Focus Policy Blog
Amidst recent improvement in health insurance coverage throughout the United States, one group had been left out of the Affordable Care Act (ACA): undocumented immigrants. According to the ACA, undocumented immigrants are not allowed to purchase subsidized insurance from marketplaces. Documented reasons for this exclusion include undocumented immigrants burdening the healthcare system because of over-utilization of healthcare services and overcrowding of emergency rooms.
According to the Public Policy Institute of California, California had the highest number of undocumented immigrants at 2.8 million individuals as of 2013. Researchers at the University of California, Los Angeles Center for Health Policy Research conducted a study recently to examine the likely costs and healthcare services utilization of undocumented immigrants. Using data from theCalifornia Health Interview Survey in 2010, the study’s authors developed a hypothetical model that estimated California’s adult and child undocumented immigrant population and analyzed survey data on 2009 emergency room visits, doctor’s visits, and insurance status. The study found that there was no healthcare service over-utilization among undocumented adults. Some findings include:
- 11% of undocumented adults had visited a hospital in 2009, which is 9 percent lower than the national average among U.S.-born adults.
- 78% of undocumented children had at least one doctor’s visit in 2009, compared to 90% among U.S. born children
- Undocumented immigrants were also found to have significantly lower rates of colorectal cancer prevention screenings and mammograms
The authors noted explanations for these lower utilization rates may include the limited number of resources available for this population, out-of-pocket costs, language barriers, and fear of disclosing immigration status. Even among undocumented individuals who had insurance, fewer healthcare services were used. It was then recommended that undocumented immigrants be allowed to purchase subsidized insurance in these newly established marketplaces so that these individuals can address their health issues earlier and in a less expensive way. Additionally, the costs of undocumented immigrants going to safety net institutions could be reduced if these individuals were insured, especially in the midst of federal spending cuts towards safety net institutions.
Joanne Chan, Joint Center Graduate Scholar, Harvard School of Public Health