Nearly 1/3 of uninsured Americans under 65 are not citizens

Despite making up just 8% of the nonelderly population in the United States, adults under 65 who are noncitizens will comprise nearly one-third of the nation’s 27 million uninsured population in 2024, according to a new analysis from the Urban Institute with funding from the Robert Wood Johnson Foundation. Researchers estimate 8.6 million noncitizens—including individuals residing in America lawfully or who are undocumented—live without health insurance.

While the Biden administration recently unveiled a plan to expand healthcare coverage to young adult noncitizens who participate in the Deferred Action for Childhood Arrivals (DACA) program, the administration estimates the decision would extend coverage to 129,000 people in 2024. This analysis does not include the effects of this proposal on the health coverage of DACA recipients.

Meanwhile, a few states are gradually taking steps to expand health coverage eligibility to lawfully present noncitizens, such as expanding coverage to pregnant women and children who do not meet the five-year residency requirement, as well as including qualifying undocumented immigrants for Marketplace PTCs.

Key findings include:

• The uninsurance rate among nonelderly people who are noncitizens will be nearly four times higher than it is for the entire U.S. population in 2024 (39.2% vs. 9.8%).
• More than 80% of uninsured people who are noncitizens live in families that include at least one employed worker, but many work in industries that do not offer employer-sponsored coverage.
• More than 1 in 3 (36.0%) people who are noncitizens have employer coverage, compared to 54.4% of all nonelderly people in the United States.
• People who are not citizens are less likely to have public health coverage, with many facing federal and/or state eligibility restrictions.
• Only 16.5% of uninsured people who are noncitizens are eligible for Medicaid, CHIP, or subsidized Marketplace coverage.
• Two-thirds of uninsured noncitizen adults are ineligible for public health coverage based solely on their immigration status.

“As the uninsurance rate has declined, noncitizens comprise a growing share of those without coverage,” said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. “The recent proposed rule regarding DACA recipients illustrates the need for expanding eligibility regardless of immigration status if we want to attain universal coverage.”

“Despite some efforts to cover certain lawfully present noncitizens and the availability of Marketplace options, only 16.5% of uninsured noncitizens gained eligibility for Medicaid, CHIP, or Marketplace premium tax credits,” said Matthew Buettgens, senior fellow at the Urban Institute. “States have several options to extend coverage to noncitizens and undocumented immigrants and expand overall health coverage in the United States.”

Read the full report, "The Health Coverage of Noncitizens in the United States, 2024."