Non-U.S. citizens are significantly more likely to be uninsured than citizens, according to a recent study from Kaiser Family Foundation (KFF).
In fact, 23% of lawfully present immigrants and 45% of undocumented immigrants are uninsured, versus only about 8% of citizens. And recent changes in immigration policy have the potential to lead to further declines in coverage among immigrant families, according to the study.
Specifically, the report cites changes to public charge policy that would take into consideration whether a person would use Medicaid or other social services when determining whether to approve permanent residency. Knowing that signing up for noncash programs would reduce the likelihood of citizenship, families would be more reluctant to sign up, the KFF researchers said.
"Today, many immigrants live in mixed immigration status families and one in four children in the U.S. have an immigrant parent," Samantha Artiga, analyst Kaiser Family Foundation told FierceHealthcare. "Growing fears and uncertainties among immigrant families may lead to declines in coverage among immigrant families, including their citizen children. Losses in health coverage would negatively affect both the health and financial stability of families and negatively affect the growth and healthy development of their children."
Other previous research suggests that Medicaid and Children's Health Insurance Program enrollment could drop significantly thanks to the public charge rule. Rhetoric around immigration is also a likely factor in the first increase in the first increase in the number of uninsured children in a decade.
In 2017, about 7% of the U.S. population was considered noncitizens—including undocumented and lawfully present immigrants—amounting to about 22 million people, according to the study. About 13% of the population were children who were citizens, but had noncitizen parents.
Even among the lawfully present immigrants in the U.S., there can be certain eligibility restrictions to Medicaid and CHIP coverage. For example, many green card holders must wait five years after being qualified before enrollment, according to the study.
In 2017, although about three-quarters of uninsured, lawfully present immigrants were eligible for Affordable Care Act (ACA) coverage, many remained dropped from the rolls due to fear, confusion about policies, difficulty navigating the process or language barriers, KFF found.
"Past experience suggests that one-on-one enrollment assistance provided by trusted individuals is key for overcoming enrollment barriers. However, it may be more difficult to overcome these barriers because fears and uncertainty about participating in programs are growing due to recent shifts in immigration policy," Artiga said.
Overall, the uninsured rate hit a four-year high in 2018, reaching 13.7%, according to a Gallup poll.