The Health Insurance Gap in New York City: Promoting Citizenship for a Healthier Tomorrow

About 8 percent of New York City’s 8.4 million residents do not have health insurance. However, the percentages of New Yorkers without insurance vary by legal status. In New York City, 47 percent of undocumented people do not have health insurance, compared to 12.6 percent of legal noncitizens, 6.1 percent of naturalized citizens, and 4.8 percent of native-born citizens.

For immigrants, advancing to more secure and permanent legal statuses is highly correlated with having health insurance. Data on health insurance and other factors that impact immigrant health are available in CMS’s health report and data tool entitled “Mapping Key Determinants of Immigrants’ Health in Brooklyn and Queens.”

Figure 1 below illustrates the large gap in health insurance rates between immigrants who are naturalized US citizens and non-citizens. It also shows differences in health insurance rates among New York City neighborhoods.

How Immigration Status Impacts Health Insurance Access

There are a number of hurdles to gaining coverage that put non-citizens and undocumented immigrants at higher risk of being uninsured. Most US residents are insured through their employers.  Non-citizens are more likely to be employed in the informal economy or in low-wage jobs, which typically do not offer health insurance. Even if an employer provides health insurance, it may be cost-prohibitive. Eligibility restrictions prevent undocumented people from accessing healthcare coverage through Medicaid, Medicare, CHIP or the Healthcare.gov marketplaces.

Health Insurance Prevents Premature Deaths

When compared to other developed countries, the United States has the highest rate of premature deaths from conditions that are considered preventable with timely access to healthcare. A study published in The Lancet estimated that a single-payer healthcare system (which provides universal coverage) would prevent approximately 68,000 deaths in the United States annually.

The NYC Care health access program provided by NYC Health + Hospitals provides low-cost and no-cost services to those who do not qualify for or cannot afford health insurance. This program is a lifeline for uninsured New Yorkers.

Prioritizing Citizenship to Heal from the Pandemic

CMS’s recent health study shows that lack of immigration status is highly correlated with a number of factors linked to poor health outcomes. These health determinants include lack of health insurance, limited English proficiency, poverty, and living in overcrowded housing.  Healthcare access is more critical now than ever before.

The Biden administration has taken actions to increase healthcare coverage by creating fiscal incentives for states to expand Medicaid, increasing subsidies for insurance premiums, and opening a special enrollment period for Healthcare.gov and corresponding state exchanges. None of these programs extend to undocumented immigrants.

A path to citizenship would close this gap. The US Citizenship Act of 2021 would make approximately 10.35 million undocumented immigrants eligible for Lawful Prospective Immigrant (LPI) status, which would allow them to purchase healthcare coverage on Healthcare.gov. As CMS research has shown, on most measures of immigrant integration, such as employment, income, and education, legal noncitizens fare better than the undocumented, and the naturalized population matches or exceeds the native-born population by many metrics. The same is true for health insurance.

As we recover from a pandemic that brutalized immigrants in New York City and countless other US communities, we ought to be thinking about how we can improve the health of all US residents. Expanding pathways to permanent residence and citizenship would make our communities healthier.

June 17, 2021