Browsing by Subject "Health insurance coverage"

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Health insurance coverage of noncitizens and the exclusion of undocumented immigrants
(2020-05-14) Arboleda, Juan Sebastian; Olmstead, Todd; Wasem, Ruth E
Federal policies enacted over the last 50 years have created barriers for noncitizens to access the health care system in the United States. The outcomes are disparities in health insurance coverage based on citizenship and immigration status. This report first focuses on the history of statutes and regulations that have created these barriers for noncitizens, including the impacts of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), the Patient Protection and Affordable Care Act (ACA), and the most recent amended regulations to the public-charge ground of inadmissibility. Although the implementation of the (ACA) has overall been successful in reducing the number of uninsured in the U.S., it continued the trend from previous statutes to exclude certain groups of noncitizens. This report uses data for the periods 1999-2017 from the Current Population Survey to analyze the impact of the ACA on insurance coverage among U.S. natives, naturalized citizens, and noncitizens. For noncitizens, the expansion of Medicaid and the ability to purchase insurance through private health insurance exchanges have played the biggest role in the uninsured rate dropping from 38 percent in 2013 to 24 percent in 2017. While the drop has been significant, the uninsured rate for noncitizens is more than three times the rate for citizens. Furthermore, the exclusion of some noncitizen groups from the ACA has created a disparity of health insurance coverage between legal permanent residents (LPRs) and undocumented immigrants. Lastly, the report analyzes the unique circumstances that undocumented immigrants experience with respect to health insurance. Statutes have excluded undocumented immigrants from accessing federal health benefits such as Medicaid, CHIP, and the ACA. Furthermore, undocumented immigrants often work in industries that pay low wages and do not offer health insurance coverage to their workers. As a result, the uninsured rate for undocumented immigrants is more than five times the rate for citizens. Although the options for undocumented immigrants are limited, safety-net health care institutions that serve low-income patients have become pivotal in their access to the health care system. Additionally, 17 states are using their own funding to offer undocumented immigrants additional health benefits.