The Health Coverage of Noncitizens in the United States, 2023

Despite making up just 8 percent of the nonelderly population in the United States, adults under 65 who are not citizens comprise nearly one-third of the nation’s 29.6 million uninsured population.

The Issue

Approximately 8.6 million noncitizens, including those who live in America legally or are undocumented, lack access to health insurance. Recent Biden administration efforts to expand coverage to DACA recipients only cover a small portion of uninsured noncitizens.

Key Findings

• The uninsurance rate among people who are not citizens is nearly four times higher than it is for the entire U.S. population (39.4% vs. 10.6%)

• More than 80 percent of uninsured people who are not citizens live in families that include at least one full-time worker, but many work in industries that do not offer employer-sponsored coverage. More than one in three (36%) people who are not citizens have employer coverage, compared to 54.4 percent of all nonelderly people in the United States

• People who are not citizens are less likely to have public health coverage, with many facing federal and/or state eligibility restrictions

• Only 16.5 percent of uninsured people who are not citizens are eligible for Medicaid, CHIP, or subsidized Marketplace coverage

• Two-thirds of noncitizen adults are ineligible for public health coverage based solely on their immigration status

Conclusion

Despite recent state and federal efforts to expand coverage to noncitizens, few have gained eligibility for Medicaid, CHIP, or Marketplace coverage. Additional options to expand coverage to noncitizens should be implemented to improve health outcomes.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.