Undocumented Make Up Large Portion of Uninsured

WASHINGTON (By Ricardo Alonso-Zaldivar, LATimes) June 13, 2005 — Undocumented accounted for nearly all the recent increase in the number of U.S. residents without health insurance, and California has by far the largest number of uninsured undocumented, a study released today found.

"The face of the uninsured is changing, and it is more likely to be an immigrant today than it was 10 years ago," said Paul Fronstin, director of health research for the Employee Benefit Research Institute here. "As long as the immigrant population increases and nothing else changes," he said, "it's going to drive up the number of uninsured."

The unrelenting rise in the number of uninsured is widely seen as one of most pressing social problems facing the country. The EBRI study suggested that any solution might have to involve changes in immigration policy as well.

The study found that more than 11 million undocumented were uninsured in 2003, the latest year for which data are available. That represented a little over a quarter of the 45 million people the Census estimates are uninsured.

Although the native born account for the vast majority of the uninsured-about three-fourths of the total-the EBRI study found that between 1998 and 2003 undocumented represented 86% of the growth in the number of people lacking insurance.

That was a sharp jump from an earlier period. Between 1994 and 1998, undocumented had accounted for only about one-third of the increase in the number of uninsured.

The study looked at the foreign born as a group and did not distinguish between legal and undocumented. At least one quarter of all immigrants are estimated to be undocumented, with the largest group coming from Mexico.

In California, undocumented accounted for nearly half of the state's uninsured. California had 3.2 million uninsured undocumented, more than any other state. Texas, with 1.7 million, came second.

EBRI is a privately funded, non-partisan organization that conducts studies on health care, pensions, retirement savings and other workplace issues.

Changes in federal policy may have increased the number of uninsured undocumented, suggested Fronstin. Congress restricted healthcare and welfare benefits for legal migrants in the mid-1990s. Some of those policies have been eased, but it is still harder for undocumented to get public assistance now than it was in the early 1990s.

"The welfare reform bill may not have had much impact on immigration, but it had an impact on who is eligible for Medicaid," said Fronstin. Lawmakers are going to have to consider undocumented in any serious effort to reduce the number of uninsured, he added.

Some of the problems of undocumented are common to all lower-wage workers.

"They are uninsured because health costs are rising," said Fronstin. "They are uninsured because they are disproportionately employed by small businesses. They are uninsured because they have service and agricultural jobs that are less likely to come with benefits."

Among Latinos, 60% of undocumented were uninsured, compared with 22% of those who were born here, from the first generation onward, according to EBRI.

Proponents of immigration restrictions said reducing the size of the illegal immigrant population would lead to higher wages and improved benefits for other workers, including legal migrants and native born.

"What this tells us is there is a very high cost to cheap labor," said Steven Camarota, research director at the Center for Immigration Studies, which favors curbs on immigration. "I come down on the side of the debate that says you pay your own workers more and invest in labor saving devices and technology."

The cost of caring for uninsured undocumented is often borne by local hospitals, which are barred by federal law from refusing emergency room care. The federal government recently announced a program to reimburse some of those costs, but it will cover only a fraction of the expenses. "If you are going to have undocumented here, you are going to have to accept the cost," said Camarota.

But Jane Delgado, president of the National Alliance for Hispanic Health, said immigrant labor is vital to such industries as construction, hotels and agriculture.

"The term 'uninsured' is being used in a certain way to connote a drain society, but the overwhelming majority of the uninsured are working," said Delgado. And undocumented "are blood, sweat and tears of this country-what makes this country grow,' she added.

Delgado also pointed to a healthcare paradox that medical research studies have long validated. Although Mexican undocumented are more likely to be uninsured, their health status is generally better than that of native-born Americans.

Asian undocumented are also less likely to suffer from heart disease, cancer and other chronic illnesses. The immigrant health advantage, however, is not passed on as their children and grandchildren adopt America's high-fat diet and sedentary lifestyle.

"What we need are policies that make low-premium (insurance) plans available for people who are working," said Delgado. "It's a Catch-22. If you're working, you can't get public assistance. But there may not be any way for you to get health insurance.