Nchc Fact Sheet - Immigrant Children

Health Care Facts: Immigrant Children

While citizen children of immigrants have better access to health insurance and medical care than non-citizen children, health disparities continue to persist between all children of immigrants and children of U.S.-born parents. Children of immigrant families are less likely to have health insurance, preventive medical and dental care,7, 8 and immunizations than native children.9, 10

Figure 1: Percentage of Children U.S. Children Immigrant Percentage of U.S. from from Immigrant Families, by Year and Citizenship Families, by Year and Citizenship 25% Percent Immigrant Children

The number of children of immigrants in the United States is continually growing.1, 2 Today, more than one in five U.S. children (21.6%) lives in an immigrant family,3 compared to only 6% of children in 19704 (Figure 1). While most of these children have one or more noncitizen parent, more than three-quarters of children from immigrant families were born in the United States and are therefore citizens.5 , 6

All Immigrant Children

20%

U.S.-Born Children of Immigrants

15% 10% 5% 0%

1970

Year

2005

Sources: Van Hook and Fix (2000), Urban Institute tabulations from Census 2000 Supplementary Survey Public Use Microdata Samples (PUMS).; Capps (2007). Urban Institute Tabulations of the March 2005 Current Population Survey

Regardless of citizenship status, children of immigrants play a significant role in our Nation’s future. Children of immigrants grow into adults who join the workforce, start businesses, enter the U.S. military, pay taxes, and generally integrate into the American economy.11, 12 In addition, the large majority (90%) of non-citizen children who remain in the U.S. become naturalized citizens during their lifetime.13 Access to affordable health insurance and quality health care is essential to promoting wellness and public health to afford all children the opportunity to realize their potential to become contributing members of society. Definition of Citizenship Terms While much of the public debate focuses on undocumented (illegal) immigrants, it is estimated that among children of immigrants, only 3% of children under the age of six and 12% of children ages 6-17 are undocumented.14 Unfortunately, most data sets do not collect information on undocumented immigrants, making it difficult to study the needs of this population. There is great diversity in the citizenship status of children of immigrants. This fact sheet focuses primarily on non-citizen children. Immigrant family refers to any family with at least one parent born outside the U.S. This term includes all immigrants, regardless of whether they are naturalized citizens, legal residents, or undocumented. Non-citizen refers to people born outside the U.S. who are residing in the U.S. This term includes legal residents and the undocumented. Citizen immigrant children refers to children born in the U.S. with at least one foreign-born parent (regardless of their parents’ legal immigration status) AND naturalized foreign-born children. Native children refers to children whose parent or parents were born in the U.S. Undocumented refers to immigrants whom are living illegally in the U.S. National Coalition on Health Care

August 2009

PUBLIC HEALTH INSURANCE FOR IMMIGRANT CHILDREN

Prior to the Children’s Health Insurance Program Reauthorization Act (CHIPRA), enacted in early 2009, low-income,i non-citizen children who were legally living in the United States for less than five years were not eligible to receive federal funding for health insurance through Medicaid or CHIP. •

While the original passage of CHIP in 1997 improved health insurance coverage for low-income children, the percentage of non-citizen children without health insurance increased, exacerbating the disparity in health insurance coverage between non-citizen and native children.15, 16

•

Although the five year waiting period restriction has been lifted, only 16 states and the District of Columbia currently offer state-funded health insurance to most or all legal immigrant children as of July 2009.17

•

Undocumented children are not eligible to receive federal funds for health insurance through Medicaid or CHIPRA, making it difficult for these children to access primary and preventive care. As of July 2009, only three states and the District of Columbia offer state-funded health insurance to most or all undocumented, low-income children.18 HEALTH INSURANCE COVERAGE

•

•

•

Children in working immigrant families are almost twice as likely to be low-income as children of native parents (33% immigrant vs. 17% native).19 Having a low-income negatively impacts a family’s ability to obtain health insurance, access quality health care, and provide a healthy living environment for their children.20

Figure 2: Percent of Low-Income Children who are Uninsured by Citizenship 60% Percent Insured Percent Uninsured

