Uninsured Working Immigrants: A View from a California County
Tóm tắt
We inform a county’s efforts to provide health insurance to uninsured working immigrants—a group left out of national and state strategies that aim to expand coverage. We analyzed a population-based survey data administered in English, Spanish, Cantonese, Mandarin, Korean, Vietnamese, and Dari on 5,540 nonelderly adult workers in Alameda County, California. The study models the likelihood of employment-based coverage, estimates the eligibility for public programs, and evaluates the affordability of average employee share of premiums by citizenship status and years lived in the United States (tenure). Immigrant workers in Alameda County are disproportionately uninsured. They constitute 29% of the employee labor force but 54% of uninsured employees. Employment-based coverage increased with citizenship and length of stay (tenure) in the United States. Noncitizens with less than 5 years residency in the United States faced the greatest disadvantage in securing employment-based coverage, an effect that is greater than disadvantages associated with race/ethnicity. A citizenship-tenure divide existed in obtaining employment-based coverage, suggesting that policies focusing on noncitizen and new immigrant workers would greatly relieve the disparate uninsured rates among workers. The expansion of nonemployment-based coverage programs would cover more than 30% of Alameda County’s uninsured immigrant workers; but subsidies will also be needed for the lowest-income workers who are not eligible for these programs.
Tài liệu tham khảo
Current Population Survey, February 1999: Washington, DC: Bureau of the Census for the Bureau of Labor Statistics; 2000
Carrasquillo O, Carrasquillo AI, Shea S: Health insurance coverage of immigrants living in the United States: Differences by citizenship status and country of origin. Am J Public Health 2000; 90(6):917–923
Ku L, Matani S: Left out: Immigrants’ access to health care and insurance. Health Aff 2001; 20(1):247–256
Brown ER, Ponce, NA, Rice T: The State of Health Insurance in California: Recent Trends, Future Prospects. Los Angeles: UCLA Center for Health Policy Research; 2001
Thamer M, Richard C, Casebeer AW, Ray NF: Health insurance coverage among foreign-born U.S. residents: The impact of race, ethnicity, and length of residence. Am J Public Health 1997; 87(1):96–102
Schur C, Feldman J: Running in Place: How Job Characteristics, Immigrant Status, and Family Structure Keep Hispanics Uninsured. Project HOPE Center for Health Affairs 2001
Borjas GJ: The earnings of Mexican immigrants in the United States. J Dev Econ 1996; 51:69–98
Farber HS, Levy H: Recent trends in employer-sponsored health insurance coverage: Are bad jobs getting worse? J Health Econ 2000; 19(1):93–119
Marquis MS, Long SH: Worker demand for health insurance in the non-group market. J Health Econ 1995; 14(1):47–63
Chernew M, Frick K, McLaughlin CG: The demand for health insurance coverage by low-income workers: Can reduced premiums achieve full coverage? Health Serv Res 1997; 32(4):453–470
Cooper PF, Schone BS: More offers, fewer takers for employment-based health insurance: 1987 and 1996. Health Aff 1997; 16(6):142–149
Fronstin, P: Health insurance coverage and the job market in California. EBRI Issue Brief Spec 2000; 36:1–32
Feder J, Levitt L, O’Brien E, Rowland D: Covering the low-income uninsured: The case for expanding public programs. Health Aff 2001; 20(1):27–39
Long, SH, Marquis MS: Low-wage workers and health insurance coverage: Can policymakers target them through their employers? Inquiry 2001; 38(3):331–337
Rosenbaum S, Borzi PC, Smith V: Allowing small businesses and the self-employed to buy health care coverage through public programs. Inquiry 2001; 38(2):193–201
Zelenak L: A health insurance tax credit for uninsured workers. Inquiry 2001; 38(2):106–120
Garrett B, Nichols L, Greenman E: Workers without health insurance: Who are they and how can policy reach them? Washington, DC: Urban Institute; 2001
California Health Interview Survey Technical Paper {#}1: The CHIS 2001 Sample: Response Rate and Representativeness: December 2003. Available at: www.chis.ucla.edu
Ponce N, Conner T, Barrera BP, Suh, D: Advancing universal health insurance coverage in Alameda County: Results of the County of Alameda Uninsured Survey. Summary Report. Los Angeles: UCLA Center for Health Policy Research, 2001
Long, P: County Efforts to Expand Health Coverage Among the Uninsured in Six California Counties. Oakland: Medi-Cal Policy Institute; 2002
Mercer/Foster Higgins Employer-Sponsored Health Insurance Survey. Oakland: California Health Care Foundation; 1999
U.S. Census Bureau, American Community Survey Office, 2002: Accessed from the web on March 9, 2003 at:http://www.census.gov/acs/www/Products/Profiles/Single/2002/ACS/Narrative/050/NP05000US06001.htm