Immigrants are less likely to have adequate insurance coverage and access to health care, according to three RWJF-supported studies.

Findings from the three studies included:

• Welfare reform. Research conducted during the 1990s predicted that policy changes resulting from 1996 welfare and immigration reforms were likely to increase uninsurance among immigrant children. (See Program Results on ID# 026855.)
• Effect of coverage on immigration. Excluding undocumented immigrants from receiving government-funded health benefits is not likely to reduce the level of immigration, according a survey of undocumented immigrants in Texas during the late 1990s. The survey found that immigrants do not come to the United States for health or social services and that immigrant use of ambulatory care services was low compared to the U.S. population. (See Program Results on ID# 026618.)
• Coverage for immigrant kids. Compared to citizen children in native-born families, being a noncitizen or having immigrant parents puts a child at greater risk of being uninsured, of not having seen a physician in the last year for acute or chronic conditions, and of having fewer opportunities for preventive health care services. (See Program Results on ID# 026855.)
• Access to care for women immigrants. Chinese and Vietnamese women in New York, Houston and Chicago have lower access to health care—measured by the rate of annual physician contact and the rate of annual well check-ups—than the general population, according to research by the Association of Asian Pacific Community Health Organizations. The findings also show that the longer a family resides in the United States, the better its members' access to health care. (See Program Results on Opening Doors.)

Barriers to Care
There are two types of barriers to receiving health care for immigrants in the post-welfare-reform policy environment, according to policy research conducted in the late 1990s at Georgetown University. (See Program Results on ID# 034515.)

The two types of barriers are:

• Barriers related to immigration status, such as fear of the Immigration and Naturalization Service.
• Barriers related to vulnerable and low-income populations such as culture, language, transportation and complex procedures for getting access to care.

A study of low-income Vietnamese and Chinese immigrant families in Philadelphia found that transportation and language difficulties were the most common obstacles to getting health care. (See Program Results on ID# 049106.)

The researchers recommended several improvements that were adopted by the Pennsylvania Department of Public Welfare, including requiring managed care organizations to:

• Develop written plans for serving patients with limited proficiency in English.
• Translate materials into the five major languages in common use in Philadelphia.
• Track patients who need interpreters so that they do not need to ask for interpreters.

Immigrant Health Policy Priorities
In the late 1990s, the National Conference of State Legislatures (NCSL) identified five priority issues with a significant state component for improving access to care for immigrants. (See Program Results on ID# 023269.)

The five priority areas are:

• Assessing the impact of welfare reform on elderly legal immigrants receiving Supplemental Security Income, a federal cash assistance program.
• Increasing access to Medicaid managed care through medical interpretation.
• Providing access to prenatal care for women who are in the country illegally.
• Providing early and periodic screening, diagnosis and treatment for migrant farmworkers' children.
• Treating tuberculosis among the foreign-born.

NCSL staff wrote briefing papers on each topic, longer policy-analysis papers on prenatal care, and two publications on welfare reform and immigrant health.

Research Methodology

• Measuring access to care. Researchers at Project Hope found that immigrants may not report their access to care accurately. The researchers developed a new way to measure access that asks immigrants about recent physician visits and their usual sources of care. (See Program Results on ID# 036333.)
• Measuring Latino immigrant substance abuse. After reviewing literature on Latino substance abuse, researchers at the University of Texas recommended that substance-use surveys on Latinos should separate subjects into a U.S.-born group and an immigrant group. (See Programs Results on ID# 034551 for other recommendations on measuring Latino substance abuse.)

Health of Immigrant Newborns
A study of health outcomes for Mexican-American infants found that those born to immigrant mothers were healthier than those born to American-born Mexican Americans. Health experts concluded they need more data in order to understand this "paradox." (See Program Results on ID# 030613.)