Session: Insured vs Uninsured
Room: Upson 117
Time: Tue 10:15-11:45

Presenter: Stephen Zuckerman (Urban Institute. Health Policy Center)

Discussant: Neeraj Sood (RAND)

Abstract

There are about 12 million undocumented immigrants in the United States and more that 50 percent of them are uninsured. However, health care reform has explicitly excluded this group from any of the eligibility expansions or subsidies that will be available to expand insurance coverage. This almost certainly assures that coverage and access problems among undocumented immigrants will continue into the future, and an examination of recent trends may illuminate how large these problems may be. In particular, has the coverage problem been getting worse for undocumented immigrants over the past decade and has this been contributing to the growth in the overall numbers of uninsured in the U.S.? Are undocumented immigrants a burden on health care providers by utilizing services without having coverage and generating a disproportionate share of the uncompensated care that is provided? This paper uses data insurance coverage data from the 2000-2008 March Supplements of the Current Population Surveys and data on utilization and spending from the 2007 Medical Expenditure Panel Study to explore these two questions. Undocumented immigrants are identified using imputations derived by Jeffrey Passel of the Pew Hispanic Center.

Between 1999 and 2007, the number of uninsured in the United States grew from 40.8 to 46.0 million, an increase of 5.2 million. Undocumented immigrants accounted for 1.8 million of this overall increase, or about 35 percent. Given that undocumented immigrants only accounted for only 3.4 percent of the population in 1999 this seems dramatic, but is roughly consistent with the 39 percent growth in the number of the undocumented immigrants in the country between 1999 and 2007. By 2007, undocumented immigrants accounted for almost 15 percent of the uninsured population, more that 3 times its share in the overall population. In large part, the high rate of uninsurance among undocumented immigrants is due to their relative concentration within low-income groups and their ineligibility for most forms of public coverage.

Results from the spending analysis are not yet available. However, based on some existing literature (Goldman et al. 2006) and their high rate of uninsurance, we expect to find that undocumented immigrants consume a smaller share of overall spending than might be expected based on their share of the population. This may not hold as strongly when we explore the distribution of uncompensated care by immigration status, because uncompensated care is disproportionately provided to people without health insurance.

Key Terms

Immigrants, Insurance Coverage, Health Spending

Authors:

Timothy Waidmann (The Urban Institute. Health Policy Center) , Stephen Zuckerman (The Urban Institute. Health Policy Center) and Baoping Shang (The Urban Institute. Health Policy Center)