Employment Among Immigrants and Implications for Health and Health Care

Introduction

Immigrants are an integral part of our nation, including our nation’s workforce. Immigrants support the U.S. economy and its workforce by filling unmet labor market needs, especially in industries such as construction and agriculture that are at increased risk of adverse health outcomes and injuries, including climate-related health hazards.^1,2 Through entrepreneurship and establishment of businesses, immigrants also create jobs that generate employment for other U.S. residents, including U.S.-born citizens.³ However, their employment patterns contribute to them having higher uninsured rates and facing increased health risks relative to their U.S.-born peers.⁴ While their employment patterns, in part, reflect lower educational attainment levels and skills among immigrant workers versus U.S.-born workers, research and data suggest that some immigrant workers may be overqualified for their jobs—that is having education or skills beyond what is necessary for their job.^5,6 Addressing this occupational mismatch could help reduce disparities in health and health care faced by immigrant families and positively benefit the U.S. economy.

This brief examines socioeconomic characteristics and employment patterns among immigrant workers and examines how they compare to U.S.-born workers, including differences among college-educated workers. It discusses the implications of these patterns for their health and well-being as well as the nation’s economy. It is based on KFF analysis of the 2022 Current Population Survey Annual Social and Economic Supplement. The analysis is limited to nonelderly adult workers between ages 19-64 who are employed either full-time or part-time in the U.S. labor force. All differences between U.S.-born and immigrant workers described in the text are statistically significant at the p<0.05 level. In sum, it finds:

• In 2021, there were 27 million immigrants employed in the labor force, making up close to one in five (17%) nonelderly adult workers (ages 19-64) in the U.S. The share of nonelderly adults who were employed was similar across U.S.-born citizens (78%), naturalized citizens (79%), and noncitizens in the U.S. for five or more years (76%), while it was 63% among recent noncitizens (in the U.S. for less than five years). Compared to their U.S.-born counterparts, nonelderly adult immigrant workers were more likely to be Hispanic or Asian, were younger, and had lower levels of educational attainment.
• Among nonelderly adults, noncitizen workers were more likely than citizen workers to be employed in construction, agricultural, and service jobs. While some of these differences in occupation patterns likely reflect lower educational levels and skills among immigrant workers, differences in occupations persisted among college-educated workers. One in ten noncitizen workers with a college degree were employed in service jobs, compared with 6% of their U.S.-born peers. College-educated noncitizen workers were also more likely than their citizen counterparts to be employed in construction and transportation jobs.
• Reflecting these differences in employment patterns, noncitizen workers were more likely than citizen workers to be low-income and uninsured, even among those with college degrees. Roughly one in three noncitizen workers was low-income (below 200% of the federal poverty level (FPL)), compared with 15% of U.S.-born workers. In addition, over three in ten nonelderly adult noncitizen workers lacked health insurance, over three times higher than the uninsured rate of their citizen counterparts, reflecting lower rates of private coverage. Incomes and coverage rates were higher among college-educated workers across citizenship statuses, but, among college-educated nonelderly adult workers, noncitizens still were more likely to be low-income and uninsured than their citizen counterparts.

Immigrant Worker Characteristics

In 2021, there were 27 million immigrants employed in the labor force, making up close to one in five (17%) nonelderly adult workers in the U.S. Roughly 8% of nonelderly workers were naturalized citizens and 9% were noncitizens, the majority of whom had been in the U.S. for five or more years (Figure 1). The share of nonelderly adults (ages 19-64) who were employed on either a full- or part-time basis was similar across U.S.-born citizens (78%), naturalized citizens (79%), and noncitizens in the U.S. for five or more years (76%), while it was 63% among recent noncitizens.

Compared to their U.S.-born counterparts, nonelderly adult immigrant workers were more likely to be Hispanic or Asian, were younger, and had lower levels of educational attainment (Figure 2).

