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Health Care and Immigration


Robert Samuelson raises an awkward but important question: How will future immigration flows affect the U.S. health-care system? “From 1999 to 2008,” he writes, “about 60 percent of the increase in the uninsured occurred among Hispanics. That was related to immigrants and their children (many American-born). Most illegal immigrants aren’t covered by Obama’s proposal. If we don’t curb immigration of the poor and unskilled — people who can’t afford insurance — Obama’s program will be less effective and more expensive than estimated. Hardly anyone mentions immigrants’ impact, because it seems insensitive.”

As Samuelson indicates, Hispanics make up a disproportionate share of America’s uninsured: In 2008 they accounted for less than 16 percent of the overall U.S. population but 31.4 percent of those who lacked health insurance at a given time, according to the Census Bureau. The 2008 National Health Interview Survey (NHIS) found that 34 percent of nonelderly (under the age of 65) Hispanics reported lacking health insurance, compared with just 14 percent of nonelderly non-Hispanics. About 43 percent of those uninsured Hispanics had never been insured, compared with only 15 percent of the non-Hispanic uninsured.

In terms of citizenship status and birthplace, the Census Bureau reckons that 44.7 percent of noncitizens and 33.5 percent of foreign-born residents were uninsured at a given moment in 2008, compared with 18 percent of naturalized citizens and 12.9 percent of native-born residents.

(Note: The Census Bureau and NHIS figures have not been adjusted for the Medicaid undercount, and they also include people who are eligible for Medicaid or CHIP but not enrolled.)

Samuelson is correct to say that immigration is a “wild card” in projections of how much Obamacare will reduce the number of uninsured. According to the Pew Hispanic Center, “The flow of immigrants from Mexico to the United States has declined sharply since mid-decade, but there is no evidence of an increase during this period in the number of Mexican-born migrants returning home from the U.S.” The recent drop in Mexican immigration can be attributed largely to stronger border enforcement and the recession. But future trends remain highly uncertain. What is certain is that Luis Gutierrez and other House Democrats are pushing to reignite the immigration debate in 2010.