Black immigrant adults in the United States are more likely to be uninsured than their U.S.-born and non-Black immigrant counterparts, despite having the highest employment rates among the groups studied, according to new research from the Equity Research Institute (ERI) at the USC Dornsife College of Letters, Arts and Sciences.
Published in Health Affairs , the study highlights critical health care access gaps for this rapidly growing segment of the U.S. population, suggesting possible links to wage penalties and systemic barriers based on race and immigration status.
"Our results suggest that Black immigrants may be concentrated in jobs that don't offer health insurance benefits, potentially due to lower wages or limited access to employer-sponsored benefits," said Ezinne Nwankwo , ERI's National Equity Atlas Postdoctoral Scholar and the study's lead and corresponding author.
"Factors such as fears related to immigration status, complexities in navigating coverage within mixed-status families, policy restrictions, language barriers and employment in sectors that do not provide health insurance may contribute to these disparities," she said.
High employment, low coverage
Black immigrants make up a substantial and rapidly expanding segment of the Black population in the United States. 4.6 million, or 1 in 10, Black people living in the United States are immigrants , a number that has tripled since 1980 and is projected to more than double again by 2060.
The majority of Black immigrants in the United States come from the Caribbean and Africa, which together made up 88% of the Black foreign-born population in 2019. The Caribbean is the most common region of birth for Black immigrants (46%), with Jamaica and Haiti as the leading countries of origin. However, African immigrants have been the main driver of recent growth in the Black immigrant population, increasing 246% since 2000. They now make up 42% of Black immigrants in the United States, primarily from Nigeria and Ethiopia, according to Pew Research Center.
To understand health insurance coverage across racial and immigrant groups, the researchers used data from the U.S. Census Bureau's five-year American Community Survey (ACS) from 2017-2021 and the Survey of Income and Program Participation (SIPP). Because the ACS does not collect data on immigration status, ERI developed a dataset that distinguishes between undocumented individuals, naturalized citizens and those with different visa types (e.g., student, H-1B).
The researchers' analysis considered factors like employment, state Medicaid coverage and language barriers that could influence access to health care coverage. They then compared Black immigrants with their U.S.-born Black and U.S.- and foreign-born white, Latino and Asian American and Pacific Islander (AAPI) counterparts.
They found that Black immigrants have a 9% higher likelihood of being uninsured compared to U.S.-born white adults. This disparity occurs despite Black immigrants having a 70.2% employment rate, higher than the 60.5% rate for U.S.-born Black individuals, according to U.S. Census data.
In contrast, there were no significant differences in insurance coverage between U.S.-born Black and white individuals.
The study also found significant disparities among Latino populations. U.S.-born Latinos were 31% more likely to be uninsured than U.S.-born white individuals, while Latino immigrants faced more than twice the odds of lacking coverage.
Both Black immigrants and Latino populations — whether U.S.-born or immigrant — were less likely to receive employer-sponsored or union-backed health insurance compared to U.S.-born white individuals.
"Addressing these systemic issues requires comprehensive policy reforms that consider the unique challenges faced by immigrants," said Manuel Pastor , director of ERI and co-author of the study.
"Ensuring equitable access to health care is not only a matter of social justice but also essential for the well-being of our communities," said Pastor, a Distinguished Professor of Sociology and American Studies and Ethnicity and Turpanjian Chair in Civil Society and Social Change at USC Dornsife.
Gender disparities in health insurance coverage
Female respondents across all groups were significantly less likely to be uninsured than their male counterparts. Previous research indicates higher U.S. naturalization rates among immigrant women, suggesting they may play an important role in helping their families and communities navigate the United States' complex health care system.
"As primary caregivers and community connectors, immigrant women are uniquely positioned to expand outreach and ensure their families access the benefits they are entitled to," Nwankwo said.
Training them could be an effective strategy for increasing coverage, particularly among underserved groups, including men, she added.
"Our findings underscore the deep-rooted inequities in health care access that persist despite employment and economic contributions from immigrant populations," Pastor said. "Tackling these issues with policy reforms and community-driven solutions could ensure more equitable access to health care, particularly for those most at risk of being left out."
