Importing the Uninsured

By James R. Edwards, Jr. on September 30, 2011
A new report

documents that America's "crisis" of the uninsured is to a great extent self-imposed. By reducing immigration, both legal and illegal, to traditional levels, we would derive the benefit of reducing the rising share of the population without health insurance.

The Employee Benefit Research Institute has produced a new study on the uninsured that bears this out. Using Census data for 2010, EBRI presents the facts:

  • Some 18.5 percent of the total U.S. population under 65 was uninsured.

  • A sizably lower share of the native-born, 15.7 percent, lacked health coverage.

  • Almost a quarter (24.3 percent) of naturalized citizens was uninsured.

  • Nearly half (47.1 percent) of noncitizens had no health coverage.

Not surprisingly, the ethnic breakdown reflected a disproportionate likelihood of uninsurance among Latinos, the predominant immigrant ethnic group:

Individuals of Hispanic origin were more likely to be uninsured than other groups (32.1 percent) (Figure 16). This may be due in part to the fact that 55 percent of the Hispanic population reported income of less than 200 percent of the federal poverty level. Also, a higher proportion of Hispanics are [sic] immigrants and may work for small firms or be employed on a part-time or part-year basis. However, even at high income levels, Hispanics generally were more likely to be uninsured than other racial groups and were less likely to have employment-based health benefits.

Other notable factors that correlate with immigration status and being uninsured include occupational skill level and where one falls on the official poverty scale. Just "31.3 percent among workers in service occupations" have employment-based health coverage (less than half the share of management and professionals). "Although public programs cover many individuals in poor families, most poor families are not covered. In 2010, 51.1 percent of the nonelderly with family incomes below the poverty line were covered by a public plan – 47.3 percent by Medicaid...."

This phenomenon of admitting uninsured immigrants runs counter to our age-old public charge doctrine. It would be worth considering ways we might curb the importation of a larger uninsured population. The straightforward approach is putting an end to chain migration visas and eliminating those slots. Rather, with lower immigration we could devote more resources to offering coverage to uninsured Americans, without forcing them into Medicaid or other government-run programs – the equivalent of medical destitution.