WASHINGTON — Immigrants accounted for nearly all of the recent increase in the number of U.S. residents without health insurance, and California has by far the largest number of uninsured immigrants, a study released Monday found.
"The face of the uninsured is changing, and it is more likely to be an immigrant today than it was 10 years ago," said Paul Fronstin, director of health research at the Employee Benefit Research Institute here. "As long as the immigrant population increases and nothing else changes, it's going to drive up the number of uninsured."
The unrelenting rise in the number of people without health insurance is widely seen as one of the most pressing social problems facing the country. The institute's study suggested that any solution might require changes in immigration policy as well.
The study found that in 2003, the latest year for which data are available, more than 11 million immigrants were uninsured. That represented about a quarter of the 45 million people the U.S. Census Bureau estimates are uninsured.
Although native-born Americans account for the majority of the uninsured -- about three-fourths of the total -- the institute's study found that between 1998 and 2003, immigrants represented 86% of the growth in the number of people lacking insurance.
That was a sharp jump from the period between 1994 and 1998, when immigrants had accounted for about a third of the increase in the number of uninsured.
The study described foreign-born residents only by their U.S. citizenship status and did not distinguish between legal and illegal immigrants among those who were not U.S. citizens.
At least a quarter of all immigrants are estimated to be undocumented, with the largest group coming from Mexico.
In California, immigrants accounted for nearly half of the state's uninsured. California had 3.2 million uninsured immigrants, more than any other state. Texas, with 1.7 million, was second.
The Employee Benefit Research Institute is a privately funded nonpartisan organization that conducts studies on healthcare, pensions, retirement savings and other workplace issues.
Changes in federal policy may have increased the number of uninsured immigrants, Fronstin suggested. Congress restricted healthcare and welfare benefits for legal immigrants in the mid-1990s. Some of those policies have been eased, but it is still harder for immigrants to get public assistance now than it was in the early 1990s.
"The welfare reform bill may not have had much impact on immigration," Fronstin said, "but it had an impact on who is eligible for Medicaid," the federal-state healthcare program for the poor. Lawmakers will have to consider immigrants in any effort to reduce the number of uninsured, he added.
Some of the problems with immigrants are common to all lower-wage workers. "They are uninsured because health costs are rising," Fronstin said. "They are uninsured because they are disproportionately employed by small businesses. They are uninsured because they have service and agricultural jobs that are less likely to come with benefits."
Among Latinos, 60% of immigrants were uninsured, compared with 22% of those who were born in the United States, according to the institute.
Proponents of immigration restrictions said reducing the number of illegal immigrants would lead to higher wages and improved benefits for other workers, including legal immigrants and native-born Americans.
"What this tells us is there is a very high cost to cheap labor," said Steven Camarota, research director at the Center for Immigration Studies, a Washington policy organization that favors curbs on immigration. "I come down on the side of the debate that says you pay your own workers more and invest in labor-saving devices and technology."
The cost of caring for uninsured immigrants is often borne by hospitals, which are barred by federal law from refusing to provide emergency room care. The federal government recently announced a program to reimburse some of those costs, but it would cover only a fraction.
"If you are going to have illegal immigrants here, you are going to have to accept the cost," Camarota said.
But Jane Delgado, president of the National Alliance for Hispanic Health, said immigrant labor was vital to such industries as construction, hotels and agriculture.
"The term 'uninsured' is being used in a certain way to connote a drain on society, but the overwhelming majority of the uninsured are working," she said. And immigrants, she added, "are the blood, sweat and tears of this country -- what makes this country grow."
Delgado also pointed to a healthcare paradox that medical research studies had long validated: Although Mexican immigrants are more likely to be uninsured, their health status is generally better than that of native-born Americans.
Asian immigrants are also less likely to suffer from chronic illnesses such as heart disease and cancer.