December 2006

Grant Results

SUMMARY

A team of researchers at the University of California, Los Angeles, School of Public Health conducted a series of studies on the effects of immigrant and citizenship status on health insurance coverage and access to health care services.

Drawing on data from the federal National Health Interview Survey (1995 and 1996, National Center for Health Statistics) and the Current Population Survey (1990, 1993, and 1998, Bureau of the Census), the studies examined coverage and access nationally, as well as in six states where immigrant populations are highly concentrated: California, New York, Texas, Florida, Illinois, and New Jersey.

In addition, the studies analyzed data from the Legalized Population Survey (1989, US Immigration and Naturalization Service; 1992, U.S. Department of Labor) to explore how changes in status from undocumented immigrant to legalized resident might affect health insurance coverage.

Key Findings
The studies showed, among other things, that:

  • While the main reason U.S. residents (both citizens and noncitizens) are uninsured is the cost of health insurance, children who are noncitizens or with immigrant parents are less likely to have health insurance than citizen children.
  • A 1989 amnesty period allowed many undocumented immigrants to gain legal resident status but did not immediately improve their health insurance coverage. The change in legal status, however, may have offset the negative effects of the recession occurring at the time.

Key Results
Data and analysis supported by this grant contributed to a study and publications by the National Research Council/Institute of Medicine (NRC/IOM) Committee on the Health and Adjustment of Immigrant Children and Families simultaneously being undertaken during the grant period.

The project resulted in several published reports, book chapters, and policy briefs. Policy reports and briefs may be accessed on the UCLA Center for Health Policy Research Web site.

Funding
The Robert Wood Johnson Foundation (RWJF) provided a $217,195 grant to support this work.

 See Grant Detail & Contact Information
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THE PROJECT

Public policy attention has focused on participation by both legal and illegal immigrants in a variety of public social, health, and education services programs paid for with tax dollars. Various legislative proposals that would deny many publicly funded services to immigrants have surfaced in congressional budget and deficit battles in Washington, D.C., and at the state level, particularly from 1994 to 1996.

Little is known, however, about immigrants' access to health services. Previous research has demonstrated that Latinos are less likely to be insured than members of other ethnic groups and that they have poorer access to health services. What is not known, however, is the extent to which poorer access to health insurance coverage and to health services is concentrated among immigrants of an ethnic group or is shared more broadly by immigrants and nonimmigrants of that ethnic group.

Furthermore, little is understood about the potential health effects of denying immigrants eligibility for publicly financed health care such as Medicaid.

To address such policy issues, this grant funded a series of studies on the effects of immigrant and citizenship status on health insurance coverage and access to health care services. Drawing on data from the 1995 and 1996 National Health Interview Survey (federal National Center for Health Statistics) and the Current Population Survey (1990, 1993, and 1998, federal Bureau of the Census), the studies examined coverage and access nationally, as well as in six states in which immigrant populations are highly concentrated: California, New York, Texas, Florida, Illinois, and New Jersey.

In addition, the studies analyzed data from the Legalized Population Survey (1989, US Immigration and Naturalization Service; 1992, US Department of Labor) to explore how changes in status from undocumented immigrant to legalized resident may affect health insurance coverage. At the same time, RWJF funded researchers at People to People Health Foundation to conduct a study of immigrants' access to health services in Texas. (See Grant Results on ID# 026618.)

Shortly after the grant was funded, the principal investigator was invited to serve as a member of the NRC/IOM Committee on the Health and Adjustment of Immigrant Children and Families, agreed to do so, and provided data and analysis of health insurance coverage and health care access of immigrant children for the committee's work. Thus, findings generated by the RWJF-supported work appear in the committee's report, From Generation to Generation: Health and Well-Being of Children in Immigrant Families (National Academy Press, 1998).

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FINDINGS

Among the project's findings from its analyses of data from the Current Population Survey and the National Health Interview Survey are these:

  • Compared to citizen children in native-born families, being a noncitizen or having immigrant parents puts a child at greater risk of being uninsured, of not having seen a physician in the last year for acute or chronic conditions, and of having fewer opportunities for preventive health care services.
  • Irrespective of ethnicity or immigration status, the unaffordability of health insurance coverage is the main reason for being uninsured.
  • Policies that more generously extend Medicaid to refugees protect children in immigrant families from Southeast Asia.
  • Having Medicaid or other insurance greatly increases the probability that a child will receive health services.
  • Policy changes resulting from 1996 welfare and immigration reforms are likely to increase uninsurance among immigrant children. These reforms, for example, terminated Medicaid eligibility for most new legal immigrants and, at state option, for legal immigrants who resided in the United States when reform legislation was enacted on August 22, 1996.

The researchers also analyzed data from the Legalized Population Surveys of the more than one million undocumented immigrants who legalized their status (as of 1989) under the amnesty provisions of the Immigration Reform and Control Act of 1986. Analysis focused on how changing from an undocumented to a legalized immigrant affected health insurance status. Major findings of the study include:

  • At the beginning of the amnesty process in 1989, just half of the amnesty population had any private insurance, compared to three-fourths of the general adult population. These lower rates of health insurance coverage were particularly striking because the amnesty population had higher rates of labor force participation and worked longer hours than comparable groups in the general population.
  • In 1989, almost half of undocumented immigrants were uninsured, nearly three times the rate for the general US adult population. The risk of being uninsured varied by the characteristics of the individual immigrant:
    • Women were more likely than men to be uninsured.
    • Educational attainment was an important predictor of being uninsured; uninsured rates were higher among those with less education.
    • Applicants who could converse in English on the telephone were more likely to be insured.
    • Low-income applicants from Mexico and other Latin American countries were less likely to be privately insured and more likely to be uninsured than applicants from other countries.
  • Medicaid and other public coverage protected more than four times as large a share of adults in the general population as it did amnesty applicants.
  • Legalization of their status did not immediately improve the amnesty population's health insurance coverage. Data suggest that legalization may have partially offset the effects of the recession by increasing access to Medicaid for some of the uninsured women.

