Health Care & Immigration Reform

As Congress considers the reform of our health care system, there will be efforts by some in Congress to conflate health care reform and immigration reform in an effort to defeat both.  These Members of Congress will argue that immigrants are responsible for our rising uninsured rate and rising health care costs, and they will push amendments to exclude immigrants from health care coverage.  They will try to add immigration enforcement amendments unrelated to health care.

Health care reform and immigration reform should be argued on their own merits.  The intersection of our immigration system and our health care system has been the subject of some research—and the facts, not surprisingly, differ from those asserted by those opposed to immigration.  Below you will find links to resources that debunk some of the assertions being made by immigration restrictionists inside and outside of Congress. There are also links to materials concerning how immigrants should be treated in any overhaul of the health care system. 

2010

How are Immigrants Included in Health Care Reform?

March 22, 2010 - National Immigration Law Center

This fact sheet summarizes the treatment of immigrants in the Patient Protection and Affordable Care Act (H.R. 3590), which became law in March 2010.

Trends In Health Care Spending For Immigrants In The United States

February 11, 2010 - Jim P. Stimpson, Fernando A. Wilson, and Karl Eschbach, in Health Affairs (March 2010)

An examination of health care spending during 1999–2006 for adult naturalized citizens and immigrant noncitizens (which includes some undocumented immigrants) finds that the cost of providing health care to immigrants is lower than that of providing care to U.S. natives and that immigrants are not contributing disproportionately to high health care costs in public programs such as Medicaid.

2009

Critical Care: The Role of Immigrant Workers in U.S. Health Care

December 11, 2009 - Immigration Policy Center

Immigrants are a critical component of the health care workforce at both the high-skilled and less-skilled ends of the occupational spectrum. Most notably, immigrants comprise more than one-quarter of all Physicians and Surgeons in the United States, and roughly one-fifth of all Nursing, Psychiatric, and Home Health Aides.

Immigrants and Health Care Reform: What’s Really at Stake?

October 05, 2009 - Randy Capps, Mark Rosenblum, Michael Fix, Migration Policy Institute

This report offers 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 analysis of Census Bureau data, also examines health coverage for immigrants by legal status, age and poverty levels.

The Truth About Costly Verification Systems, Unauthorized Immigrants and Health Care

September 30, 2009 - Immigration Policy Center

Past attempts to implement verification measures to preclude undocumented immigrants from obtaining government-subsidized health care have prevented U.S. citizens and legal immigrants from receiving health care, while uncovering very few instances of unauthorized immigrants trying to abuse the system. If additional verification rerquirements are included in current health care proposals, they will ensnare far more citizens than unauthorized immigrants and add unnecessary costs to health care reform.

Hispanics, Health Insurance and Health Care Access

September 25, 2009 - Gretchen Livingston, Pew Hispanic Center

This report, based on a survey of 4,000 Latino adults, measured health insurance coverage, type of health care provider used, health status, and experience with the health care system. Among other findings: six-in-ten Hispanic adults in the U.S. who are neither citizens nor legal permanent residents lack health insurance. They are also relatively young and less likely than other adults to report being sick.

Why Excluding People from the Health Care Exchange Is Impractical and Harmful to All of Us

September 14, 2009 - National Immigration Law Center

This paper argues against provisions in legislation being drafted to reform health care that would exclude undocumented immigrants from purchasing health care in the new health insurance exchanges.

Fact Check: Health Care and Undocumented Immigrants

September 11, 2009 - Marshall Fitz, Center for American Progress

This short article exposes five falsehoods that are commonly used by advocates for the broken status quo in the health care debate regarding undocumented immigrants and health care reform proposals.

Including Legal Immigrants in Health Care Reform: Just What the Doctor Ordered

August 19, 2009 - Immigration Policy Center

This fact sheet explains why it is important to include legal immigrants in any health care reform proposal.

Health Care Reform Toolkit

August 10, 2009 - National Immigration Law Center

The tools in this kit are intended to help advocates mobilize to forcefully counter anti-immigrant and anti-health care reform forces who are spreading untruths about immigrants and affordable health care. It includes talking points and policy priorities on immigrant inclusion, a fact sheet on the truth about immigrants in health care reform, talking pionts on how to respond to verification requirements, and other materials.

Sharing the Costs, Sharing the Benefits: Inclusion is the Best Medicine

July 22, 2009 - Immigration Policy Center

This fact sheet provides basic analysis on the benefits of inclusion and the actual impact of immigrant participation on the current health care system.

Health Reform Proposals Should Ensure that All Workers Have a Level Playing Field

May 15, 2009 - National Immigration Law Center

Arguments for equal treatment of workers, regardless of citizenship status, in forthcoming health care reform proposals.

Health Care Expenditures for Immigrants Are Lower Than for Citizens

May 15, 2009 - National Immigration Law Center

One-page fact sheet on immigrants' use of health care and coverage by health insurance

Improving Immigrant Access to Affordable Health Coverage: Analysis of the Massachusetts System

May 15, 2009 - National Immigration Law Center

This paper discusses the strengths and weaknesses of the Massachusetts health care system in addressing the health care needs of low-income immigrants.

2008

Five Basic Facts on Immigrants and Their Health Care

March 15, 2008 - The Henry J. Kaiser Family Foundation

This fact sheet address the reasons immigrants come here, the reasons America's uninsured population is growing, rules regarding immigrant access to health care, and the use of health care and emergency room facilities by immigrants compared to citizens.

