Health coverage of low-income citizen and noncitizen wage earners: sources and disparities

The health coverage of low-income workers represents an area of continuing disparities in the United States system of health insurance. Using the 2001 California Health Interview Survey, we estimate the effect of low-income wage earners' citizenship and gender on the odds of obtaining primary employment-based health insurance (EBHI), dependent EBHI, public program coverage, and coverage from any source. We find that noncitizen men and women who comprise 40% of California's low-income workforce, share the disadvantage of much lower rates of insurance coverage, compared to naturalized and U.S.-born citizens. However, poor coverage rates of noncitizen men, regardless of permanent residency status, result from the cumulative disadvantage in obtaining dependent EBHI and public insurance. If public policies designed to provide a health care safety net fail to address the health care coverage needs of low-wage noncitizens, health disparities will continue to increase in this group that contributes essentially to the U.S. economy.