Coverage of Without Coverage

Presidential election campaigns may not be the best time for candid and fruitful discussions of public policy. Still, it is something of a scandal that both Al Gore and George W. Bush have talked about the medically uninsured while avoiding any mention of how mass immigration compounds the problem.

Limiting the debate in this way is something akin to discussing electricity without uttering the word "current." As the Center for Immigration Studies has conclusively demonstrated, mass immigration is a major factor in recent increases in the ranks of the uninsured. Immigration is likely to play an even more important role in the years just ahead.

Any attempt to address the problem of the medically uninsured without dealing with one of its major causes will be both an exercise in futility and an example of shameful political cowardice.

The center has recently published a study titled "Without Coverage: Immigration's Impact on the Size and Growth of the Population Lacking Health Insurance." The study is based on Census Bureau and insurance data and is available on the Internet at www.cis.org.

The center found that in 1998, the last year for which complete data are available, 32.4 percent of persons in immigrant households were lacking in health insurance, a figure that is more than twice that for persons in native households.

Immigrants who arrived between 1994 and 1998 and their children accounted for 59 percent of the 2.7 million increase in the ranks of the uninsured.

The center also found that the government programs designed to address the problem aren't keeping up. While the federal government was, with great fanfare, extending insurance to 700,000 children, about the same number of children joined the ranks of the uninsured.

It is not hard to locate the reason for the low rates of insurance in this group. According to the center, they can be explained by low levels of education, which, in turn, produce higher poverty rates.

Steven A. Camarota, one of the study's authors, has previously noted that "31 percent of immigrants in the labor market had no high school education, and for those who entered in the preceding five years, 36 percent lacked a high school diploma. In comparison, only 9 percent of natives in the work force did not have a high school education." He added, "Immigrants now comprise about 32 percent of the high school dropouts in the work force, while accounting for only 9 percent of workers with more than a high school education."

The study's conclusion follows naturally from these facts: "Because of the limited value of their labor in an economy that increasingly demands educated workers, many immigrants hold jobs that do not offer health insurance and their low incomes make it very difficult for them to purchase insurance on their own."

The government has but two choices. It can either act to admit fewer unskilled and poorly educated workers, or it can expect that the pressure will increase to adopt what amounts to universal healthcare insurance. The simple fact is that the uninsured, at the minimum, receive unpaid emergency health care today, the cost of which is borne by paying customers. The more uninsured, the higher those costs will be.

Eventually the nation must make a decision. If it is to help immigrants already here by providing expanded access to health insurance, it cannot at the same time maintain existing immigration policies which act to defeat this purpose.

This is a case where the future looks worse than the past. The most disturbing figure in the study has to do with current Census Bureau estimates showing that 11 million new immigrants are likely to settle in the United States in the next decade.

This influx will, as surely as night follows day, add at least 3 million people to the ranks of American's uninsured.

It would be nice if, in the remaining weeks of the presidential campaign, the candidates were asked what, if anything, they can do about it.

WASHINGTON — Immigrants and their children make up more than half of the growth in the nation's uninsured population since 1993, a study says. But another report says few immigrants come here just for health benefits.

A report today by a group that supports immigration limits says legal immigration should be restricted if the United States wants to slow the growth of the ranks of the uninsured.

The study by the Center for Immigration Studies says the uninsured could grow by 3 million to 4 million over the next decade if nothing is done.

A separate study funded by the Robert Wood Johnson Foundation and published Monday in the journal Health Affairs did not disagree that immigrants make up a growing proportion of the uninsured, but it found that insurance was not why illegal immigrants are coming here.

Based on interviews with undocumented Latino workers, the Wood study concludes that most come here for jobs or to reunite with family. So restricting illegal immigrants already in the United States from government health care programs is not likely to reduce the level of immigration, it said. The foundation study also said those who immigrated illegally use fewer medical services than the general population.

Few previous studies have addressed immigration and health insurance specifically. The reports come at a time when solving the problem of the uninsured is receiving political interest.