Communications

Investigators published findings in two book chapters, two policy reports, and three policy briefs. Policy reports and briefs may be accessed on the UCLA Center for Health Policy Research Web site.

Investigators sent one policy brief, 830,000 California Immigrants May Lose Medi-Cal and Become Uninsured (1996), to 1,700 policymakers nationwide. The study received front-page news coverage in the Los Angeles Times, extensive coverage in other newspapers, and precipitated interviews with the investigators on a number of television and radio stations.

In addition, the principal investigator participated in briefings to congressional staff and senior staff at the US Department of Health and Human Services, providing research findings on behalf of the NRC. He also conducted press briefings about his work in Austin, Texas, Washington, D.C., and San Francisco, Calif., the latter in connection with his presentation of project results before the 1998 annual meeting of the American Sociological Association. See the Bibliography for details.

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GRANT DETAILS & CONTACT INFORMATION

Project

Study of Immigrants' Access to Health Insurance Coverage and Health Services

Grantee

University of California, Los Angeles, School of Public Health (Los Angeles,  CA)

  • Amount: $ 217,195
    Dates: January 1996 to May 1999
    ID#:  026855

Contact

Richard Brown, Ph.D.
(310) 794-0812
erbrown@ucla.edu

Web Site

http://www.healthpolicy.ucla.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Books and Reports

Brown ER, Wyn R, Fong K, Valenzuela A, Morales L, Cumberland WG, Ong P, and Becerra R. 830,000 California Immigrants May Lose Medi-Cal and Become Uninsured. Los Angeles, Calif.: UCLA Center for Health Policy Research, 1996. Also available at the UCLA Center for Health Policy Web site. 1,700 copies disseminated.

Brown ER, Ojeda VD, Lara LM, and Valenzuela A. Undocumented Immigrants: Changes in Health Insurance Coverage with Legalized Immigration Status. Los Angeles, Calif.: UCLA Center for Health Policy Research, 1999. Also available at the UCLA Center for Health Policy Web site.

Brown ER, Wyn R, and Ojeda VD. Access to Health Insurance and Health Care for Children in Immigrant Families. Los Angeles, Calif.: UCLA Center for Health Policy Research, 1999. Also available at the UCLA Center for Health Policy Web site.

Brown ER, Wyn R, and Ojeda VD. Noncitizen Children's Rising Uninsured Rates Threaten Access to Health Care. Los Angeles, Calif.: UCLA Center for Health Policy Research, 1999. Also available at the UCLA Center for Health Policy Web site. 5,000 copies disseminated.

UCLA Center for Health Policy Research staff. Proceedings from the Forum: Children in Immigrant Families: Issues for California's Future. Los Angeles, Calif: UCLA Center for Health Policy Research, 2000. Also available at the ULCA Center for Health Policy Web site.

Book Chapters

Brown ER, Wyn R, Yu H, Valenzuela A, and Dong L. "Access to Health Insurance and Health Care for Mexican-American Children in Immigrant Families." In Crossings: Mexican Immigration in Interdisciplinary Perspectives. M. Suarez-Orozco (ed). Cambridge, Mass.: David Rockefeller Center for Latin American Studies and Harvard University Press, 1998.

Brown ER, Wyn R, Yu H, Valenzuela A, and Dong L. "Access to Health Insurance and Health Care for Immigrant Children." In Children of Immigrants: Health, Adjustment, and Public Assistance. FJ Hernandez (ed). Washington, D.C.: National Academy Press, 1999.

Presentations and Testimony

E. Richard Brown, "Access to Health Insurance and Health Care for Mexican Immigrant Children," at an invitational conference on "Immigration and the Socio-Cultural Remaking of the North American Space," David Rockefeller Center for Latin American Studies, Harvard University, April 11–12, 1997, Cambridge, Mass.

E. Richard Brown, "Access to Health Insurance and Health Care for Mexican-American Children in Immigrant Families: Inequities and Public Policy," at the American Sociological Association, August 22, 1998, San Francisco, Calif.

E. Richard Brown, "Access to Health Insurance and Health Care for Children in Immigrant Families," at the American Sociological Association, August 24, 1998, San Francisco, Calif.

E. Richard Brown, "Access to Health Insurance and Health Care for Children in Immigrant Families," to congressional staff, September 1998, Washington, D.C. Invited as a member of the National Research Center study committee at this presentation sponsored by the National Research Council.

E. Richard Brown, "Access to Health Insurance and Health Care for Children in Immigrant Families," to senior staff, US Department of Health and Human Services, September 1998, Washington, D.C. Invited as a member of the National Research Center study committee at this presentation sponsored by the National Research Council.

News Conferences

Press briefing on access to health insurance and health care for immigrant children Austin, Texas, April 1997. Attended by 60 journalists.

Press briefing on access to health insurance and health care for children in immigrant families, San Francisco, Calif., August 1998.

Press briefing on access to health insurance and health care for immigrant children, Washington, DC, September 1998.

Press Kits and News Releases

A news release, entitled "Growing Number of Immigrant Children Lack Health Insurance; Trend Seen as Unintended Results of Welfare Reform," was distributed to the wire services and news media on July 14, 1999.

Print Coverage

"A Growing Number of Immigrant Children Lack Health Insurance," in Nation's Health, October 1999.

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Report prepared by: Donna Lloyd-Kolkin
Reviewed by: James Wood
Reviewed by: Janet Heroux
Program Officer: Elize M. Brown