• Among nonelderly adult workers, both naturalized citizens and noncitizen immigrants included higher shares of Hispanic and Asian adults compared to U.S.-born citizens, although the shares varied by citizenship status and length of time in the country. Over six in ten (62%) of noncitizen nonelderly adult workers in the U.S. for five years or more were Hispanic, while one in three (31%) naturalized citizens were Asian. Among more recent nonelderly noncitizen adult workers in the U.S. for less than five years, over half were Hispanic (53%) and one in five (21%) were Asian.
• Recent noncitizen nonelderly adult workers had the largest share of younger workers, with over half (55%) between 19 and 34 years of age, while those who had been in the country for five or more years and naturalized citizens had the largest share of workers between ages 35-54 (57%). Naturalized citizen nonelderly adult workers were older compared to their U.S.-born and noncitizen counterparts, with a quarter between ages 55-64.
• Roughly a quarter of noncitizen nonelderly adult workers had less than a high school education, compared to just 3% of their U.S.-born peers. However, similar proportions of nonelderly adult U.S.-born citizens (41%), naturalized citizens (47%), and recent noncitizens (44%) in the labor force had a bachelor’s degree or higher. In contrast, less than three in ten nonelderly adult noncitizen workers in the country for at least five years (29%) had at least a college degree. Research shows that an increasing number of immigrants who arrived in the U.S. in the last five years have a college degree, driven largely by an increase in the share of high-skilled immigrants arriving from Asian countries.⁷

Occupations Among Immigrant Workers

Among nonelderly adults, noncitizen workers were more likely than citizen workers to be employed in construction, agricultural, and service jobs. Noncitizen workers were nearly three times as likely to be employed in construction jobs compared to naturalized and U.S. born citizen workers (14% vs. 5% and 4%, respectively) (Figure 3). Moreover, one in four (25%) noncitizen workers was employed in service jobs, such as food preparation and health care support, compared with 18% of naturalized citizen and 15% of U.S.-born citizen workers. Small shares of workers were employed in agriculture across citizenship statuses, but noncitizen workers were slightly more likely to be employed in these jobs than their citizen counterparts (2% vs. less than 1%), and they accounted for 18% of all agricultural workers. They also were more likely to be employed in production and transportation jobs compared with their citizen counterparts. Occupation patterns among naturalized citizen workers were more similar to U.S.-born citizen workers, although they were more likely than their U.S.-born peers to be employed in service jobs.

While some of these differences in occupation patterns likely reflect lower educational levels and skills among immigrant workers compared with U.S.-born workers, differences in occupations persisted among workers with a college degree. Among nonelderly adult workers with a bachelor’s degree or higher, nearly half of workers were employed in professional occupations, such as accounting, engineering, and legal services, across citizenship statuses. However, one in ten noncitizen workers with a bachelor’s degree or higher were employed in service jobs such as food preparation and health care support, compared with 6% and 7% of their U.S.-born and naturalized citizen peers (Figure 4). College-educated noncitizen workers were also more likely than their citizen counterparts to be employed in construction and transportation jobs. There were no significant differences in employment in these occupations between naturalized and U.S.-born college-educated workers, although naturalized citizens were less likely than U.S-born citizens to be in management occupations (26% vs. 29%).

Income and Health Coverage among Immigrant Workers

Reflecting these differences in employment patterns, noncitizen workers were more likely than citizen workers to be low-income (income below 200% of the FPL). Nearly one in three (31%) noncitizen workers in the country for five or more years was low-income, including one in ten (9%) who had incomes below poverty (Figure 5). This share was 38% among recent noncitizen workers in the country for less than five years, including 16% with incomes below the poverty level. In contrast, 15% of U.S.-born workers were low-income, with 4% having incomes below poverty.

Incomes were higher among college-educated workers across citizenship statuses, but, among college-educated nonelderly adult workers, noncitizens were still more likely to be low-income than their citizen counterparts. Over one in ten (11%) college-educated noncitizen workers in the country for five or more years were low-income, with this share rising to 24% among college-educated recent noncitizen workers, including 10% who had incomes below the poverty level (Figure 5). In contrast, 5% of college-educated U.S.-born citizen workers were low-income, with just 1% having income below poverty.

