Conclusion

For reasons outlined at the outset of this report, the lack of insurance among immigrants and their children is clearly a serious problem. With more than 35 million people living in immigrant households, how immigrants and their children do in the United States should be a matter of concern for anyone interested in the future of our republic. The huge number of persons in immigrants households without health insurance cannot be neglected indefinitely.

Why Has the Problem Been Ignored?

Part of the reason policymakers and researchers interested in health insurance coverage have not devoted much attention to immigration’s role in this growing problem is that they have generally been focused on other issues such as medical inflation, changing employment practices, and Medicaid eligibility. In addition, until recently it was very difficult to estimate the impact of immigration on the size of the uninsured population in United States. Only in 1994 did the Census Bureau begin to ask a nativity question on a regular basis as part of the CPS. Moreover, immigrants are not politically powerful. Many are not citizens and therefore cannot vote or make campaign contributions. Thus, politicians could ignore immigrants without paying much of a political price. Also, as has already been pointed out, immigration is a discretionary policy of federal government. Elected officials in Washington may be reluctant to deal with the problem because to do so would call attention to the fact that a conscious policy that they have either supported or at least not tried to modify has led to an enormous growth in the uninsured population. It is far easier to emphasize the positive effects of current immigration policy and espouse vague platitudes about "a nation of immigrants" than to deal with the problems federal immigration policy creates.

Another important reason the problem has not received the attention it should stems from the nature of the immigration debate. Most of the advocates for immigrants are also advocates for the current high level of immigration. These advocacy groups cannot call too much attention to the fact that immigration is responsible for a large share of the growth in the uninsured population because to do so would highlight a fundamental problem with the very policy they work so hard to keep in place. Thus, those who might be expected to push for greater efforts to help immigrants remain mostly silent on this issue. Costly new programs designed to provide health coverage to immigrants and increase the skills of immigrants so they can better compete in the labor market would undermine one of the arguments most often made by the advocates of high immigration, namely that it is an economic and fiscal benefit to the country. Therefore, in a very real sense, there is a conflict of interest between being an advocate for immigrants and at the same time being an advocate of mass immigration. Supporters of high immigration are trapped by their own rhetoric. As a result, relatively little attention is paid to the millions of immigrants and their children without adequate health care.

A Problem that Cannot Be Ignored.

While some may be tempted to ignore the lack of health insurance among immigrants and their children at a time of relative prosperity, this seems very unwise. In just the last four years immigration has increased the size of the uninsured population by 2.7 million people. Without a change in immigration policy and greater efforts to increase health care coverage among immigrants and their children already in the country, the problem will grow much worse. This can only make it more difficult and costly to solve. The implications of this situation for the immigrants themselves, their children, the health care system, and society as a whole are such that we simply must confront this problem head on. It is our hope that this study will give policymakers, researchers, and all those concerned about the uninsured a better understanding of the central role that immigration policy has played in this problem.