Immigrants, both those residing lawfully in the United States and those who are undocumented, will continue to face major barriers to health coverage even if federal health care reform is enacted, according to a new study released today by New Yorkers for Accessible Health Coverage (NYFAHC) and the New York Immigration Coalition (NYIC). Currently, noncitizens comprise 12 percent of New York State’s population but 29% of its uninsured population.
“Two million New Yorkers are noncitizens, and they lack health insurance to a much greater extent than citizens,” said Jenny Rejeske, study co-author. “The substantial majority of these noncitizens are here legally, and they pay the same taxes as citizens do. There is no justification for impeding their access to insurance and the care that they and their families need. It is time for policy makers to remove the barriers that prevent immigrants from getting the health care they need.”
The New York State Health Foundation-funded report, Health Insurance and Immigrants: Obstacles to Enrollment and Recommendations, documents numerous factors contributing to high uninsurance rates among noncitizens:
- Immigrants work in lower paying jobs and for smaller firms that tend not to provide health insurance;
- Undocumented immigrants are barred from public health insurance programs like Medicaid and Medicare that are available to citizens;
- Even lawful permanent residents are barred from Medicaid and Medicare for five years,
- Legal immigrants fear that enrolling in public coverage will classify them as “public charges” who may be denied permanent residence status;
- Legal immigrants fear that receiving public coverage will expose their sponsors to claims for reimbursement;
- Immigrants face cultural and language barriers; and
- Immigrants are sometimes arbitrarily denied benefits even when they are entitled to them.
“The health reform bills currently being debated in Congress fail to address most of these barriers. Even more ominous, some proposals, such as one to exclude undocumented immigrants from using their own money to purchase full-price coverage in health insurance exchanges, would make it even harder for immigrants to enroll in coverage,” said study co-author Mark Scherzer.
“Immigrants make up a large proportion of the uninsured but are conspicuously absent from plans to expand coverage,” said David Sandman, Senior Vice President of the New York State Health Foundation. “If immigrants are left behind, we must ensure a strong safety net of health care services is in place to address their needs and fulfill the promise of opportunities to lead healthy and productive lives.”
The report’s key recommendations include:
- Develop subsidy systems that allow low-income workers to enroll in affordable health insurance through their employers or independently;
- Repeal the federal government’s “five-year bar” on Medicare and Medicaid enrollment;
- Make public coverage available to all New York State residents, regardless of immigration status;
- Develop a public education campaign to eradicate the notion that enrolling in public coverage would endanger immigration status;
- Carefully monitor and control immigration officers who improperly exclude immigrants from adjusting their legal status;
- Change federal and state laws to remove covered health expenses from the categories that can be recovered from immigrant sponsors;
- Address cultural, linguistic and navigational barriers confronting immigrants by enforcing existing language access rules and improving support of community-based outreach, education, and navigation programs; and
- Ensure the preservation and strengthening of robust hospitals and community health clinics, where the majority of low-income uninsured residents seek care.
Health Insurance and Immigrants: Obstacles to Enrollment and Recommendations is the third in a series of reports that analyze how health coverage among immigrants can be increased. The complete report is available upon request or at www.NYShealth.org; www.thenyic.org or www.cidny.org.