•

50% 40% 30% 20% 10%

Among low-income immigrant families, 0% nearly half of non-citizen children21 and one Non-Citizen Citizen Immigrant Native quarter of citizen children lack health Citizenship Status of Children insurance coverage. In contrast, only 15% of children with low-income native parents lack Source: Ku (2007), Author’s tabulation of Current Population Survey Data, 2005 health insurance.22 (Figure 2) Although immigrant families are as likely as native families to have at least one parent working full-time, non-citizen immigrants are more likely to work in low wage jobs and in industries that do not offer employer-sponsored health insurance.23, 24 While 63% of native parents receive employer-sponsored health insurance, only 38% of non-citizen immigrants receive such coverage.25 Even with health insurance, non-citizen children continue to face barriers to health care. Among insured low-income children, 44% of non-citizen children have not received a well-child visit in the past year, compared to 27% of all citizen children.26

i

“Low-income” is generally defined as a household income below 200% of the Federal Poverty Line, although states often establish their own maximum income eligibility levels.

National Coalition on Health Care

August 2009

ACCESS TO CARE

While having health insurance does not guarantee access to health care, immigrant children with health insurance are significantly more likely to use cost-effective preventive health services and less likely to use emergency departments for care.27 •

Non-citizen parents are three times as likely to report that their children are in fair or poor health as native parents, regardless of whether their children are citizens or not.28

•

Language barriers also prevent immigrant children from receiving health care. Immigrants with limited English proficiency and their children are less likely to have a usual source of care, receive less preventive care, and have fewer medical visits than children of adults who only speak English.29

Low-Income

Non-Citizen Children

•

Among low-income children, uninsured non-citizens have the least access to preventive medical care. Over half (51%) of uninsured non-citizen children have no usual source of health care, compared to 11% of insured non-citizens and 3% of insured citizens.30

•

Among low-income immigrant children, more than half (52%) of children with health insurance had a well-child visit in the past year, compared to less than one third (30%) of children without health insurance. Uninsured immigrant children are also four times as likely to have visited an emergency room two or more times in the past year as insured immigrant children.31

•

Among non-citizen children, children with health insurance are twice as likely to have seen a primary care doctor (66% insured vs. 35% uninsured) and are three times as likely to have had a preventive well-child visit (65% insured vs. 23% uninsured) in the past 12 months.32

•

Uninsured non-citizen children are four times as likely to have visited an emergency room in the past 12 months (2.7% insured vs. 10.8% uninsured) as insured non-citizen children. Uninsured children often end up visiting the emergency room for illnesses that could have been prevented or better managed if they had access to regular primary care.33

•

Although native children are twice as likely to have visited the emergency room in the past year as non-citizen children, 28% of non-citizen children have no usual source of health care other than the emergency room, compared to 6% of native children.34

This fact sheet was researched and prepared by Julie Bromberg on 8/7/09.

References 1

Capps R, Fix M, Ost J, Reardon-Anderson J, and Passel JS. “The Health and Well-Being of Young Children of Immigrants.” Urban Institute. 2005. Available at: http://www.urban.org/UploadedPDF/311139_ChildrenImmigrants.pdf 2 Passel JS, and D’Vera Cohn. “A Portrait of Unauthorized Immigrants in the United States.” Washington: D.C. Pew Hispanic Center. 2009. Available at: http://pewresearch.org/pubs/1190/portrait-unauthorized-immigrants-states 3 Ku L. “Improving Health and Insurance and Access to Care for Children in Immigrant Families” [Perspective]. Ambulatory Pediatrics, 7(6): 412-420. Nov 2007; Capps R. “Tabulations of the March 2005 Current Population Survey.” Washington, DC: Urban Institute. 2007.

