A national analysis of health survey data finds that older immigrants living in the United States, particularly those who are not U.S. citizens, confront substantial barriers to medical care even though many report relatively good health.
Key findings from a large national sample
Researchers at the Johns Hopkins Bloomberg School of Public Health examined responses from more than 76,000 adults aged 50 and older collected through the National Health Interview Survey between 2019 and 2023. Their paper, published May 23 in Health Affairs Scholar, compares health status and access indicators across U.S.-born adults, foreign-born citizens and foreign-born noncitizens.
After controlling for demographic and socioeconomic characteristics, investigators found that foreign-born older adults—both citizens and noncitizens—were less likely than U.S.-born peers to report their health as fair or poor. At the same time, noncitizen older adults experienced greater obstacles to care:
- Lower insurance coverage rates relative to U.S.-born adults.
- Higher likelihood of going a year without seeing a doctor.
- Greater probability of lacking a regular source of care.
- Increased worry about paying medical bills if they fell ill or were injured.
“One of the most striking findings is that many older immigrants appear to maintain relatively good health despite facing significant barriers to care,”
said Darrell Gaskin, the study's lead author and a professor in the Bloomberg School’s Department of Health Policy and Management.
What the results mean
The juxtaposition of comparatively favorable self-reported health and pronounced access challenges raises concerns about long-term outcomes. Preventive care and early management of chronic conditions often depend on regular contact with clinicians and reliable insurance coverage. Researchers warn that lacking these resources may hinder the ability to detect and treat emerging health problems as people age.
Study authors note the analysis did not separate undocumented immigrants from lawfully present noncitizens. That distinction matters because federal eligibility for programs such as Medicaid and Marketplace subsidies has historically differed by immigration status and length of U.S. residency. The paper also referred to policy shifts through July 2025 that changed access for some lawfully present immigrants, but it did not assign outcomes to specific legal categories within the noncitizen group.
Policy and clinical implications
Public health experts and providers say the findings underscore two separate issues: the need to preserve and expand access to routine care for older adults regardless of origin, and the importance of addressing financial insecurity tied to medical costs. For policymakers, the analysis provides evidence that gaps in insurance and primary care access disproportionately affect noncitizen older adults—gaps that could translate into higher emergency care use and delayed diagnoses over time.
The researchers emphasize caution in interpreting the healthier self-reports among some immigrant groups. Self-rated health can reflect cultural perceptions, selection effects among migrants, or differences in expectations about aging. Still, the team argues, sustained barriers to care and coverage could erode those advantages.
Summary table
| Group | Self-reported fair/poor health (relative) | Insurance & access (relative) |
|---|---|---|
| U.S.-born adults | Reference | Reference |
| Foreign-born citizens | Less likely to report fair/poor health | Some access gaps vs. U.S.-born |
| Foreign-born noncitizens | Less likely to report fair/poor health | Lower insurance, less regular care, more worry about bills |
The study contributes to an evolving conversation about health equity for older adults. It points to a persistent disconnect: many older immigrants report better-than-expected health even as structural and financial barriers limit their use of primary and preventive services. As federal and state policymakers weigh eligibility rules and program expansions, the analysis offers data that could inform decisions affecting older immigrants’ access to care.
Further research, the authors say, should aim to disaggregate noncitizen groups by legal status and examine how recent policy changes influence insurance coverage and access for older immigrants over time.