Noncitizen nonelderly adult workers were also more likely than their citizen counterparts to be uninsured, even among those with college educations (Figure 6). Over three in ten nonelderly adult noncitizen workers lacked health insurance, over three times higher than the uninsured rate of their citizen counterparts, reflecting lower rates of private coverage among these workers. While uninsured rates were lower among college-educated workers across citizenship statuses, these differences between citizens and noncitizens persisted. Among college educated nonelderly adult workers, noncitizens were more four times as likely to lack health coverage than U.S.-born workers, with more than one in ten uninsured compared with 3% of their U.S.-born peers. This share rose to 13% among recent noncitizen workers with a college education. Medicaid coverage does not fully offset the larger gaps in private coverage for noncitizen workers, likely reflecting Medicaid eligibility restrictions for noncitizen immigrants, particularly those in the country for less than five years and for those who are undocumented, who are ineligible for any federal coverage options.⁸

Implications for Immigrant Health and the U.S. Workforce

Noncitizen immigrant workers are disproportionately employed in occupations with lower wages that often do not offer employer-sponsored health coverage, contributing to higher poverty and uninsured rates. The occupations in which noncitizen immigrant workers are disproportionately employed, such as service, farming, and construction jobs, also have higher adverse health risks including but not limited to climate related health risks such as heat strokes and respiratory illnesses and workplace injuries.^9,10 Undocumented immigrant workers may face even greater employment challenges due to lack of work authorization, which increases risk of potential workplace abuses, violations of wage and hour laws, and poor working as well as living conditions.¹¹

While some noncitizen immigrants are in lower-wage higher risk jobs due to limited experience, skills, and lack of work authorization, others may be overqualified for their positions, contributing to negative implications for immigrant families and the overall U.S. economy. This analysis finds that disparities in employment, income, and health coverage for noncitizen workers persisted among college-educated workers, suggesting some were employed in jobs for which they may be overqualified. While language barriers and work eligibility restrictions may explain part of this employment pattern, other factors such as time since immigration, age, and cultural obstacles may also play a role. Research suggests that immigrants with limited English proficiency, those who earned degrees in a country outside the U.S., and those who are recent or first-generation immigrants are more likely to experience underutilization of skills in the workplace.¹² In addition, cultural barriers such as lack of familiarity with the U.S. labor market and lack of professional and social networks can also lead to this occupational mismatch. Beyond contributing to higher rates of poverty and uninsured rates among immigrants, this occupational mismatch can also have adverse impacts on mental health. Research suggests that working in jobs for which people may be overqualified can lead to lower rates of job as well as life satisfaction and declines in mental health.^13,14 A shortage of immigrant workers, including those who are college-educated, can also have a negative impact on productivity, job creation, and can consequently slow down economic growth.¹⁵ Moreover, the employment of overqualified immigrants in low-skilled jobs contributes to forgone earnings as well as tax revenues.

Actions to increase job opportunities for immigrants that fully utilize their skills could not only improve the health and well-being of immigrants but also support the economy by helping to address the country’s unmet labor market needs. Broadening pathways for migrants to enter the U.S. to fill gaps in the labor force, improving the processing of applications for work visas and work authorization, recognizing credentials for immigrant professionals, and investing in English language training for recent immigrants could benefit the U.S. economy by helping immigrants find jobs that are an appropriate match for their educational background and training.¹⁶, ¹⁷, ¹⁸ These actions could also support the U.S. economy by helping to fill gaps in industries experiencing the greatest shortage of workers. These include lower-skilled occupations such as manufacturing and food services, but also higher-skilled occupations such as health, professional, and business services, especially following the labor force disruptions that resulted from the COVID-19 pandemic.¹⁹ As the U.S. continues to experience workforce shortages, it is important to fully utilize the skills and potential of immigrants who form a growing share of the country’s labor market not only as workers but also as job creators.