While Con­gress debates whether pub­licly sup­ported health care should be avail­able to undoc­u­mented immi­grants who may be placed on a path to cit­i­zen­ship under immi­gra­tion reform, the health care needs of already legal immi­grants con­tinues to be over­looked. More than 12 mil­lion immi­grants are law­fully present in the United States. They serve in the mil­i­tary, pay taxes, and con­tribute to the economy. Yet like undoc­u­mented immi­grants, whose health care vul­ner­a­bil­i­ties are out­lined in the Per­spec­tive article by Som­mers, legal immi­grants face sub­stan­tial bar­riers to obtaining insur­ance cov­erage (see graph). As a result, some — such as Antonio Torres, an unin­sured Ari­zona farm­worker who was in a coma after a car acci­dent — have been force­fully trans­ferred to their native country when their treating hos­pi­tals were unable to find facil­i­ties willing to pro­vide them with long-​​term care.1

Legal immi­grants form a highly het­ero­ge­neous group that includes legal per­ma­nent res­i­dents (“green card holders”), refugees, asylum seekers, and many others. Because of the het­ero­geneity of the class and the com­plexity of immi­gra­tion cat­e­gories, infor­ma­tion on the pro­por­tion insured is scarce. Aug­menting data from the 2008 Cur­rent Pop­u­la­tion Survey, the Pew His­panic Center reports that 24% of legal immi­grants were unin­sured in 2008, as com­pared with 59% of unau­tho­rized immi­grants and 14% of native cit­i­zens.2 In a 2005 article that was based on data from the Los Angeles Family and Neigh­bor­hood Survey, Goldman et al. reported that 32% of per­ma­nent legal res­i­dents remained unin­sured for an entire 2-​​year period, as com­pared with 65% of undoc­u­mented immi­grants and 18% of cit­i­zens.3 Although legal immi­grants, like other immi­grants, spend less on health care and appear to be healthier than cit­i­zens, that appear­ance may be attrib­ut­able in part to undi­ag­nosed ill­nesses and lack of access to a reg­ular source of care.4

Read the article at New England Journal of Medicine →