National Coalition on Health Care

August 2009

4

Van Hook J, and Fix M. “A Profile of Immigrant Students in U.S. Schools.” Overlooked and Underserved: Immigrant Students in U.S. Secondary Schools, by Ruiz-de-Velasco J., and Fix M. Washington, DC: The Urban Institute. pp. 9–33. 2000. Available at: http://www.urban.org/UploadedPDF/overlooked.pdf 5 Ku L. “Improving Health and Insurance and Access to Care for Children in Immigrant Families” [Perspective]. Ambulatory Pediatrics, 7(6): 412-420. Nov 2007. 6 Capps R, Fix M, Ost J, Reardon-Anderson J, and Passel JS. “The Health and Well-Being of Young Children of Immigrants.” Washington, DC: Urban Institute. 2005. Available at: http://www.urban.org/UploadedPDF/311139_ChildrenImmigrants.pdf 7 Huang ZJ, Yu SM, and Ledsky R. “Health Status and Health Service Access and Use Among Children in U.S. Immigrant Families.” American Journal of Public Health, 96(4): 634-40. 1996. 8 Derose KP, Escarce JJ, and Lurie N. “Immigrants and Health Care: Sources Of Vulnerability.” Health Affairs, 26(5): 1258-1268. 2007. 9 Ibid. 10 Ku L. “Restoring Medicaid and SCHIP Coverage to Legal immigrant Children and Pregnant Women: Implications for Community Health and Health Care for Tomorrow’s Citizens” [Policy Research Brief]. Geiger Gibson / RCHN Community Health Foundation Research Collaborative. January 13, 2007. http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_A61E7016-5056-9D203DB38C7EC7B0B408.pdf 11 National Immigration Law Center. “Facts About Immigrants’ Low Use of Health Services and Public Benefits” [Fact Sheet]. Sept 2006. Available at: http://www.nilc.org/immspbs/research/imms&publicservices_2006-9-12.pdf 12 Ku L. “Restoring Medicaid and SCHIP Coverage to Legal immigrant Children and Pregnant Women: Implications for Community Health and Health Care for Tomorrow’s Citizens” [Policy Research Brief]. Geiger Gibson / RCHN Community Health Foundation Research Collaborative. January 13, 2007. Available at: http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_A61E7016-5056-9D203DB38C7EC7B0B408.pdf 13 Ibid. 14 Capps R, Fix M, Ost J, Reardon-Anderson J, and Passel JS. “The Health and Well-Being of Young Children of Immigrants.” Washington, DC: Urban Institute. 2005. Available at: http://www.urban.org/UploadedPDF/311139_ChildrenImmigrants.pdf 15 Ku L. “Improving Health and Insurance and Access to Care for Children in Immigrant Families” [Perspective]. Ambulatory Pediatrics, 7(6): 412-420. Nov 2007. 16 Ku L. “Restoring Medicaid and SCHIP Coverage to Legal immigrant Children and Pregnant Women: Implications for Community Health and Health Care for Tomorrow’s Citizens” [Policy Research Brief]. Geiger Gibson / RCHN Community Health Foundation Research Collaborative. January 13, 2007. Available at: http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_A61E7016-5056-9D203DB38C7EC7B0B408.pdf 17 The Kaiser Commission on Medicaid and the Uninsured. “New Option for States to Provide Federally Funded Medicaid and CHIP Coverage to Additional Immigrant Children and Pregnant Women” [Fact Sheet]. The Henry J. Kaiser Family Foundation. July 2009. Available at: http://www.kff.org/medicaid/upload/7933.pdf 18 Ibid. 19 National KIDS COUNT Program. “Data Across States: Children in low-income working families by children in immigrant families (Percent) – 2007” [Data Set]. The Annie E. Casey Foundation. Accessed July 29, 2009. Available at: http://datacenter.kidscount.org/data/acrossstates/Rankings.aspx?ind=119 ; Population Reference Bureau, analysis of data from the U.S. Census Bureau, Census 2000 Supplementary Survey, 2001 Supplementary Survey, 2002 through 2007 American Community Survey. 20 Capps R, Fix M, Ost J, Reardon-Anderson J, and Passel JS. “The Health and Well-Being of Young Children of Immigrants.” Washington, DC: Urban Institute. 2005. Available at: http://www.urban.org/UploadedPDF/311139_ChildrenImmigrants.pdf 21 Artiga S, and Schwartz K. “Health Insurance Coverage and Access to Care for Low-Income Non-Citizen Children” [Fact Sheet] The Henry J. Kaiser Family Foundation. May 2007. Available at: http://www.kff.org/medicaid/upload/7643.pdf 22 Ku L. “Improving Health and Insurance and Access to Care for Children in Immigrant Families” [Perspective]. Ambulatory Pediatrics, 7(6): 412-420. Nov 2007. 23 Alker J, Ng’andu J, et al. “The Role of Employer-Sponsored Health Insurance for Immigrants: A Primer.” The Kaiser Commission on Medicaid and the Uninsured and the National Council of La Raza, The Henry J. Kaiser Family Foundation. June 2006. Available at: http://www.kff.org/uninsured/upload/7524.pdf 24 Buchmueller T, LoSasso A, Lurie I, et al. “Immigrants and Employer-Sponsored Insurance.” Health Service Research, 42(1 pt 1): 286–310. 2007. 25 Alker J, Ng’andu J, et al. “The Role of Employer-Sponsored Health Insurance for Immigrants: A Primer.” The Kaiser Commission on Medicaid and the Uninsured and the National Council of La Raza, The Henry J. Kaiser Family Foundation. June 2006. Available at: http://www.kff.org/uninsured/upload/7524.pdf 26 Artiga S, and Schwartz K. “Health Insurance Coverage and Access to Care for Low-Income Non-Citizen Children” [Fact Sheet] The Henry J. Kaiser Family Foundation. May 2007. Available at: http://www.kff.org/medicaid/upload/7643.pdf National Coalition on Health Care

