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How Immigrants Use Health Care


President Trump has announced another new immigration rule set to take effect next month, though it's likely headed to federal court. The rule would require foreign nationals to prove they have health insurance or the money to pay for their own health care costs before they can legally enter the United States. Simply put - no proof, no visa. The president said this action is necessary to, quote, "protect the availability of health care benefits for Americans."

We wanted to get a better understanding of how immigrants use and pay for health care in the United States. Anne Dunkelberg is an associate director of the Center for Public Policy Priorities in Austin, Texas. She's spent her career working on health care access issues, and she joins us now.


ANNE DUNKELBERG: Good morning.

GARCIA-NAVARRO: How would this work? I mean, if you're a visitor and you're traveling, you would obviously get travel insurance, which isn't terribly expensive. If you are coming to immigrate, then what would you have to show?

DUNKELBERG: It's a great question that we probably can't answer. It sounds to me like, you know, it could conceivably require the creation of a whole new segment of the health insurance industry that's just designed to answer this new requirement for even visiting the United States.

GARCIA-NAVARRO: The other thing that confuses me a little bit about this is this seems like an additional step that - already, when you apply for a visa outside of the United States, you do have to prove some sort of financial stability.

DUNKELBERG: You're absolutely right. Even for these short-term visitor-type visas, there's already screening to try to detect people who might be coming here without means and likely to, for example, overstay their visa.

GARCIA-NAVARRO: Getting insurance in this country is complicated for Americans. It is even more complicated if you're coming into this country. And presumably, if you have a work visa and you're being sponsored by someone, you would have insurance already. So it's unclear, a little bit, who this is targeting exactly.

DUNKELBERG: It sounds, frankly, more like the intention is for the optics of the policy as much as it is, you know, having a practical system in place to do it. If you read the document that was announced, you find that it actually outlines many of the other things that the Trump administration has either proposed or is in the process of trying to pursue. So they've presented it in their own document as part of what advocates for immigrants refer to as the invisible wall.

GARCIA-NAVARRO: Your state, Texas, has one of the highest number of uninsured people in the U.S. So are the people who are uninsured Americans, or is the bigger portion people who are immigrants?

DUNKELBERG: Seventy-five percent, at least, of our uninsured are U.S. citizens. And then maybe another half a million are lawfully present immigrants. Some of the barriers to coverage that both U.S. citizens and lawfully present immigrants face, you know, are things that are well within the authority of our legislature and our governor to address. And obviously, some of the shortcomings of the Affordable Care Act that have left some Americans still unable to afford coverage are squarely in the lap of the U.S. Congress.

GARCIA-NAVARRO: So when the president says that uninsured individuals who are immigrants are a burden on the health care system, that is not the main cause of the burden of the uninsured. Most of that is citizens, so he is actually incorrect.

DUNKELBERG: Absolutely. The vast majority of uninsured Americans are U.S. citizens. That is the big challenge we have. We are obviously way more complicated here, and we're looking to make it even more complicated for people to visit the United States, potentially more expensive, and thereby discourage particularly people who are not of means from visiting the United States.

GARCIA-NAVARRO: That was Anne Dunkelberg of the Center for Public Policy Priorities in Austin, Texas. Thank you so much.

DUNKELBERG: Thank you, Lulu. Transcript provided by NPR, Copyright NPR.

Corrected: October 5, 2019 at 11:00 PM CDT
In an earlier version of this story, Anne Dunkelberg's organization was incorrectly listed as the Center for Children and Families. Dunkelberg oversees health care policy at the Center for Public Policy Priorities.
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