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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

Sep 9, 2021 - Health

HHS awards over $18M in grants to bolster students' health care access

Students and parents in line to enter school. Photo: Al Seib/Los Angeles Times via Getty Images

The Biden administration has awarded over $18 million in grants to expand students' access to health care and mental health support as the new school year takes off, according to new numbers shared with Axios.

Why it matters: Both children's mental health and their utilization of mental health services worsened during the COVID-19 pandemic, per research from the Kaiser Family Foundation (KFF). The return to in-person instruction could also lead to increased health risks depending on masking and vaccinations in the community.

Updated 3 hours ago - Science

Huge wildfire reaches edge of Sequoia National Park

A plume of smoke and flames rise into the air as the fire burns towards Moro Rock during the KNP Complex fire in the Sequoia National Park near Three Rivers, California, on Saturday. Photo: Patrick T. Fallon/AFP via Getty Images

Firefighters in Sequoia National Park were working into the night after two wildfires merged to reach the Giant Forest Saturday.

Why it matters: This forest contains over 2,000 giant sequoias, including the General Sherman Tree — the world's largest tree by volume. Park officials wrapped the redwoods in foil last week as the Paradise and Colony Fires, now known as the KNP Complex Fire, neared. Protection efforts appeared to be working overnight.

4 hours ago - World

Hong Kong holds first "patriots only" elections

Hong Kong Chief Executive Carrie Lam during a news conference last Monday. Photo: Lui Siu Wai/Xinhua via Getty Images

Hong Kong's elections to choose the city's Election Committee members opened to a select group of voters on Sunday, under a new "patriots only" system imposed by China's government.

Why it matters: All candidates running to be members of the electoral college have been "vetted" by Beijing, per Reuters. They will go on to choose the Asian financial hub's next leader, approved by China's government, and some of its legislature.