For many immigrants in New Jersey, the challenge of accessing medical care is twofold: for some, health insurance is out of reach entirely; for others, having coverage does not guarantee they can afford care, find a provider, or get to an appointment. In the U.S., about 47 million immigrants (14% of the total population) live across the country[1], and around 13.7 million of these immigrants are estimated to be undocumented[2]. In New Jersey, the share is even higher, with over 2 million immigrants[3] making up nearly one-quarter of the state’s residents.
Primary care is one of the most important building blocks for a healthy population. It prevents illness, catches conditions early, and reduces costly emergency room visits. However, many immigrants, especially those with low incomes, face significant barriers to accessing and utilizing primary care. It is therefore crucial for policymakers in New Jersey and across the U.S. to address this ongoing issue.
Since the implementation of the Affordable Care Act (ACA) in 2014, uninsured rates among immigrants have dropped significantly; for instance, non-citizens’ rates decreased from 48% in 2010 to 31% in 2019[4]. However, coverage gains have not translated into equal access or use of healthcare. Compared to U.S.-born citizens, non-citizen immigrants face legal exclusions from public insurance programs. For instance, a Kaiser Family Foundation survey revealed that half of undocumented immigrants in the U.S. are uninsured, compared to 18% of lawfully present immigrants and 8% of U.S.-born citizens[5]. Even lawfully present immigrants who qualify for public insurance can often face a five-year wait period before enrolling. As a result, many immigrants go without care or rely on costly private insurance. In addition, those with coverage face high premiums and deductibles, making routine check-ups a difficult financial decision.
Transportation is another major barrier to primary care utilization among immigrants. Studies have shown that a lack of access to a personal vehicle and or limited access to public transit can prevent immigrant women from seeking preventive screening services, which in turn delays timely diagnosis[6][7]. The consequences of transportation barriers extend beyond preventive care; they also emerge in the experiences of immigrant families with children who have complex medical needs. For example, a study revealed that undocumented Latino caregivers who lacked a driver’s license faced challenges transporting their children with medical complexities to their appointments[8]. While New Jersey offers Non-Emergency Medical Transportation (NEMT) for Medicaid beneficiaries, users have reported delayed pick-ups, missed rides, and a complicated enrollment process, particularly among those with limited English proficiency8[9][10].
These insurance and transportation barriers often work hand in hand with another challenge: navigating the healthcare system itself. For immigrants unfamiliar with U.S. insurance requirements or those who face language barriers, completing applications, scheduling appointments, and understanding coverage limitations can be overwhelming, particularly when coupled with the fear of deportation or the consequences of being labelled as a public charge. This can leave people technically “insured” but practically disconnected from care.
New Jersey has made notable progress in addressing these issues. The state has expanded Medicaid to cover all children regardless of status, created programs for undocumented pregnant women, and offered state premium subsidies through GetCoveredNJ. Yet other states have gone further. Oregon, for example, has implemented a state-funded health insurance program for all low-income residents regardless of immigration status, and MetroPlan Orlando in Florida integrates health equity goals in its transportation planning.
To truly close the gap between coverage and care, New Jersey will need to expand affordable health insurance options for all immigrant adults, integrate health equity into transportation planning, and remove barriers to NEMT services.
References:
[1] U.S. Census Bureau. (2023). Selected characteristics of the foreign-born population by period of entry into the United States (American Community Survey 1-Year Estimates Subject Tables; Table S0502). Retrieved July 28, 2025, from https://data.census.gov/table/ACSST1Y2023.S0502
[2] Waldrop, T. (2025, February 27). Improving Affordability and Advancing Health Equity for Immigrants. The Century Foundation. https://tcf.org/content/report/improving-affordability-and-advancing-health-equity-for-immigrants/
[3] Department of Health, State of New Jersey. (2025). Foreign-born residents by year, New Jersey and the United States [Indicator report]. NJ State Health Assessment Data. Retrieved July 28, 2025, from https://www-doh.nj.gov/doh-shad/indicator/view/Dem_Nat.Trend.html
[4] Vargas Bustamante, A., Chen, J., McKenna, R. M., & Ortega, A. N. (2019). Health Care Access and Utilization Among U.S. Immigrants Before and After the Affordable Care Act. Journal of Immigrant and Minority Health, 21(2), 211–218. https://doi.org/10.1007/s10903-018-0741-6
[5] Drishti Pillai, Samantha Artiga, Liz Hamel, Shannon Schumacher, Ashley Kirzinger, Marley Presiado, & Audrey Kearney. (2023, September 17). Health and health care experiences of immigrants: The 2023 KFF/LA Times survey of immigrants. Kaiser Family Foundation. Updated February 14, 2024. Retrieved July 25, 2025, from https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-and-health-care-experiences-of-immigrants-the-2023-kff-la-times-survey-of-immigrants/
[6] Amuta-Jimenez, A., Sokale, I., & Reitzel, L. (2023). Barriers to cervical cancer screening among Sub-Saharan African immigrant women in the United States: A qualitative report. Health Behavior and Policy Review, 10(5), 1368–1375. https://doi.org/10.14485/hbpr.10.5.1
[7] Savage, L. C., Minardi, F., Miller, S. J., Jandorf, L. H., Erblich, J., Margolies, L. R., Konte, H., & Sly, J. R. (2025). Identifying Frequently Endorsed Benefits and Barriers to Breast Cancer Screening for African-Born Women in the NYC Metropolitan Area: A Pilot Study. Journal of Racial and Ethnic Health Disparities, 12(1), 212–221. https://doi.org/10.1007/s40615-023-01865-2
[8] Nageswaran, S., Rosado, A. I., & Beveridge, M. S. (2018). Challenges Faced by Latino Caregivers in Transportation of Children with Medical Complexity. North Carolina Medical Journal, 79(6), 358–364. https://doi.org/10.18043/ncm.79.6.358
[9] Ganuza, A., & Davis, R. (2017). Disruptive Innovation in Medicaid Non-Emergency Transportation. Center for Health Care Strategies, Inc. www.chcs.org
Hall, E., & Cuellar, N. G. (2016). Immigrant Health in the United States: A Trajectory Toward Change. Journal of Transcultural Nursing, 27(6), 611–626. https://doi.org/10.1177/1043659616672534
[10] Center for Health Law Policy Innovation of Harvard Law School & Lung Cancer Alliance (2018). Nonemergency Medical Transportation: Past, Present, and Futyre of a Critical Service. JAMA, 316(9), 921. https://doi.org/10.1001/jama.2016.9970