Immigrants & Health Care: MPI Analyzes Health Reform Eligibility, Verification Issues and Provides New Estimates of Coverage by Legal Status, Poverty, Firm Size and for Select States

Health care reform proposals under consideration in Congress that would exclude many legal immigrants from core benefits and impose new verification requirements would have important spillover consequences for taxpayers and other health care consumers, according to an analysis released today by the Migration Policy Institute.In a new report, Immigrants and Health Care Reform: What’s Really at Stake?, MPI’s National Center on Immigrant Integration Policy offers the first-ever estimates of the size of uninsured immigrant populations in major immigrant-destination states, the number of immigrant workers covered by employer-provided plans and the share of immigrants employed by small firms likely to be exempted from employer coverage mandates. The report, based on MPI’s analysis of Census Bureau data, also examines health coverage for immigrants by legal status, age and poverty levels.

Of the estimated 12 million lawful permanent residents in the United States, 4.2 million are uninsured and more than 1 million would be excluded from Medicaid coverage or insurance subsidies if Congress does not remove the five-year waiting period for eligibility. Thirty-eight percent of legal immigrants work at small firms of 25 workers or less, which are likely to be exempted from employer mandates. Just 32 percent of legal immigrant workers at these small firms have insurance compared with 71 percent for U.S.-born workers.

If denied eligibility for Medicaid and insurance subsidies but subjected to mandates requiring them to purchase coverage, as contemplated by some legislative proposals, many legal immigrants (who have the same tax and Selective Service responsibilities as citizens) would face a significant burden.

“Leaving large numbers of legal immigrants out of health care reform would defeat the core goal of the legislation, which is to extend coverage to the nation’s 46 million uninsured,” said MPI Senior Vice President Michael Fix, who co-authored the report. “Congress recently restored some of the public benefit cuts imposed on legal immigrants by the 1996 welfare reform law, so excluding them now from health care reform would reverse this policy trajectory.”

The report also examines eligibility screening proposals, and questions whether the benefits of insurance reform could be reduced by expensive and badly designed verification requirements to ensure unauthorized immigrants aren’t getting health care benefits for which they are ineligible.

“Past experience with Medicaid suggests fraudulent use by unauthorized immigrants is very rare, raising questions about the value of an expensive pre-screening verification system that would impose clear burdens on many vulnerable Americans,” said MPI Senior Policy Analyst Marc Rosenblum, a co-author of the report. “Document checks would be especially costly, and would have the biggest impact on U.S. citizens who cannot produce birth certificates or other forms of ID, leading to lost or delayed coverage.”

Among the report’s other findings:

• 38 percent of legal immigrant children and 31 percent of unauthorized immigrant children have employer-provided coverage, compared to 61 percent of U.S.-born children.
• 23 percent of the uninsured in California are legal immigrants, who account for more than 10 percent of the uninsured in Texas, New York, Florida, Illinois and New Jersey. States with large immigrant populations could see expanded use of emergency rooms and public clinics if health care reform results in legal immigrants (and the unauthorized as well) being dropped from employer-sponsored insurance.
• The share of legal immigrant adults who are uninsured ranges from 54 percent in Texas, 45 percent in Florida and 44 percent in North Carolina to 28 percent in New York.
• Unauthorized immigrants represent 15 percent of the nation’s 46 million uninsured, while legal immigrants account for 9 percent.

“The budget projections for health care reform assume substantial savings by excluding many immigrants, but do not factor in the costs associated with leaving so many people uninsured. Denying coverage does not eliminate the need for health care, and uninsured immigrants will head to emergency rooms or may postpone necessary medical attention – ultimately shifting costs to taxpayers and other health care consumers,” said MPI Senior Policy Analyst and report co-author Randy Capps.

The full report is available at www.migrationpolicy.org/pubs/healthcare-Oct09.pdf.

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The Migration Policy Institute is an independent, non-partisan, non-profit think tank in Washington, DC dedicated to analysis of the movement of people worldwide. MPI provides analysis, development and evaluation of migration and refugee policies at the local, national and international levels. For more on MPI’s National Center on Immigrant Integration Policy, visit: www.migrationpolicy.org/integration/.

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