Immigrants face considerable barriers to health insurance in the US. A 2026 survey found 21 percent of lawfully present and 46 percent of likely undocumented immigrant adults reported being uninsured in 2025, compared with just seven percent of naturalized citizens and six percent of US-born adults. Certain lawfully present immigrants can receive subsidized private coverage through the Affordable Care Act marketplace or public coverage through Medicare or Medicaid. By contrast, undocumented immigrants are ineligible for virtually all forms of federally financed health insurance, except Emergency Medicaid. However, even this is restricted to discrete management of acute symptoms.
In an invited commentary for JAMA Network Open, Dr. William Schpero, associate professor of population health sciences, and Dr. Patricia Mae G. Santos, assistant professor of radiation oncology at the Emory University School of Medicine, explore state-funded coverage for immigrants and the evidence of its benefits for both enrollees and healthcare organizations.
Studies have shown that state-funded coverage for immigrants can reduce uninsurance rates among both children and adults, improve prenatal care and birth outcomes, and yield long-run, positive effects for children. Without state-funded coverage, much of the cost of delivering services to uninsured patients is borne by hospitals as uncompensated care.
Dr. Schpero and Dr. Santos write about a recent 2026 study that examined whether targeted expansions of state-funded coverage to immigrant populations can affect hospitals’ provision of uncompensated care, finding that Illinois’ Health Benefits for Immigrant Seniors (HBIS) and Health Benefits for Immigrant Adults (HBIA) programs were associated with reductions in bad debt and charity care.
These findings are timely given the recent cutbacks in state-funded coverage for adult immigration programs across multiple states, including the HBIS and HBIA programs in Illinois. With the Budget Reconciliation Act of 2025 (HR 1) expected to reduce the federal Medicaid budget by over $900 billion over ten years, states may be compelled to further cut state-funded immigrant coverage and other discretionary programs. As the risk of rising rates of uninsurance among immigrants mounts, Dr. Schpero and Dr. Santos highlight the need for states to take meaningful steps to direct resources to healthcare organizations that have an explicit mandate to serve patients regardless of insurance or immigration status.
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