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  • Holes in the Safety Net — Legal Immigrants’ Access to Health Insurance

    New England Journal of Medicine - 07/24/2013

    While Congress debates whether publicly supported health care should be available to undocumented immigrants who may be placed on a path to citizenship under immigration reform, the health care needs of already legal immigrants continues to be overlooked. More than 12 million immigrants are lawfully present in the United States. They serve in the military, pay taxes, and contribute to the economy. Yet like undocumented immigrants, whose health care vulnerabilities are outlined in the Perspective article by Sommers, legal immigrants face substantial barriers to obtaining insurance coverage (see graph). As a result, some — such as Antonio Torres, an uninsured Arizona farmworker who was in a coma after a car accident — have been forcefully transferred to their native country when their treating hospitals were unable to find facilities willing to provide them with long-term care.1

    Legal immigrants form a highly heterogeneous group that includes legal permanent residents (“green card holders”), refugees, asylum seekers, and many others. Because of the heterogeneity of the class and the complexity of immigration categories, information on the proportion insured is scarce. Augmenting data from the 2008 Current Population Survey, the Pew Hispanic Center reports that 24% of legal immigrants were uninsured in 2008, as compared with 59% of unauthorized immigrants and 14% of native citizens.2 In a 2005 article that was based on data from the Los Angeles Family and Neighborhood Survey, Goldman et al. reported that 32% of permanent legal residents remained uninsured for an entire 2-year period, as compared with 65% of undocumented immigrants and 18% of citizens.3 Although legal immigrants, like other immigrants, spend less on health care and appear to be healthier than citizens, that appearance may be attributable in part to undiagnosed illnesses and lack of access to a regular source of care.4

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