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Illustration: Shoshana Gordon/Axios

Health care systems in the U.S. are largely unprepared to deal with aging immigrants, according to a new report published in Health Affairs.

Why it matters: The group skews older than U.S.-born adults, the study warns, and many of these aging immigrants aren't eligible for Medicare and Medicaid.

  • Even aging documented immigrants may have difficulty qualifying for Medicare because they need to account for at least 10 years of Social Security earnings to be eligible, the authors write.

By the numbers: The proportion of U.S.-born adults who are 55–64 increased by 69%, compared with 121% for immigrants between 2000 and 2018, the study analyzed.

  • Nearly 60% of noncitizen immigrants who had been in the U.S. for more than five years were aged 35–64 in the same time frame.
  • In 2018, about 23% of documented immigrants and 45% of undocumented immigrants were uninsured, compared with 9% of U.S. citizens.

State of play: Immigrants who have spent a longer time living in the U.S., are able to show documentation and had some proficiency in English have increased chances of health insurance coverage and access to health care, the authors said.

  • Often emergency care is a mainstay for immigrants, but its high cost for patients and taxpayers could become unsustainable long-term.
  • The Affordable Care Act had a positive impact by reducing inequities between legally authorized immigrants and U.S.-born adults, but not undocumented immigrants, per the report.

What's next: The report points to a few state policy initiatives that would help increase physician visits and overall coverage.

  • The California state legislature is debating to expand Medicaid coverage for low-income undocumented immigrants ages 65 and older.
  • Illinois is the only state to cover transplants for uninsured undocumented immigrants who have end-stage kidney disease.

Yes, but: Immigration criminalization and enforcement policies in recent years have led to an underuse of health care even if services are available, author Arturo Vargas Bustamante of the University of California, Los Angeles, tells Axios.

  • "Trust in the health care system is a very important topic, but it is often a reflection of systematic exclusion from and lack of familiarity with the U.S. health system among immigrants," he said.

Go deeper

Philadelphia health care workers face Friday vaccine deadline

Illustration: Eniola Odetunde/Axios

Philly is pushing forward with its mandate that all health care workers must get their first dose of the COVID-19 vaccine by Friday, the city's health chief said at a press conference Wednesday.

State of play: More than 85% of the city's health care workers in long-term care facilities have at least one dose.

John Frank, author of Denver
Oct 13, 2021 - Axios Denver

A reality check on Colorado's mandate to cover transgender services

Illustration: Sarah Grillo/Axios

Colorado made a national statement Tuesday, becoming the first state to require some insurers to cover transition-related care for transgender people as an essential benefit.

Driving the news: The Biden administration agreed to the expansion sought by Gov. Jared Polis and affirmed two more mandates approved by Colorado lawmakers to cover more opioid treatments and a yearly mental health exam.

Nathan Bomey, author of Closer
10 mins ago - Economy & Business

Tesla delays Cybertruck until 2023

Tesla debuts the Cybertruck in Hawthorne, Calif., on Nov. 21, 2019. Photo: Frederic J. Brown/AFP via Getty Images

Tesla is at risk of falling behind on one of the most critical products in the American auto industry: pickups.

Why it matters: Pickups are the most profitable segment in the business and account for the first, second and third best-selling vehicles in the country. Without a serious pickup strategy, Tesla could miss out on a huge source of future income.