Hispanics, Health Insurance and Health Care Access

WASHINGTON (By Gretchen Livingston, Pew Hispanic Center) September 26, 2009 ― Six-in-ten Hispanic adults living in the United States who are neither citizens nor legal permanent residents lack health insurance, according to a new analysis by the Pew Hispanic Center of a survey it conducted in 2007. The nationwide survey offers a detailed look at the health insurance and health care access of an immigrant subgroup that has become a focus of attention in the current debate over health care reform.

The share of uninsured among this group (60%) is much higher than the share of uninsured among Hispanic adults who are legal permanent residents or citizens (28%), or among the adult population of the United States (17%).

Hispanic adults who are neither citizens nor legal permanent residents tend to be younger and healthier than the adult U.S. population and are less likely than other groups to have a regular health care provider. Just 57% say there is a place they usually go when they are sick or need advice about their health, compared with 76% of Hispanic adults who are citizens or legal permanent residents and 83% of the adult U.S. population.

Overall, four-in-ten (41%) non-citizen, non-legal permanent resident Hispanics state their usual provider is a community clinic or health center. These centers are designed primarily as "safety nets" for vulnerable populations and are funded by a variety of sources, including the federal government, state governments and private foundations, as well as reimbursements from patients, based upon a sliding scale (U.S. Department of Health and Human Services, 2008).

Some 15% of Hispanic adults who are neither citizens nor legal permanent residents report they use private doctors, hospital outpatient facilities or health maintenance organizations when they are sick or need advice about their health. Traditionally, patients in these settings are required to pay for their care, either via insurance or out of pocket.

An additional 6% of Hispanic adults who are neither citizens nor legal permanent residents report they usually go to an emergency room when they are sick or need advice about their health. Most emergency rooms are required by law to provide care to all patients. Patients are responsible for payment for emergency room services, but in some instances the Federal government partially reimburses hospitals for expenses the patients cannot afford.

Some 37% of Hispanic adults who are neither citizens nor legal permanent residents have no usual health care provider. More than one-fourth (28%) of the people in this group indicate financial limitations prevent them from having a usual provider ― 17% report their lack of insurance is the primary reason, while 12% cite high medical costs in general. However, a majority (56%) say they do not have a usual provider because they simply do not need one. An additional 5% state difficulty in navigating the U.S. health care system prevents them from having a usual provider.

Undocumented immigrants and their children comprise 17% of the estimated 46 million Americans who lack health insurance.  According to Pew Hispanic Center estimates, 11.9 million undocumented immigrants were living in the U.S. in 2008. Three-quarters (76%) of these undocumented immigrants were Hispanics.

Overall, about one-quarter of all adult Hispanics are undocumented. Pew Hispanic Center analyses of Current Population Survey data indicate that approximately 98% of Hispanic immigrants who are neither citizens nor legal permanent residents are undocumented. So, while the survey classification used in this report does not line up exactly with the Hispanic undocumented population, the two groups are nearly identical.

Health Status

The Hispanic population in the U.S. is relatively young, and Hispanic adults who are neither citizens nor legal permanent residents are younger still. Some 43% of adult Hispanics who are not citizens or legal permanent residents are younger than age 30, compared with 27% of Hispanic adults who are citizens or legal permanent residents and 22% of the adult U.S. population. The youthfulness of this population contributes to its relative healthiness. Among adult Hispanics who are neither citizens nor legal permanent residents, about one-third (34%) report they either missed work, or spent at least half a day in bed over the past year, because of illness or injury. The rate rises to 42% among adult Hispanics who are citizens or legal permanent residents and to 52% among the U.S. adult population.

Experiences in the Health Care System

Three-fourths (76%) of Hispanic adults who are neither citizens nor legal permanent residents report the quality of medical care they received in the past year was excellent or good. This is similar to the proportion of adult Hispanic citizens and legal permanent residents (78%) who express satisfaction with their recent health care.

However, when asked a separate question ― whether they had received any poor medical treatment in the past five years ― adult Hispanics who are neither citizens nor legal permanent residents are less likely (16%) to report any problems than are Hispanics who are citizens or legal permanent residents (24%).

Among those Hispanics who are neither citizens nor legal permanent residents who report receiving poor medical treatment in the past five years, a plurality (46%) state that they believed their accent or the way they spoke English contributed to that poor care. A similar share (43%) believed their inability to pay for care contributed to their poor treatment. More than one-third (37%) felt their race or ethnicity played a part in their poor care, and one-fourth (25%) attributed the unsatisfactory treatment to something in their medical history.

When asked about their most recent medical appointment, three-fourths (76%) of Hispanic adults who are neither citizens nor legal permanent residents report they felt comforted or relieved by the visit, and 69% report feeling reassured. Much smaller proportions left their most recent medical visit feeling frustrated (31%) or confused (27%).