Immigrant adults constitute 16% of the U.S. adult population, playing a vital role in the workforce and communities, with a significant diversity in their backgrounds including varied citizenship statuses, countries of origin, and socio-economic circumstances. Notably, one in four children in the U.S. has at least one immigrant parent. Despite this diversity, the complexity of the immigrant experience is often overlooked in policy debates, especially since data on health and healthcare by immigration status are scarce due to its exclusion from federal surveys.

A recent report produced from the Survey of Immigrants conducted by KFF and the Los Angeles Times in mid-2023, offers unprecedented insights into the health and healthcare experiences of immigrant adults by examining factors such as immigration status, income, and ethnicity. This survey, the largest non-governmental examination of its kind, alongside focus groups from diverse backgrounds, provides a comprehensive view of immigrant interactions with healthcare settings, surpassing the scope of previous data.

While many immigrants report improved conditions compared to their home countries and are generally healthy and employed, they face significant obstacles in accessing U.S. healthcare. These include higher uninsured rates, affordability issues, and linguistic and cultural barriers, which adversely affect their health and financial well-being. Challenges are particularly acute for undocumented immigrants, those with lower incomes, Black and Hispanic individuals, and those with limited English proficiency. Immigrants often work in sectors less likely to provide health coverage, contributing to higher uninsured rates. Furthermore, noncitizen immigrants encounter eligibility restrictions for federally funded health coverage, though state policies can alleviate some of these challenges. The uninsured among them face considerable barriers to healthcare access, and many, especially Black, Hispanic, and Asian immigrants, report experiencing unfair treatment and difficulties in accessing respectful, culturally competent care.

Here are some key takeaways from the survey:

Half of likely undocumented immigrant adults and one in five (20%) lawfully present immigrant adults report being uninsured compared with less than one in ten citizens. Coverage rates also vary by income, with a quarter (24%) of lower income immigrant adults reporting being uninsured compared with 5% of immigrant adults with household incomes of at least $90,000. The high uninsured rates among noncitizen and lower income immigrant adults primarily reflect lower levels of private coverage due to disproportionate employment in lower income jobs that are less likely to offer employer-based insurance. 

While immigration status is a primary factor driving differences in uninsured rates, where immigrants live also matters, as those residing in states that provide more expansive coverage are less likely to be uninsured. States vary in the coverage they provide for their low-income population overall and immigrants specifically. Those that have adopted the ACA Medicaid expansion have broader eligibility for low-income adults, but noncitizen immigrants still face eligibility restrictions for this coverage. Some states have expanded coverage for immigrants by eliminating the five-year waiting period in Medicaid and/or CHIP for children and/or pregnant people and/or extending coverage to some groups regardless of immigration status through fully state-funded programs. Immigrants in states that have taken up more of these coverage options are less likely to be uninsured. 

Among immigrant adults who have received care in the U.S., one in four (25%) reports being treated unfairly by a health care provider because of their insurance status or ability to pay (16%); accent or ability to speak English (15%); and/or their race, ethnicity, or skin color (13%). Black immigrant adults are more than twice as likely as White immigrant adults to report being treated unfairly for at least one of these reasons (38% vs. 18%), and the share is also higher among Hispanic immigrant adults (28%). Black, Asian, and Hispanic immigrant adults are all more likely than their White counterparts to say they have been treated differently by a health care provider because of their race, ethnicity, or skin color as well as due to their accent or ability to speak English.

About three in ten (29%) immigrant adults who have sought care in the U.S. report experiencing at least one of several difficulties obtaining respectful and culturally competent care asked about on the survey. These difficulties include a provider not taking the time to listen or ignoring concerns (17%); a provider not explaining things in a way they could understand (15%); being treated with disrespect by front office staff (12%); and, among those with limited English proficiency who completed the survey in a non-English language, interpretation services not available or provided in a timely manner (17%). The shares reporting any of these difficulties are higher among Black (34%), Hispanic (33%), uninsured (39%), and likely undocumented (34%) immigrant adults and those with lower household incomes compared with their White, insured, citizen, and higher income counterparts.

Many immigrant adults are uncertain about how using assistance for food, housing, and health care may impact their immigration status, and some are fearful of applying for this assistance. Given lower incomes among immigrant families and difficulties paying for basic needs and monthly bills, food, housing, and health care assistance programs could reduce financial stress and facilitate access to care for them and their children. Although many noncitizen immigrants are ineligible for these programs, children in immigrant families are often U.S.-born citizens who may be eligible. However, nearly three-quarters of immigrant adults, including nine in ten of those who are likely undocumented, report uncertainty about how use of these programs may impact immigration status or incorrectly believe use may reduce the chances of getting a green card in the future. About a quarter (27%) of likely undocumented immigrants and nearly one in ten (8%) lawfully present immigrants say they avoided applying for food, housing, or health care assistance in the past year due to immigration-related fears. 

Please click here to read the full report. 

LanguageLine Can Help

LanguageLine has more than 40 years of experience providing healthcare translation and interpretation; in fact, we currently work with 18 of the top 22 healthcare systems in the United States and Canada. We are experts at assisting limited-English speakers, as well as the Deaf and Hard of Hearing, in achieving mutual understanding during medical appointments, as well as comprehending medical documents and insurance coverage. We invite you to contact us so that we may learn more about the challenges and opportunities within your organization. 

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