The 2010 Affordable Care Act (ACA) includes a number of provisions that will expand access to subsidized health insurance coverage to the non-elderly population, including immigrants. Major provisions of the ACA include: The expansion of Medicaid up to 133 percent of the federal poverty level1; New state-based health insurance exchanges combined with insurance market reforms; Premium subsidies for individuals with incomes below 400 percent of the Federal Poverty Limit (FPL) and cost-sharing subsidies for individuals with incomes below 250 percent FPL; and an individual requirement to obtain health insurance coverage.
According to projections by the Congressional Budget Office, the ACA will reduce the uninsured rate by 11 percentage points, reducing the share without insurance coverage from 19 to 8 percent by 2017 when most key provisions will be fully phased in, with the largest gains occurring among those with lower-incomes (CBO, 2010). The ACA will expand the coverage options for some, but not all immigrant groups. Indeed, undocumented immigrants, who are prohibited from enrolling in Medicaid and purchasing coverage through the new health insurance exchanges, are projected to constitute 25 percent of the uninsured after the major provisions of the ACA are fully implemented (Buettgens et al., 2010). In addition, options available to lawfully residing immigrants under the ACA also depend on the number of years they’ve lived in the United States. This brief highlights the demographic, socioeconomic, and geographic characteristics and uninsured rates for key immigrant subgroups and describes how the ACA could affect coverage and access to care for these subgroups and their families. The ACA has particular relevance for the United States’ foreign-born population since they are over 2.5 times more likely than their native-born peers to be uninsured (33.7 percent compared to 12.8 percent, respectively) and because they constitute a large and growing share of the US population (Pew Hispanic Center, 2011).
The following section describes the data source for the estimates included in this brief, the American Community Survey (ACS). Subsequent sections contain estimates of the foreign-born population, describe relevant ACA coverage provisions with respect to immigrant subgroups in more detail, and discuss their potential impacts.