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The high costs of health care and the erosion of health insurance coverage are two important long-term challenges that confront all Americans.  But these problems are especially acute for immigrants to the United States, who have extremely low rates of health insurance coverage and very poor access to health care services.  Immigrants — particularly those who have not yet naturalized into American citizenship — encounter roadblocks that make it far more difficult to get either public or private health insurance and to obtain adequate access to health care.

As a result of these barriers, almost half of all immigrants are uninsured, a level that falls far outside the mainstream of most Americans’ experiences. 


Recent MPI Analyses

Immigration Reform: A Long Road to Citizenship and Insurance Coverage
In an article in the April issue of Health Affairs, Migration Policy Institute Senior Policy Analyst Randy Capps and Senior Vice President Michael Fix examine the key questions surrounding legalization and the Affordable Care Act (ACA). With Congress poised to consider a major overhaul of US immigration laws and legalization for many of the nation’s unauthorized immigrants, how legalization affects implementation of the ACA is a key policy question. The article examines current coverage rates for unauthorized immigrants, eligibility for coverage under expansion of Medicaid, the distribution of costs of uncompensated care, and options for covering those who will remain uninsured under ACA.
Read the Article

Critical Immigration, Health, and Education Policies Affecting Young Children of Immigrants
A conference with leading experts in health, education, and immigration policy discussing public policies affecting the young children of immigrants. Click here for audio and video of the conference panels.
January 17, 2013

Young Children of Black Immigrants in America: Changing Flows, Changing Faces
Edited by Randy Capps and Michael Fix
The US child population is rapidly changing and diversifying, in large part because of immigration. Today, nearly one in four US children under age 18 is the child of an immigrant. While research has focused on the largest of these groups, far less academic attention has been paid to the changing Black child population, with the children of Black immigrants representing an increasing share of the US Black child population. This interdisciplinary volume, with chapters by leading researchers, examines the health, well-being, school readiness, and academic achievement of children in Black immigrant families, most with parents from Africa and the Caribbean. The volume explores the migration and settlement experiences of Black immigrants to the United States, focusing on contextual factors such as family circumstances, parenting behaviors, social supports, and school climate that influence outcomes during early childhood and the elementary and middle-school years. Its findings hold important policy implications for education, health care, child care, early childhood development, immigrant integration, and refugee assistance.
Press Release | Purchase a Copy

Patterns and Predictors of School Readiness and Early Childhood Success among Young Children in Black Immigrant Families
By Danielle A. Crosby and Angel S. Dunbar
This report examines levels of school readiness among young children by race/ethnicity and nativity, helping fill a significant gap in knowledge about the early childhood experiences of young children in Black immigrant families. Using a nationally representative US birth-cohort study (the Early Childhood Longitudinal Study, Birth Cohort), the authors identify the contextual factors - such as family circumstances, parenting practices, and enrollment in center-based child care - that encourage early school success.
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Parenting Behavior, Health, and Cognitive Development among Children in Black Immigrant Families: Comparing the United States and the United Kingdom
By Margot Jackson
Racial disparities in child development in the United States are significant, with a particularly pronounced disadvantage among Black children. This report focuses on the development of children of Black immigrants, comparing against the outcomes for their peers in native-born and other immigrant families. The report also compares children in the United States to those in the United Kingdom, where there is a large Black immigrant population but a notably different policy context of reception.
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The 2012 Winners of MPI’s E Pluribus Unum Prizes for Exceptional Immigrant Integration Initiatives
MPI is pleased to announce the winners of its 2012 E Pluribus Unum Prizes: ACCESS (Arab Community Center for Economic and Social Services), a Michigan-based Arab American organization that strengthens ties between immigrant and native-born communities; Building Skills Partnership, a California labor-business alliance that provides on-the-job English language and other classes for janitors; and Californians Together, a California education coalition that has achieved significant instructional reform for English language learners. Each was given a $50,000 award. The Prizes’ Corporate Leadership Award was given to Citi Community Development, which supports citizenship promotion for eligible legal immigrants and economic empowerment.
Press Release | Awards Event Program | ACCESS | Building Skills Partnership | Californians Together | Citi Community Development

Black and Immigrant: Exploring the Effects of Ethnicity and Foreign-Born Status on Infant Health
By Tiffany L. Green
The birth experiences and prenatal behaviors of Black immigrant mothers have received relatively little attention. This report compares prenatal behaviors and birth outcomes of Black immigrant mothers to those of other immigrant and US-born mothers, using federal vital statistics. It finds that Black immigrant mothers are less likely to give birth to preterm or low-birth-weight infants than US-born Black women, yet are more likely to experience these adverse birth outcomes than other groups of immigrant and US-born women.
Download Report | Press Release

Immigrants and Health Care Reform: What’s Really at Stake?
By Randy Capps, Marc R. Rosenblum, and Michael Fix
Health care reform proposals under consideration in Congress that would exclude many legal immigrants from core benefits and impose new verification requirements would have important spillover consequences for taxpayers and other health care consumers. In a new report, MPI’s National Center on Immigrant Integration Policy offers the first-ever estimates of the size of uninsured immigrant populations in major immigrant-destination states, the number of immigrant workers covered by employer-provided plans, and the share of immigrants employed by small firms likely to be exempted from employer coverage mandates. The report, based on MPI analysis of Census Bureau data, also examines health coverage for immigrants by legal status, age, and poverty levels.
Download Report | Press Release

