Immigration Status and Nativity

Although their numbers are small, foreign-born residents are much more likely to be uninsured than native residents. Employment status, income, length of residence, and recent welfare and immigration reform legislation account for much of the difference.

• The foreign-born population in the United States is almost three times as likely to be uninsured as the native population.¹ Among the foreign-born, citizens are more than twice as likely to have insurance as non-citizens.² The uninsured rate for immigrants declines with increasing length of residency in the United States.³
• More than 11 million immigrants in the United States were uninsured in 2006, accounting for 26.6 percent of all uninsured individuals in the country.⁴ Research has found that immigrants accounted for about one-third of the increase in the uninsured between 1994 and 1998, but between 1998 and 2003 they accounted for 86 percent of the growth in the uninsured.⁵ More recently, researchers have suggested that 1998-2000 should be examined separately from 2000-2003 because 1998-2000 was an aberration because it was a very strong period of economic growth.⁶
• Several related factors help account for the disparity in insurance rates between native and foreign-born residents. The latter are more likely to be employed in low-wage jobs, and in employment sectors (for example, agriculture and health care) that are less likely to offer insurance. They are, therefore, less likely to have employment-based coverage.⁷
• With exceptions, those needing emergency care and refugees, all legal immigrants who arrive in the United States after August 1996 are barred from participation in public health insurance programs (Medicaid and SCHIP) for their first five years in this country. This prohibition adds to the discrepancy in insurance rates between the native and foreign-born populations.⁸