Understanding the Role of Immigration Status in U.S. Health Coverage

Although national uninsured rates have reached an all-time low, there are still an estimated 27 million people who remain uninsured—which means they are missing out on preventative care, assistance with managing chronic conditions like heart disease and diabetes and timely diagnosis of diseases. 

A person's immigration status alone can prevent them from being eligible for health coverage. The deep-rooted racism in the United States, outdated immigration policies, and an individual's immigration status are all connected. Even those who are eligible also fear discriminatory and uneven immigration enforcement practices, which prevent them from enrolling in services—even when eligible.

Noncitizens in the United States are four times as likely to be uninsured compared to individuals who are citizens (39.2% versus 9.8%). This is due to eligibility restrictions for Medicaid, Children's Health Insurance Program (CHIP), and Marketplace coverage, as well as limited employer-sponsored coverage.

The current state of healthcare coverage for immigrants affects us all. Policymakers cannot advance health equity in this country without prioritizing immigrant health coverage. Now is the time to break down barriers to improve healthcare for all.

Opportunities to Expand Health Coverage for Immigrants 

There are pathways to coverage for noncitizens living in the United States. The pathways available vary by immigration status, with lawfully present immigrants eligible for more options and undocumented immigrants eligible for fewer. Below are opportunities at the federal and state level:

Federal Action

The Biden administration announced a plan to extend coverage to Deferred Action for Childhood Arrivals (DACA) recipients previously excluded from federal health programs, including Medicaid and marketplace premium assistance. Finalizing this rule is a necessary first step towards closing the healthcare gap among immigrant populations.

Legislation has been introduced in Congress to allow states to include undocumented immigrants in Medicaid and CHIP and remove the five-year bar for lawfully present immigrants. 

State Action

Medicaid Expansion

Expanding Medicaid could offer coverage to many more people, including lawfully present residents and others with immigration statuses eligible for Medicaid. 

Use of State-Only Funds to Provide Coverage or Subsidies

State leaders can utilize state-only funds to extend coverage to low-income residents currently ineligible for Medicaid/CHIP or subsidized health insurance under the ACA, regardless of immigration status.

Extensions of Coverage Under CHIP

While many immigrants remain ineligible for federally funded health benefits, Congress has provided states various opportunities to extend CHIP coverage in certain situations. Many states have exercised these options, but many others have not.

Innovative Policy Elements to Advance Equity

Addressing concerns that enrollment can lead to adverse immigration-related outcomes, considering affordability for those who exceed income eligibility, and conducting community outreach to eligible undocumented immigrants so they understand how to access benefits can help more immigrants access health coverage.

Conclusion 

To achieve health equity, we must identify where racism has shaped our nation’s governance, social structures, and policies perpetuating inequities. We must consider longer-term solutions that could transform several of our nation’s systems, policies, and practices built on a legacy of exclusion to ensure a future where everyone’s children and grandchildren can achieve their best health and wellbeing.