About 44 million U.S. residents lack health insurance. They instead pay cash for care or seek free or low-cost care at public clinics, hospitals and emergency rooms, or in some cases do without.

Immigrants and their children make up more than a quarter of the nation's uninsured, the center says. Most of those are legal immigrants, it says.

Also, 59% of the growth in the number of uninsured since 1993 were legal and illegal immigrants and their children, it says. ''Immigration is playing a big role in the uninsured problem,'' says the report's co-author, Steven Camarota. His group supports offering health coverage even while it seeks limits on the total number of immigrants admitted to the United States.

Other findings of the center's report:

• Twenty-six percent of the nation's uninsured are living in households headed by an immigrant.
   

• Even immigrants in high-earning households (more than $75,000 a year) tend to have lower rates of health insurance coverage than their native-born counterparts.

Critics of the center's study say it misses the real issue: Employers are clamoring for workers, yet many companies don't offer insurance benefits.

"Right now the high-tech industry is pushing Congress to get more temporary workers from abroad, and the service industry is also interested in increasing the labor pool," says Marisa Demeo of the Mexican American Legal Defense and Education Fund.

''The problem is not immigrant workers, but it's how to get those workers access to insurance.''

WASHINGTON — Immigrant households are twice as likely to be without health insurance as native-born families, researchers said yesterday.

California ranked third among the states with the highest rates of uninsured residents, said the Center for Immigration Studies.

Immigration has fueled most of the growth in uninsured households since 1993, said the center, a research group that frequently spotlights problems associated with high levels of immigration.

San Diego's health insurance coverage for immigrants is better than the national average, the study says.

The findings, based on Census Bureau reports, "show that we cannot hope to contain health-care costs or reduce the number of uninsured in the U.S. without addressing the role of immigration policy," said Steve Camarota, co-author of the report and a research director at the center.

Immigration has an "enormous impact on the nation's health-insurance crisis," he said.

Immigration advocates blasted the report.

The center's report is "erroneously claiming that the root of this nation's health-insurance problems is mass immigration," said Marisa J. Demeo, regional counsel for the Mexican-American Legal Defense and Education Fund.

"It is imperative that we as a country focus on the real problem here," Demeo said. "It is not immigrants coming to the U.S. The problem is lack of access to health insurance for all low-wage workers."

About 44 million people nationwide lack health insurance — about one-sixth of the country's population. Many people without health insurance use cash to pay for care or receive low-cost assistance at public clinics.

The government spends up to $30 billion annually for health care for the uninsured, according to Camarota.

The report showed that 32.4 percent of people living in immigrant households lacked health insurance — more than twice the 13.9 percent of U.S.-born households.

Illegal immigrants make up 26.8 percent of the uninsured living in immigrant households, according to the study.

In California, the percentage of immigrants without health insurance is even higher — 35.8 percent. About 14.9 percent of native-born Californians are without health insurance. Only Arizona and Texas have higher uninsured rates, the study shows.

"In San Diego, it's still a significant problem, the uninsured, but it's somewhat exceptional compared to the rest of the nation," Camarota said. San Diego "doesn't seem to be a magnet for enormous numbers of unskilled immigrants."

About 28 percent of the immigrant households in San Diego are uninsured, while 16 percent of the U.S.-born households lack coverage, according to Camarota.

Most of the immigrants who lack health insurance are uneducated and impoverished. But Camarota said cultural reasons also might be a factor because many higher-income immigrants also tend to be uninsured.

A national study finds that 59 percent of immigrant families living in Houston have no health insurance, by far the highest rate of any U.S. city.

The report, released Tuesday by the Washington-based Center for Immigration Studies, is the first to document the link between immigration and access to health insurance, according to Steven A. Camarota, the center's director of research.

Nationwide, nearly one-third of all immigrant families have no health insurance, with the rate being 47 percent in Dallas and 41 percent in Los Angeles. Houston also has the highest overall uninsured population.

"It's difficult to overstate the seriousness of the problem in a city like Houston," said Camarota.

