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Immigration-Related Barriers Result in High Uninsured Rates Within All Racial and Ethnic Groups

Despite significant progress in health coverage gains since enactment of the Affordable Care Act (ACA), 26 million people in the U.S. remain uninsured. There are significant inequities in coverage rates between racial and ethnic groups — and within each broad racial group, people who are immigrants are more likely than citizens to be uninsured, a recent CBPP report finds.

People who are immigrants face a variety of systemic barriers to obtaining health coverage. Many work in jobs that don’t offer employer-sponsored health coverage or face barriers in obtaining those benefits.

There are also harsh, long-standing eligibility restrictions that prevent many people who are immigrants — including those with lawful immigration statuses — from enrolling in Medicaid. Approximately 9.5 million adult immigrants in our nation meet income requirements to enroll in Medicaid, but 45 percent (4.3 million) of them are barred from enrolling due to the restrictive immigration-related eligibility requirements.

The ACA marketplaces have less restrictive immigration-related eligibility requirements than Medicaid but still block people without documented immigration statuses from enrolling in coverage. Approximately half of people without a documented status are uninsured, so ending the block to ACA marketplace coverage would go a long way in reducing the number of immigrants who are uninsured.

The results of this exclusionary approach are harrowing. Often, people with kidney failure wait until near death to get dialysis, older adults’ health deteriorates due to preventable illnesses, and pregnant people avoid prenatal care because they fear enrolling in government programs.

Taking an inclusive approach to making coverage available to immigrants would improve not just their health outcomes but their financial well-being, thanks to the associated reductions in medical debt and lowered risk of catastrophic care costs (all improvements that benefit the nation’s communities, as well).

The Biden Administration recently took important steps to help address inequities in health coverage for immigrants. The Department of Health and Human Services (HHS) finalized a rule that is estimated to result in 100,000 people with Deferred Action for Childhood Arrivals and certain other immigration statuses gaining the ability to purchase health insurance in the ACA marketplaces. And HHS finalized another rule that provides anti-discrimination protections, including language access provisions, that will improve how people with limited English proficiency can learn about and use health care services.

Ultimately, Congress needs to close the gap in coverage for people who are immigrants. Comprehensive immigration reform that provides lawful status with a pathway to citizenship could dramatically increase their ability to sign up for coverage through their employers or through public coverage. In the meantime, Congress can also remove the remaining immigration-related barriers to government health coverage programs, and both the Health Equity and Access under the Law for Immigrant Families Act and the LIFT the BAR Act would make significant progress on this front.

Also, many states have taken important steps to ensure more people who are immigrants can access comprehensive, affordable health coverage. More states should follow their lead and close eligibility gaps so that all states’ residents can attain better health outcomes and the peace of mind that comes with health coverage.

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