Public and private health insurance of us foreign‐born residents: Implications of the 1996 welfare reform law

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Abstract
Objective. US policy towards immigrants is undergoing considerable change, often in the absence of objective data. In this paper, the insurance status of the US foreign‐born population is presented overall and disaggregated by race, ethnicity and length of residence in the USA. Design. Data from the National Health Interview Surveys, a cross‐sectional household survey representing the non‐institutionalized US population, was used to identify respondents as foreign‐ or native‐born and to determine the type of health insurance coverage. The surveys also collected race and ethnicity information from all respondents based on self‐reports, and, for the foreign‐born population, the length of residence in the USA. Results. Compared to native‐born residents, foreign‐born residents are twice as likely to be uninsured (26.3% versus 13.0%), less likely to have private insurance (62.3% vs 78.8%) and Medicare (88.6% vs 96.2%) and somewhat more likely to have Medicaid (6.5% vs 4.1%). A separate analysis of Hispanic and Asian foreign‐born residents was conducted. Length of residence in the USA, race and ethnicity significantly impact the type and extent of health insurance coverage among the foreign‐born population. Conclusion. Recent legislative initiatives restricting immigrants’ access to public services could lead to adverse public health consequences including further exacerbation of the high rates of uninsuredness found in this study.