Local immigrant-rights activists said they are not surprised, attributing the result to local politics and a lack of adequate organization in the largely Hispanic immigrant community here.

"Latinos in places like Los Angeles are better organized," said Omar Velez, a native of Colombia. "Here, we are just starting to organize ourselves, and there are still divisions between the newcomers like me and the people who have been here a long time."

Plus, Velez added, "The policies of Harris County do not allow immigrants access to health care."

Harris County Hospital District officials say they are working to change their policies toward immigrants to provide more routine care, rather than treating them only after a catastrophe.

The county's health care program for the poor, known as the Gold Card, is offered now only to people who have or are seeking long-term residency, said district spokeswoman Dinah Massie. But the district plans to change that policy.

"We're very interested in making sure more people are covered," she said, "because that means less people will show up at the emergency room."

Taxpayers shelled out $51 million for the emergency health care the hospital district offered undocumented immigrants in the 12 months ending in February 1999, according to a county study.

Camarota said Houston's problem may be related to the origin of its immigrants. The study found that Mexican immigrants are less likely to have insurance than people from any other country. Houston and Dallas have a larger percentage of Mexican immigrants than other U.S. cities, he said.

The study found that immigrants accounted for nearly one-quarter of the 44 million people who lacked health insurance in this country in 1998, the latest year for which statistics are available. The study also found that the number is growing faster than in the general population.

Between 1994 and 1998, the number of immigrants without health insurance grew by 2.7 million, the study found.

The study, titled "Without Coverage: Immigration's Impact on the Size and Growth of the Population Lacking Health Insurance," argues that the high number of uninsured immigrants affects everyone, through higher taxes and, insurance premiums as well as increased spread of disease.

"We had better understand there is a high cost to cheap labor," said Camarota.

The authors argue that it is impossible to deal with the problem of insurance without addressing immigration. They call for offering fewer visas to unskilled foreigners every year and increasing enforcement to reduce illegal immigration.

But skeptics argue that access to insurance may have more to do with poverty than immigration.

"The lack of insurance has not happened just in the past 10 to 15 years," when immigration has taken off, argues Peggy Goetz, a Houston pediatrician who works with Latinos. "I don't have hard numbers, but I suspect the immigrants may be a scapegoat here."

A disproportionate share of immigrants lack health insurance, according to a study released Tuesday by a Washington, D.C.-based group that lobbies for restricted immigration policies.

The report by the Center for Immigration Studies, based on 1999 U.S. Census Bureau data, shows that about 32 percent of immigrants nationwide and 48 percent in Texas are not insured. The percentages of native-born people without health insurance are much lower: 13 percent across the country and 20 percent in the Lone Star State.

About 25 percent of the estimated 44 million uninsured people nationwide are immigrants — a figure that outpaces their 13 percent share of the population. In Texas, about one-third of the uninsured are immigrants. The size of the state's foreign-born population is 16.5 percent.

"What this means is, we can never really reduce the size of the uninsured population if we have an immigration policy that admits a large number of unskilled people," said Steven Camarota, the center's research director.

He said a large number of immigrants — about 11.5 million nationwide, compared with 32.7 million native-born people — lack health insurance because "of the limited value of their labor in the American economy."

"So many immigrants are uneducated, in an economy that increasingly places a premium on skills," he said, adding that this gap bridles their ability to secure jobs that offer health benefits. "That's a serious problem for them, and that's a serious problem for the rest of us."

Camarota estimated that taxpayers pay about $4 billion a year for services to the uninsured, such as those provided at public health clinics.

He also said that some hospitals, despite the vigilance of managed-care organizations, pass on the costs of treating the uninsured to patients with health insurance, resulting in higher premiums.

"There's no question it happens," he said. "How much it happens is open to debate."

The Center for Public Policy Priorities, an Austin-based advocacy group for low-income families, said Camarota's study is statistically correct, but its policy conclusions are flawed.

