Public and private health insurance of US foreign-born residents: implications of the 1996 welfare reform law

Abstract

Objective: US policy towards immigrants is undergoing considerable change, often in the absence of objective data. In this paper, the insurance status of the US foreign-born population is presented overall and disaggregated by race, ethnicity and length of residence in the USA.

Design: Data from the National Health Interview Surveys, a cross-sectional household survey representing the non-institutionalized US population, was used to identify respondents as foreign- or native-born and to determine the type of health insurance coverage. The surveys also collected race and ethnicity information from all respondents based on self-reports, and, for the foreign-born population, the length of residence in the USA.

Results: Compared to native-born residents, foreign-born residents are twice as likely to be uninsured (26.3% versus 13.0%), less likely to have private insurance (62.3% vs 78.8% and Medicare (88.6% vs 96.2%) and somewhat more likely to have Medicaid (6.5% vs 4.1%). A separate analysis of Hispanic and Asian foreign-born residents was conducted. Length of residence in the USA, race and ethnicity significantly impact the type and extent of health insurance coverage among the foreign-born population.

Conclusion: Recent legislative initiatives restricting immigrants' access to public services could lead to adverse public health consequences including further exacerbation of the high rates of uninsuredness found in this study.