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THE CUTTING EDGE news + research Undocumented U.S. Born Everyone Uninsured only % Adults with Emergency Department Visit in Past Year Undocumented adults in California have statistically similar rates of emergency- department visits and similar number of doctor visits to U.S.-born adults. However, uninsured undocumented adults have significantly lower rates of emergency- department visits and fewer doctor visits than uninsured U.S.-born adults. Graph: Courtesy of Dr. Nadereh Pourat U MAGAZINE Uninsured only Average Number of Doctor Visits in Past Year The True Healthcare Costs of Undocumented Immigrants Undocumented immigrants in California see the doctor and visit emergency rooms significantly less often than U.S. citizens and documented immigrants, a UCLA study finds. Undocumented immigrants also seek fewer preventive-health services, according to the study. The findings contradict perceptions that undocumented immigrants overburden U.S. emergency departments and health providers. The UCLA researchers found striking differences in ER visits by adults: One-in-five U.S.-born adults visits the ER annually, compared with roughly one-in-10 undocumented adults. “Most people who go to the emergency room have insurance and are not worried about providing documents,” says Nadereh Pourat, PhD, director of research at the UCLA Center for Health Policy Research and a member of UCLA’s Jonsson Comprehensive Cancer Center Division of Cancer Prevention and Research. On the other hand, “the undocumented who end up in the emergency room have often delayed getting any care until they are critically sick.” The study also found that the average number of annual doctor visits by undocumented immigrants was lower: 2.3 for children and 1.7 for adults, compared with 2.8 doctor visits for U.S.-born children and 3.2 for adults. Of all California residents who lack insurance, undocumented adults who are uninsured had the fewest mean doctor visits of all groups — 1.6 per year, compared with 1.8 visits for U.S.-born residents, legal permanent residents and naturalized residents. Nine percent of uninsured undocumented immigrants had visited the ER, significantly lower than the 12 percent of uninsured U.S.-born residents, who had the highest ER use of all groups. 10 Everyone To determine undocumented immigrants’ use of health services in the state, the researchers used 2009 California Health Interview Survey (CHIS) data to predict the likelihood of respondents being undocumented. In 2009, California was home to more than 2.2-million undocumented immigrants, the study found. And while these immigrants make up 6.8 percent of California’s residents, they represent nearly a quarter of the state’s uninsured population. “The great majority of the undocumented in California are working-age adults who contribute greatly to California’s economy by working in physically demanding service, agriculture and construction jobs,” Dr. Pourat says. “It makes financial sense to make sure they have affordable health-coverage options so they can stay healthy.” Lower utilization of care comes at a great cost, the study findings suggest. The undocumented don’t get preventive care, potentially leading to more-advanced disease and higher public expenditures. If undocumented immigrants had access to health insurance, the authors say, their doctor and ER visits would remain below or be the same as documented residents. The 2010 Affordable Care Act extended access to health coverage to about 3.3-million people in the state but not to California’s undocumented immigrants, the study notes. The authors conclude that allowing undocumented immigrants to buy unsubsidized coverage could benefit the insurance-exchange market, as they are a large, young and relatively healthy population that could help keep premiums low. In addition, their health coverage could reduce the burden of uncompensated care on safety-net providers. “Assessing Health Care Services Used by California’s Undocumented Immigrant Population in 2010,” Health Affairs, May 2014