2007

Migration, Health & Work: The Facts Behind the Myths

October 15, 2007 - University of California, et. al

This report presents data on the characteristics of Mexican immigrants and on the importance of Mexican immigrant workers in certain segments of the U.S. economy. A high percentage of Mexican immigrants work in low wage industries involving greater physical risk of work-related injury that rarely offer health insurance. The report offers recommendations for reducing the health risk faced by immigrant workers.

The Truth About Health Care Use Among Immigrants

October 01, 2007 - National Council of La Raza

Data in this document represent a range of the available studies on immigrants however, most data about immigrants’ interaction with all levels of the health care system continue to be limited.

Medicaid Citizenship Documentation Requirements Deny Coverage to Citizens and Cost Taxpayers Million

July 24, 2007 - Majority Staff, House Committee on Oversight and Government Reform

Under the Deficit Reduction Act of 2005, most persons applying for Medicaid or seeking renewal of their existing Medicaid coverage are required to document their citizenship. These documentation requirements have caused eligible U.S. citizens to lose Medicaid coverage and have not achieved the goal of saving taxpayers money. The For every $100 spent by federal taxpayers to implement the new requirements in six states, only 14 cents in Medicaid savings can be documented.

MEDICAID: States Reported That Citizenship Documentation Requirement Resulted in Enrollment Declines

June 28, 2007 - Government Accountability Office

The Deficit Reduction Act of 2005 included a provision that requires states to obtain satisfactory documentary evidence of U.S. citizenship or nationality for nearly 40 million Medicaid beneficiaries. States reported that the requirement resulted in barriers to access to Medicaid, such as delayed or lost coverage for some eligible individuals. States reported spending millions of dollars to implement the program, while the amount of savings was uncertain.

Immigrants in the U.S. Health Care System: Five Myths that Misinform the American Public

June 07, 2007 - Meredith King, Center for American Progress

This document addresses the misconceptions that the U.S. public health insurance programs are overburdened with immigrants; that immigrants consume large quantities of limited health care resources; that immigrants come to the United States to gain access to health care services; that restricting immigrants’ access to the health care system will not affect American citizens; and that undocumented immigrants are “free-riders” in the American health care system.

Implementation of the U.S. Deficit Reduction Act of 2005 in Oregon

May 15, 2007 - Oregon Department of Human Services

During the first six months of program implementation, approximately 1 percent of applicants were unable to provide the required documentation, and their applications initially were closed or denied. Almost all of these individuals are believed to be U.S. citizens. Despite being citizens, these individuals were unable to provide the required proof of identity and/or citizenship.

New Medicaid Citizenship Documentation Requirement is Taking a Toll: States Report Enrollment Is Dow

March 13, 2007 - Center on Budget and Policy Priorities

A provision of the Deficit Reduction Act of 2005 requires U.S. citizens to present proof of their citizenship and identity when they apply for, or seek to renew, their Medicaid coverage. This law is creating a barrier to health-care coverage for U.S. citizens — especially children — who are eligible for health insurance through Medicaid.

2006

Why Immigrants Lack Adequate Access to Health Care and Health Insurance

September 01, 2006 - Leighton Ku, Center on Budget and Policy Priorities in Migration Information Source, Migration Policy Institute

Article exploring the key issues and research concerning immigrants' access to private health insurance, public health insurance, and to health care in general.

Unequal Access: Immigrants and U.S. Health Care

July 05, 2006 - Sarita A. Mohanty, M.D., M.P.H for the Immigration Policy Center

Policies that restrict immigrants' access to some health care services lead to the inefficient and costly use of other services (such as emergency room care) and negatively impact public health.

Deficit Reduction Act Jeopardizes Medicaid Coverage For 3 To 5 Million U.S. Citizens

January 26, 2006 - By Leighton Ku, Donna Cohen Ross and Matt Broaddus, Center on Budget and Policy Priorities

The Deficit Reduction Act (2006) contained a mandate requiring U.S. citizens covered by Medicaid to prove their citizenship by submitting a birth certificate or passport (or a limited set of similar documents) or else lose their Medicaid coverage. Based on the results of a national telephone survey (conducted prior to the effective date of the law), this paper reveals that the new requirement could have large consequences on the health insurance coverage of millions of low-income U.S. citizens.

2005

Are Immigrants Responsible for Most of the Growth of the Uninsured?

October 15, 2005 - John Holahan & Allison Cook, The Urban Institute for the Kaiser Commission on Medicaid and the Uninsured

This analysis is intended to address the extent to which immigrants are the driving force behind the increasing uninsured population. Immigration trends are not responsible, in large part, for the increase in the numbers of uninsured in this country.

Mexico-United States Migration: Health Issues

October 15, 2005 - University of California and the National Population Council of the Government of Mexico

This document addresses specific questions on Mexican migrant health. More...

Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis

August 01, 2005 - Sarita A. Mohanty, MD, MPH, et. al. in the American Journal of Public Health, V. 95, No. 8

Health care expenditures are substantially (55%) lower for immigrants than for US-born persons. This study refutes the assumption that immigrants represent a disproportionate financial burden on the US health care system. Abstract. Fact Sheet.

Health Care Expenditures for Immigrants in the United States

July 05, 2005 - Sarita A. Mohanty, Steffie Woolhandler, et. al.

Fact sheet based on a study published in the American Journal of Public Health, "Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis." This study concludes that immigrants as a whole utilize 55% less health care than U.S.-born residents.