Summary
The Impact of Immigration on Health Insurance Coverage in the United States
• The Uninsured: During nearly every year between 1994 and 2003, the number and percentage of Americans without health insurance coverage increased, from 15.9 percent of the nonelderly population in 1994 up to 17.7 percent in 2003. Numerous reasons have been cited for this increase in the uninsured: The combination of the rising cost of providing health benefits and a weak economy; structural changes in the economy, such as the movement of workers out of the manufacturing sector and into the service sector; and the decline of unionization.
• The Immigration Factor: Previous studies have found that immigrants are disproportionately employed in low-wage jobs, in small firms, and in service or trade occupations, jobs that are less likely to offer health benefits. The relative lack of employment-based coverage is compounded by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, which imposed a five-year ban on participation in health and other public programs by most newly arrived legal immigrants. Although these restrictions were subsequently loosened, the fact remains that fewer public benefits were available to recent immigrants during the latter part of the 1990s than earlier in the decade. And even after this five-year ban expired, immigrants may continue to be ineligible for public programs as a result of rules that attribute the income of an immigrant’s sponsor to the immigrant.
• Immigrants and the Uninsured: More than 11 million immigrants in the United States were uninsured in 2003, accounting for 26.1 percent of the all uninsured individuals in the country. Immigrants accounted for about one-third of the increase in the uninsured between 1994 and 1998, but between 1998 and 2003 they accounted for 86 percent of the growth in the uninsured, presumably because PRWORA restricted their benefits under public assistance programs for five years after they entered the United States. To the degree that immigration continues to increase, it is likely that the uninsured will also continue to increase as a proportion of the population.