Earlier this year, the share of people in the U.S. without health insurance hit an all-time low. But the uninsured rate remains glaringly high among the country’s roughly 10 million undocumented immigrants.
Half of these folks still report lacking insurance, compared to just 6% of U.S.-born citizens. Most remain ineligible for full Medicaid benefits and unable to buy Obamacare coverage.
Research shows patients without health insurance are more likely to skip or delay medical care and to lack a regular source of care. Can the U.S. find a way to improve access to care for these immigrants — even as lawmakers leave them in an uninsured limbo?
Absolutely, suggests a study recently published in the American Economic Review by Adrienne Sabety, Jonathan Gruber, Jin Yung Bae and Rishi Sood.
A smoother path to primary care led to fewer ER visits
This team of researchers and New York City officials partnered to run a rigorous randomized evaluation of a pilot program that connected undocumented residents who have low incomes to primary care. Their study shows this approach can work — it not only improved access to primary care, but also slashed emergency room visits by nearly one-fourth.
The intervention sounds simple: Book an initial primary care visit at one of nine city-owned clinics for any eligible undocumented person who wants one. People in the study’s control group were offered information about these clinics, but not given any direct help scheduling an initial appointment.
However, speaking with Rishi Sood (one of the New York City officials who led this study) gave me an extra appreciation for how big of a lift this intervention really was. In just the first couple months, he told me, his team interacted with prospective patients who hailed from 77 different countries and spoke 32 different languages.
Sood and his team took specific steps to ease some concerns that have historically dissuaded this population from seeking health care. The nine participating clinics, for example, were selected because they specialize in serving immigrants and have a legal obligation to serve patients regardless of insurance status or ability to pay.
By the end of the study period, people offered help booking an appointment were nearly 30% more likely to report having a primary care provider than those in the control group.
What I found even more impressive was the impact that this increased access to primary care had on people’s use of the emergency room. For patients who lack insurance, the ER is often the only available source of regular care — even for chronic conditions like diabetes or asthma that can be easily and more cheaply managed in a primary care clinic.
This paper provides strong evidence that many people will pick the more cost-effective option when it’s also easy. Compared to people who received no help booking a primary care appointment, those who did get that help made 23% fewer trips to the emergency room. The impact was even greater — a 32% dip — among patients with at least one chronic condition.
“To find that we drove down emergency department usage — particularly for primary care treatable conditions like hypertension and diabetes — that was really exciting,” Sood said.
Three Other Studies You Might Have Missed…
- Less than a third of people who have called the 988 Suicide and Crisis lifeline with serious psychological distress — including frequently feeling significantly depressed or worthless — say they are very likely to call the hotline again. (JAMA Network Open)
- Uninsured patients with Type 2 diabetes experienced a 21% reduction in hemoglobin A1c — a measure of average blood sugar levels — over the course of six months after receiving free diabetes medications. (American Journal of Managed Care)
- From 2006 to 2022, the percentage of people each year who switched from traditional fee-for-service Medicare to Medicare Advantage more than tripled, whereas the percentage switching from Medicare Advantage to traditional Medicare declined. (Health Affairs)