Immigration status and the uninsured in California: The impact of the Great Recession

Background. In the Fall of 2008, California entered a prolonged recession that resulted in a sharp increase in the uninsured population – from 6.4 million in 2007 to 7.1 million in 2009. Although non-citizens without green cards comprised only 6.1% of California's nonelderly population in 2009, there is a misconception that they drive the increase in the uninsured. We will examine the uninsured population through the lens of citizenship status, and discuss the implications of our findings in relation to the implementation of the Affordable Care Act of 2010 (ACA).

Objectives. To examine the increase of the U.S.-born population as a percentage of the uninsured in California from 2007 to 2009, determining if this increase is still significant after controlling for other factors, including household income and job loss.

Methods. Bivariate and multivariate analysis of the 2007 and 2009 California Health Interview Surveys.

Results. Our initial results indicate that the largest and also fastest-growing group within the uninsured is U.S.-born citizens, due to both the loss of health insurance among this population and the overall decrease of non-citizens without a green card in California.

Conclusions and Policy Implications. The ACA will benefit non-Latinos disproportionately due to the exclusion of non-citizens without a green card from any of the expansions. The existing disparities in health insurance coverage and resulting access to the health care system will be exacerbated as the ACA is implemented, with the possibility that more than one million Californian residents (including non-citizen children) will be left out.