Unequal Access: Immigrants and U.S. Health Care

By Sarita A. Mohanty, M.D., M.P.H.

Despite the important role that immigrants play in the U.S. economy, they disproportionately lack health insurance and receive fewer health services than native-born Americans. Some policymakers have called for limits on immigrants’ access to health insurance, particularly Medicaid, which are even more stringent than those already in place. However, policies that restrict immigrants’ access to some health care services lead to the inefficient and costly use of other services (such as emergency room care) and negatively impact public health. The future economic success of the United States depends on a healthy workforce. Therefore, policies must be devised that improve, rather than restrict, immigrants’ access to quality health care.

Among the findings of this report:

• In 1998, per capita health care expenditures were 55 percent lower for immigrants than for natives. Although immigrants comprised 10 percent of the U.S. population, they accounted for only 8 percent of U.S. health care costs.
• In 1998, immigrants received about $1,139 per capita in health care, compared to $2,546 for native-born residents.
• Despite the fact that all immigrants are eligible for emergency medical services, they had lower expenditures for emergency room visits, as well as doctor’s office visits, outpatient hospital visits, inpatient hospital visits, and prescription drugs.
• Large disparities in health care expenditures between natives and immigrants exist within minority groups. Latino immigrants accounted for $962 in per capita health care expenditures in 1998, compared to $1,870 for native-born Latinos. Black immigrants averaged $1,030 in health care expenditures, compared to $2,524 for native-born blacks. And white immigrants averaged $1,747, compared to $3,117 for native-born whites.
• Immigrant children had 74 percent lower per capita health care expenditures than U.S.-born children in 1998. However, emergency room expenditures were more than three times higher among immigrant children than U.S.-born children despite the fact that immigrant children visited the emergency room less often. This suggests that immigrant children may be sicker when they arrive in the emergency room.
• The primary reason that immigrants are using the health care system less than the native-born is lack of health insurance. According to 2002 data from the Survey of Income and Program Participation (SIPP), foreign-born adults are nearly three times as likely as native-born adults to be uninsured (32 percent vs. 13.4 percent, respectively)