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Blog Post
Black Immigrants Face Greater Barriers to Health Care
Penn LDI Team Finds Black Immigrants, Especially Those who are Undocumented, Face Higher Rates of Uninsurance and Lower Health Care Use
Print:
New policies that curtail immigrant access to health insurance on the Affordable Care Act marketplace, as well as the loss of Temporary Protected Status for Haitians, will affect Black immigrants, a growing population group largely omitted from policy conversations about health care access.
A recent study by LDI Senior Fellow Joseph Nwadiuko and colleagues anticipates what might happen next. The researchers show that, even before the latest developments, Black immigrants were less likely to be insured and less likely to use health care compared with non-Hispanic white citizens. The pattern was particularly striking for those who were undocumented.
Nwadiuko’s team used 1999-2018 results from the National Health Interview Survey to assemble a weighted sample of 298.9 million people over 40, made up of U.S.-born citizens who were identified as non-Hispanic white and as Black, and Black immigrants with naturalized, documented, and undocumented status.
Legal Status and Health Insurance are Connected for Black Immigrants
Black undocumented immigrants had substantially higher odds of being uninsured compared to all other groups and were less likely to have visited a clinician, had their blood pressure measured, visited the emergency room, been hospitalized, or, among women, to be screened for cervical cancer in the previous two years. Health insurance explained part, but not all, of the lack of health care use.
Among all Black immigrants, the likelihood of having insurance and health care visits decreased as legal status became less secure, from naturalized to documented to undocumented.
Black Immigrants and U.S.-born Black Citizens Diverged in Their Health Care Use
Black immigrants and naturalized citizens had a lower probability of hospitalization and emergency room visits than white and Black populations born in the U.S. Black women who were immigrants and those born in the U.S. had lower probability of cervical cancer screening than non-Hispanic whites.
Implications for Black Immigrant Health Care
Nwadiuko and colleagues’ work challenges the common political narrative that undocumented immigrants overuse emergency and other health care services. Their findings also demonstrate how health insurance matters in access to care among Black immigrants.
This study does not include information about what states may be doing for immigrant communities. However, current federal policies limiting insurance will likely further limit health care for Black immigrants. Policies designed specifically for this community are needed to boost their access to health care.
The study, “In the Shadows: Health Utilization Outcomes Among Black Undocumented Immigrants,” was published in Medical Care June 15, 2026 by Joseph Nwadiuko, Arrianna Marie Planey, Naomi Zewde, and Arturo Vargas Bustamante.
Author
Christine Weeks
Director of Strategic Initiatives
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