant adults age 18 and older report being uninsured as of 2025, with higher uninsured rates among those who are noncitizens, Hispanic, lower income, have limited English proficiency (LEP), or live in states with less expansive coverage. Nearly half of likely undocumented immigrant adults (46%) and one in five lawfully present immigrant adults (21%) report being uninsured compared to fewer than one in ten of their U.S.-born (6%) and naturalized citizen (7%) counterparts (Figure 1). Uninsured rates also are higher among immigrant adults who are Hispanic (27%), have lower incomes (household income of less than $40,000 per year) (23%), or have LEP (23%) compared to their White (5%), higher income (household income of $90,000 or more per year) (4%), and English proficient (10%) counterparts, likely reflecting that these groups also are more likely to be noncitizens. Further, immigrant adults who live in states that provide less expansive coverage, including not adopting the ACA Medicaid expansion to all low-income adults or any coverage expansions for immigrants, are about twice as to be uninsured compared with those living in states with more expansive policies (23% vs. 11%).
Access to Health Care
Half of uninsured immigrant adults say they do not have a usual source of care other than an emergency room (Figure 2). In comparison, about one in six (16%) insured immigrant adults say they do not have a usual source of care other than an emergency room. Research shows that having a usual source of care is associated with better access to health care even after controlling for demographic and socioeconomic characteristics.
Uninsured immigrant adults are about twice as likely as those who are insured to report delaying or going without needed care (50% vs. 26%) (Figure 3). Delaying or going without needed care can contribute to health problems becoming worse and taking more time and resources to treat. Nearly one in five (18%) of uninsured immigrant adults say they skipped or postponed health care and their health got worse compared to 9% of insured immigrant adults.
Uninsured immigrant adults are more likely than those with insurance to cite cost or lack of coverage and immigration-related concerns as reasons for delaying or going without care. Almost half (46%) of uninsured immigrant adults say they delayed or went without care because of cost or lack of insurance compared to 14% of insured immigrant adults (Figure 4). Additionally, 16% of uninsured immigrant adults identified concerns about their or a family member’s immigration status as a reason compared to 4% of insured immigrant adults, likely reflecting that uninsured immigrants include a higher share of likely undocumented immigrants. Similar shares of uninsured (14%) and insured immigrant adults (12%) cited not being able to find services at a time or location that worked for them as a reason for delaying or going without care. Language barriers were also cited by some of those with LEP.
Likely reflecting their lower incomes, uninsured immigrant adults report more difficulty paying for basic needs, including health care, compared to those with insurance. Six in ten uninsured immigrant adults say that it has been harder to earn a living since January 2025 (60%) and about seven in ten (69%) say they have had problems paying for basic necessities such as health care (62%), housing (41%), or food (36%) in the past 12 months (Figure 5). These shares are higher compared to those with insurance coverage, with the largest gap in difficulty paying for health care (62% vs. 31%).
Impacts of Parental Coverage on Children’s Coverage and Access to Care
Uninsured immigrant parents are about three times as likely as insured immigrant parents (32% vs. 10%) to report at least one uninsured child as of 2025 (Figure 6). Further, over four in ten (44%) uninsured immigrant parents say any of their children delayed or skipped health care in the past 12 months compared to about a quarter (26%) of those with insurance coverage. These findings are consistent with other research showing that parental coverage impacts children’s access to health coverage and care.
