Health insurance coverage in America: Are immigrants different

This research examines health insurance coverage in the United States among civilian adults aged 25 to 64 using information contained in the March 1996–2000 Current Population Surveys. Particular attention is given to immigrant coverage patterns as this group is over-represented among the uninsured. The demand for health insurance depends on risk adversion, demand for health care, tax advantages and immigrant influences. Probit and multinomial logit regressions that control for a rich set of economic, demographic, and immigrant-related variables reveal that immigrants are consistently less likely to be insured than the native-born. Immigrant odds of coverage are typically 10% lower than native-born counterparts', but the nativity gap widens considerably for adults reporting low personal incomes. Work-related characteristics, particularly firm size, as well as personal income, marital status and nativity are the important coverage indicators for most of the sample. Longer duration in the United States and citizenship positively effect immigrants' coverage rates. While the absolute level of personal income matters for coverage, marginal changes in income on the magnitude of up to {dollar}10,000 do little to affect coverage status regardless of nativity. This finding is consistent with previous literature and rejects the use of tax credits or vouchers as an effective way to decrease the number of uninsured. Why, ceteris paribus, immigrants have lower coverage rates is unclear. There appears to be sorting among immigrants into jobs without health insurance. While access to coverage is a problem for workers in certain industries and small firms, if immigrants prefer not to insure then their lower coverage rates result from rational decision making and are an efficient outcome. Encouraging uninsured immigrants to opt into health plans voluntarily will remain a challenge for policy makers.