"The problem is not that these people are immigrants," said Anne Dunkelberg, an analyst with the Austin group who specializes in health-care access. "The problem is that we do not have a reliable system to deliver access to health insurance, even for the gainfully employed."

She pointed out that nearly 25 percent of all Texans lack health insurance — a number that she said suggests deeper roots to the problem than country of birth or immigration status.

There also has been a documented drop in the number of eligible immigrants enrolled in Medicaid, government-paid health insurance, since Congress passed federal welfare changes in 1996. Those dropouts were afraid that they could not become citizens if they used public benefits, Dunkelberg said.

"Those are the kinds of beliefs that are out there. They are inaccurate, but they are powerful," she said, adding that this fear probably contributed slightly to the number of uninsured immigrants.

The Texas Immigrant and Refugee Coalition, an umbrella organization for immigrant and advocacy groups in the state, said the study failed to note the contributions of immigrants as laborers and taxpayers.

"Immigrants pay taxes," said Adriana Cadena, a policy analyst with the coalition. "They don't want to be given things for which they don't pay. In fact, they pay more in taxes than they take back in services."

A 1998 study by the National Academy of Sciences concluded that the average immigrant pays $80,000 more in taxes over the course of a lifetime than he or she consumes in services.

"Immigrants are the backbone of the American economy," Cadena said. "They perform jobs that sometimes Americans are unwilling to do. They are valuable to our economy, and we need them."

"And since the economy is so competitive right now for employees, we're in a position to value the contributions that immigrants make as well as return to them the benefits that they earn working hard," she said.

Immigration and the health insurance crisis are directly linked, says a study released Tuesday by the Center for Immigration Studies.

Dr. Steven A. Camarota of CIS and James R. Edwards Jr. of the Hudson Institute say the current immigration policy directly contributes to the rising number of the uninsured.

"In 1998, 32.4 percent of persons living in immigrant households . . . lacked health insurance — more than twice the 13.9 percent of persons in native households," the center said.

"The total size of the uninsured population is one-third larger when the 11.6 million persons in immigrant households without insurance are counted," said Camarota. "That's a pretty big effect."

Census data shows that immigrants and their children supplied 59 percent (or 2.7 million) of the growth in the uninsured between 1994 and 1998. In 1998, over 27 percent of the immigrants who came to the United States in the 1970s and 37 percent who entered during the 1980s still lacked insurance.

The Center identifies poor education as a primary cause of the high rate of the uninsured. Because immigrants lack technological and educational skills, many enter the lower echelons of the work force. These jobs do not offer insurance and unskilled workers cannot afford to buy private insurance, the study said.

Camarota believes U.S. immigration policy is a major factor in the burgeoning numbers of the uninsured.

"U.S. immigration policy doesn't select people based on their skills for the most part. Family relationships are the primary criteria for admission. As a consequence, you get an enormous number of unskilled people coming in each year," he said.

A release issued by CIS said, "The Census Bureau estimates that 11 million new immigrants are likely to settle . . . in the US in the next decade," possibly adding 14 million immigrants without health insurance.

CIS advocates "the adoption of an immigration policy that admits far fewer unskilled immigrants . . . [and] develop[ing] an immigrant policy that expands access to health insurance to immigrants and their children already here."

Rep. Charlie Norwood (R-GA), a leading Republican spokesman on health care issues, recognized the political ramifications of the Center's report.

"Many members [of Congress] have great fears as to investigating whether immigration policy may have a negative impact on public health," he said in his opening statement before the presentation of the study Tuesday morning. "They believe that to even raise the question will leave them vulnerable to attacks of xenophobia, protectionism, or even racism."

But the American Immigration Lawyers Association defended current U.S. immigration policy, pointing to a recent issue of the Dallas Federal Reserve Board's Southwest Economy which says "the more different immigrants are, regardless of whether they have lower or higher skills than natives, the bigger the economic gains to our nation."

"If they want to debate economic policy with the Federal Reserve Board, we'll be happy to sit back and watch them debate," said a spokesman for the Association.