Access to Health Care and Health Insurance: Immigrants and Immigration Reform
By Leighton Ku and Demetrios G. Papademetriou
Securing the Future: US Immigrant Integration Policy, A Reader
February 2007

Access to Health Care after Immigration Reform – Practical Considerations for Policymakers
By Adam Gurvitch
Securing the Future: US Immigrant Integration Policy, A Reader
February 2007

Health Insurance Coverage of Children in Mixed-Status Immigrant Families
By Randy Capps, Genevieve M. Kenney, Michael Fix
Snapshot 3 of America’s Families, No. 12
Urban Institute, 2003

The Health and Well-Being of Young Children of Immigrants
By Randy Capps, Michael Fix, Jason Ost, Jane Reardon-Anderson, and Jeffrey Passel
Urban Institute, February 2005

Did you know?

Fifty-six percent of low-income noncitizen immigrants are uninsured compared to 23 percent of low-income natives.

Between 1995 and 2004, the share of uninsured immigrant children rose from 44 to 49 percent. 

Immigrants are less likely to use emergency rooms than native citizens and their medical expenditures are substantially lower than natives’.


What’s Happening

The Immigrant Child Health Improvement Act is expected to be reintroduced in Congress this year. The Act, last introduced in 2005, would allow states to use federal funds to provide Medicaid to legally present pregnant women and their children regardless of when they entered the United States.


New Research in the Field
(List Under Development)

Health Care for Children of Immigrants
Annotated Bibliography, National Conference of State Legislatures, Health Care and Children in Immigrant Families Project, January 2007

New Medicaid Citizenship Documentation Requirement Is Taking a Toll: States Report Enrollment Is Down and Administrative Costs Are Up
By Donna Ross, Center on Budget and Policy Priorities, 2007

Hospital Language Services for Patients with Limited English Proficiency
By Romana Hasnain-Wynia, Julie Yonek, Debra Pierce, Ray Kang, and Cynthia Hedges Greising
Health Research and Education Trust, October 2006

Paying for Language Services in Medicare
By Leighton Ku
Center on Budget and Policy Priorities, October 2006

Language Services Resource Guide for Health Care Providers
By Alyssa Sampson, Cross Cultural Health Care Program
National Health Law Program and The National Council on Interpreting in Health Care, October 2006

A Profile of Young Children in the Los Angeles Healthy Kids Program
By Embry M. Howell, Lisa Dubay, Genevieve M. Kenney, Louise Palmer, Ian Hill, Moira Inkelas, and Martha Kovac
Urban Institute, October 2006

The Role of Employer-Sponsored Health Coverage for Immigrants: A Primer
The Kaiser Commission on Medicaid and the Uninsured, July 28, 2006

Unequal Access: Immigrants and U.S. Health Care PDF
By Sarita A. Mohanty
The Immigration Policy Center, July 5, 2006

New Requirements for Citizenship Documentation in Medicaid
Kaiser Commission on Medicaid and the Uninsured, July 2006

Shared Destiny: Shaping a Binational Agenda for Health Priorities in the San Diego-Baja California Border Region
By Robert L. Bach and Richard Kiy
International Community Foundation, June 30, 2006

Experiences with Medicare Part D: Stories from Low-Income, Ethnically Diverse and Medically Needy Californians
Lake Research Partners, June 2006

What Do Parents Say About the Los Angeles Healthy Kids Program?
Findings from the First Evaluation Focus Groups, Urban Institute, April 17, 2006

Making Public Programs Work for Communities of Color:
An Action Kit for Community Leaders

The Minority Health Initiatives Department at Families USA, February 2006

“A Randomized, Controlled Trial of the Effectiveness of Community-Based Case Management in Insuring Uninsured Latino Children”
By Glenn Flores, et al., Pediatrics 116(6):1433-1441, December 2005

Are Immigrants Responsible for Most of the Growth of the Uninsured?
By J. Holahan and A. Cook
Kaiser Commission on Medicaid and the Uninsured, October 2005

“Health Care Expenditures of Immigrants: A Nationally Representative Analysis”
By S. Mohanty et al., American Journal of Public Health 95, No. 8 (Aug 2005): 1431-8

Social Networks and Health Service Utilization
By Catherine Deri
Journal of Health Economics 24, No. 6 (2005): 1076-1107


Selected Readings
(List Under Development)

Language Services Guide for Healthcare Organizations
The Office of Minority Health, September 2005

Straight Talk: Model Hospital Policies and Procedures on Language Access
By Melinda Paras, Paras and Associates
California Health Care Safety Net Institute, 2005

Language Barriers in Health Care Settings: An Annotated Bibliography of Research Literature
By Elizabeth A. Jacobs, Niels Agger-Gupta, Alice Hm Chen, Adam Piotrowski, Eric J. Hardt
The California Endowment, August 2003

“Patchwork Policies: State Assistance for Immigrants Under Welfare Reform”
By Wendy Zimmermann and Karen C. Tumlin
Assessing the New Federalism Occasional Paper No. 24, Urban Institute, 1999

From Generation to Generation: The Health and Well-Being of Children in Immigrant Families
Don Hernandez and Evan Charney, Editors
National Academy Press, 1998