Immigrants and employer-sponsored health insurance.

Interest in the health status of immigrant populations has increased dramatically in response to their rapid growth over the past two decades. More immigrants came to live in the U.S. in the 1990s than in any other decade in the nation's history, surpassing even the record number of arrivals during the 1980s. As a result, the foreign born share of the population has doubled from 5 to 10 percent between 1970 and 2000 (Fix and Passel 2002). In recent years, the majority of immigrants have come from Latin America and Asia (U.S. Immigration and Naturalization Service 2003). Forty percent of Hispanics living in the U.S. and over two-thirds of Asians living in the U.S. are foreign born (Malone et al. 2003). Immigrants represent a particularly vulnerable population when it comes to health insurance coverage and access to health care.1 According to 2002 data from the Survey of Income and Program Participation (SIPP), adults who were born outside the U.S. are nearly three times as likely to be uninsured as native-born Americans: nearly 32 percent versus 13.4 percent.2 The link between health insurance and health care utilization is well documented3; several recent studies show that their lower rate of insurance coverage is one factor contributing to immigrants' lower utilization, including lower rates of cancer screening and other types of preventive care (Ku and Matani 2001; Carrasquillo and Pati 2004; Mohanty et al. 2005; De Alba et al. 2005). The difference in insurance coverage between native-born Americans and immigrants is almost entirely due to a difference in employer-sponsored insurance (ESI): 84.5 percent of native adults have such coverage compared with only 66.1 percent of foreign-born adults. Because they tend to have lower incomes, immigrant adults are actually more likely than natives to have public insurance, though the difference is small (9.2 percent versus 7.8 percent). Nongroup—i.e., individually purchased—insurance is not an important source of coverage for either group (6 percent for natives and 5 percent for immigrants). Therefore, in order to understand immigrants' lower rate of insurance coverage it is necessary to understand why they are less likely to hold ESI coverage. The objective of this study is to document and explain differences in ESI coverage between immigrant and native-born American adults (ages 18–64). The analysis is based on 2002 data from the SIPP. We begin by examining whether immigrants are less likely to have ESI because they are less likely to be employed or more likely to be self-employed than natives. Then, turning our focus to workers, we decompose the native/immigrant gap in ESI into differences in (a) the probability of working for a firm that offers insurance; (b) eligibility for coverage conditional on working for such a firm; and (c) take-up conditional on eligibility. For each outcome, we estimate multivariate regression models to determine how much of the gap between native-born citizens and immigrants is explained by observable characteristics. Among immigrants, we distinguish between naturalized citizens and noncitizens. Because of well-documented differences in labor market behavior between men and women, all analyses are performed on samples that include both men and women and separately by gender.