"Improving Affordability and Advancing Health Equity For Immigrants"

Immigrants face some of the highest barriers to affordable healthcare in the United States, despite being essential to the nation’s workforce and public health. Federal eligibility restrictions, high costs, and limited employer‑based coverage leave many immigrants, especially undocumented individuals, without insurance or access to routine care. Language barriers, discrimination, and fear rooted in past immigration policies further discourage enrollment and worsen health outcomes. State‑level reforms show that expanding coverage and culturally responsive care can significantly reduce these disparities. Improving health equity for immigrants strengthens families, communities, and the healthcare system as a whole.

Main ideas:

• Immigrants, especially undocumented individuals, are far more likely to be uninsured, with nearly half lacking coverage compared to only 8% of U.S.-born citizens.

• Coverage gaps persist because federal rules exclude undocumented immigrants from all federally funded programs and impose a five‑year waiting period on many lawfully present immigrants.

• Limited exceptions such as emergency or pregnancy‑related services, do not provide comprehensive or affordable care.

• Immigrants are overrepresented in low‑wage industries that rarely offer employer‑based insurance, and higher poverty rates make healthcare costs even harder to manage.

• As a result, many immigrants skip or delay needed medical care, often reporting worsened health due to cost or lack of coverage.

• Language barriers and low health literacy make navigating the U.S. healthcare system difficult, especially when enrollment materials are written at high reading levels or not translated.

• Discrimination based on accent, insurance status, or race/ethnicity contributes to mistrust, and past “public charge” policies have created fear that using health programs could harm immigration status.

• States can expand access through Medicaid expansion, state‑funded programs for undocumented residents, and federal waivers that allow immigrants to purchase subsidized marketplace plans.

• Strengthening culturally competent provider networks, enforcing language access laws, and partnering with immigrant‑serving organizations improves enrollment and care navigation.

• Advancing health equity for immigrants improves community health, supports children’s learning and adults’ productivity, and reduces uncompensated care costs for hospitals and providers.