Health Insurance Disparities among Immigrants: Are Some Legal Immigrants More Vulnerable than Others?.

For over 200 years, the United States has been the destination for immigrants with various socioeconomic and cultural backgrounds, arriving from all over the world. Each year, thousands of individuals are awarded legal permanent resident (LPR) status or the "green card," with 946,142 individuals receiving LPR status in 2004 alone (Office of Immigration Statistics, 2006a). Under current immigration law, these immigrants can be classified into four groups--employment or skill based; family reunification; diversity visa program; and other, including refugees and asylees. Thus far, no study has systematically examined variation in health insurance status among these immigrants. We used the New Immigrant Survey data collected in 2003 to examine the health insurance disparities among recent immigrants by their class of immigration. This study used Gelberg, Andersen, and Leake's (2000) framework for vulnerable populations to examine health insurance disparities among the new immigrants. We addressed the following questions: Do immigrants vary by class of immigration? Does the probability of having health insurance vary by class of immigration after adjusting for other factors? BACKGROUND One of the two goals of Healthy People 2010 is to eliminate health disparities among different segments of populations in the United States (U.S. Department of Health and Human Services, 2000). Most national studies examining health disparities of immigrants do not distinguish them by their immigration status, but rather focus on the analysis based on their birth and nativity status. These studies have found the following: First, immigrants are healthier than natives but their health advantages disappear over time. Foreign-born, especially most recent, immigrants are healthier than the U.S.-born population, supporting notions of positive selection and "healthy immigrant effect" (Antecol & Bedard, 2006; Frisbie, Cho, & Hummer, 2001; Hummer, Rogers, Nam, & LeClere, 1999; Singh & Siahpush, 2001; Stephen, Foote, Hendershot, & Schoenborn, 1994). Over time, however, their original health advantages wane, and they become more vulnerable than natives, especially if they are poor (Antecol & Bedard, 2006; Cho, Frisbie, Hummer, & Rogers, 2004; Frisbie et al., 2001; Lopez-Gongalez, Aravena, & Hummer, 2005; McDonald & Kennedy, 2004; Newbold, 2005). Second, as a nation, the United States spends less on health care for immigrants. Per capita health care expenditures for immigrants are substantially lower (55 percent lower) than for native-born individuals (Mohanty et al., 2005). Also, expenditures for uninsured and publicly insured immigrants are approximately half those for their U.S.-born counterparts. Third, immigrants are less likely to have health insurance and to use health care. In 2004, nearly 34 percent of all foreign-born populations, 17 percent of naturalized citizens, and 13 percent of the native populations were uninsured (Carmen, Bernadette, & Cheryl, 2005). Studies examining health care access and utilization among immigrants also show that foreign-born populations have significantly lower access and utilization of health care services than the U.S.-born population (Jacobs et al., 2002; Thamer, Richard, Casebeer, & Ray, 1997; Thamer & Rinehart, 1998). Often, those without health insurance avoid or delay seeking care and buying medications because of cost (Becker, 2004). High prevalence of uninsured people among the foreign-born populations, therefore, presents a major challenge to closing the gap in health disparities. Fourth, a number of factors are associated with lack of health insurance. As a group, immigrants are less educated, face language barriers, are concentrated in low-wage jobs, earn substantially lower wages, and are less likely to be insured than the native population (Capps, Fix, Passel, Ost, & Perez-Lopez, 2006; Fix & Capps, 2002; Holahan & Brennan, 2000; Jacobs et al. …