August 2009

27

Ku L. “Reducing Disparities in Health Coverage for Legal Immigrant Children and Pregnant Women.” Washington, DC: Center on Budget and Policy Priorities. April 2007. Available at: http://www.cbpp.org/files/4-20-07health2.pdf 28 Huang ZJ, Yu SM, and Ledsky R. “Health Status and Health Service Access and Use Among Children in U.S. Immigrant Families.” American Journal of Public Health, 96(4): 634-40. 1996. 29 Derose KP, Escarce JJ, and Lurie N. “Immigrants and Health Care: Sources Of Vulnerability.” Health Affairs, 26(5): 1258-1268. 2007. 30 Artiga S, and Schwartz K. “Health Insurance Coverage and Access to Care for Low-Income Non-Citizen Children” [Fact Sheet] The Henry J. Kaiser Family Foundation. May 2007. Available at: http://www.kff.org/medicaid/upload/7643.pdf 31 Ku L. “Reducing Disparities in Health Coverage for Legal Immigrant Children and Pregnant Women.” Washington, D.C.: Center on Budget and Policy Priorities. April 2007. http://www.cbpp.org/files/4-20-07health2.pdf ; Centers for Disease Control and Prevention’s 2005 National Health Interview Survey 32 Ku L. “Restoring Medicaid and SCHIP Coverage to Legal immigrant Children and Pregnant Women: Implications for Community Health and Health Care for Tomorrow’s Citizens” [Policy Research Brief]. Geiger Gibson / RCHN Community Health Foundation Research Collaborative. January 13, 2007. Available at: http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_A61E7016-5056-9D203DB38C7EC7B0B408.pdf ; Center for Disease Control, 2007 National Health Interview Survey 33 Ku L. “Restoring Medicaid and SCHIP Coverage to Legal immigrant Children and Pregnant Women: Implications for Community Health and Health Care for Tomorrow’s Citizens” [Policy Research Brief]. Geiger Gibson / RCHN Community Health Foundation Research Collaborative. January 13, 2007. Available at: http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_A61E7016-5056-9D203DB38C7EC7B0B408.pdf ; Center for Disease Control, 2007 National Health Interview Survey 34 Huang ZJ, Yu SM, and Ledsky R. “Health Status and Health Service Access and Use Among Children in U.S. Immigrant Families.” American Journal of Public Health, 96(4): 634-40. 1996.

National Coalition on Health Care

August 2009