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Health Care Access and Utilization Among U.S. Immigrants Before and After the Affordable Care Act

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Abstract

We examine changes in health insurance coverage and access to and utilization of health care before and after the national implementation of the Patient Protection and Affordable Care Act (ACA) among the U.S. adult immigrant population. Data from the 2011–2016 National Health Interview Survey are used to compare adult respondents in 2011–2013 (before the ACA implementation) and 2014–2016 (after the ACA implementation). Multivariable logistic regression analyses are used to compare changes over time. This study shows that the ACA has closed the coverage gap that previously existed between U.S. citizens and non-citizen immigrants. We find that naturalized citizens, non-citizens with more than 5 years of U.S. residency, and non-citizens with 5 years or less of U.S. residency reduced their probability of being uninsured by 5.81, 9.13, and 8.23%, respectively, in the first 3 years of the ACA. Improvements in other measures of access and utilization were also observed.

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Fig. 1

Source 2011–2016 National Health Interview Survey. Notes: “Before” corresponds to mean values for years 2011–2013, period before the implementation of the ACA individual health insurance mandate. “After” corresponds to mean values for years 2014–2016, period after the implementation of the ACA individual health insurance mandate. Vertical axis corresponds to percentage point changes. Horizontal axis describes the study variables

Fig. 2

Source 2011–2016 National Health Interview Survey. Notes: Marginal effect shows percentage changes in 2014–2016 compared to the 2011–2014 period. Vertical axis corresponds to percentage point changes. Horizontal axis describes the U.S. immigrant categories

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References

  1. The Uninsured: An Interactive Tool. 2014. http://kff.org/interactive/the-uninsured-an-interactive-tool/. Accessed 14 Aug 2014.

  2. Prevention CfDCa. Health insuance coverage: early release of estimtates from the National Health Interview Survey. Washington: U.S. Department of Health and Human Services; 2014.

    Google Scholar 

  3. Chen J, Vargas-Bustamante A, Mortensen K, Ortega AN. Racial and Ethnic disparities in health care access and utilization under the Affordable Care Act. Med Care. 2016;54(2):140–6.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chen J, Bustamante AV, Tom SE. Health care spending and utilization by race/ethnicity under the Affordable Care Act’s dependent coverage expansion. Am J Public Health. 2015;105(Suppl 3):S499-507.

    PubMed  Google Scholar 

  5. Sommers BD, Gunja MZ, Finegold K, Musco T. Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. JAMA. 2015;314(4):366–74.

    Article  CAS  PubMed  Google Scholar 

  6. Cutler DM. From the Affordable Care Act to affordable care. JAMA. 2015;314(4):337–8.

    Article  CAS  PubMed  Google Scholar 

  7. Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002;40(1):52–9.

    Article  PubMed  Google Scholar 

  8. Alegria M, Canino G, Rios R, Vera M, Calderon J, Rusch D, et al. Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatr Serv. 2002;53(12):1547–55.

    Article  PubMed  Google Scholar 

  9. Waidmann TA, Rajan S. Race and ethnic disparities in health care access and utilization: an examination of state variation. Med Care Res Rev. 2000;57(Suppl 1):55–84.

    Article  PubMed  Google Scholar 

  10. Weinick RM, Zuvekas SH, Cohen JW. Racial and ethnic differences in access to and use of health care services, 1977 to 1996. Med Care Res Rev. 2000;57(Suppl 1):36–54.

    Article  PubMed  Google Scholar 

  11. Uninsured KCoMat. Key facts on health coverage for low-income immigrants today and under the Affordable Care Act, Washington; 2013.

  12. Kaiser Commision on Medicaid and the Uninsured. Summary of New Health Reform Law. Kaiser Family Foundation; 2010.

  13. CBO. The impact of unauthorized immigrants on the budgets of state and local governments. Washington: Congressional Budget Office; 2007.

    Google Scholar 

  14. Zuckerman S, Waidmann TA, Lawton E. Undocumented immigrants, left out of health reform, likely to continue to grow as share of the uninsured. Health Aff. 2011;30(10):1997–2004.

    Article  Google Scholar 

  15. Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974;9(3):208–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.

    Article  CAS  PubMed  Google Scholar 

  17. Ortega AN, Rodriguez HP, Vargas Bustamante A. Policy dilemmas in latino health care and implementation of the Affordable Care Act. Annu Rev Public Health. 2015;36:525–44.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Vargas Bustamante A, Chen J, Fang H, Rizzo JA, Ortega AN. Identifying health insurance predictors and the main reported reasons for being uninsured among US immigrants by legal authorization status. Int J Health Plan Manag. 2014;29(1):e83–96.

    Article  Google Scholar 

  19. Vargas Bustamante A, Fang H, Garza J, Carter-Pokras O, Wallace SP, Rizzo JA, et al. Variations in healthcare access and utilization among Mexican immigrants: the role of documentation status. J Immigr Minor Health. 2012;14(1):146–55.

    Article  PubMed  Google Scholar 

  20. Gee EM, Kobayashi KM, Prus SG. Examining the healthy immigrant effect in mid- to later life: findings from the Canadian Community Health Survey. Can J Aging. 2004;23(Suppl 1):S61–9.

    PubMed  Google Scholar 

  21. Gushulak B. Healthier on arrival? Further insight into the “healthy immigrant effect”. CMAJ. 2007;176(10):1439–40.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Nolan A. The ‘healthy immigrant’ effect: initial evidence for Ireland. Health Econ Policy Law.1–20.

  23. Bustamante AV, Chen J. Health expenditure dynamics and years of U.S. residence: analyzing spending disparities among Latinos by citizenship/nativity status. Health Serv Res. 2012;47(2):794–818.

    Article  PubMed  Google Scholar 

  24. McDonald JT, Kennedy S. Insights into the ‘healthy immigrant effect’: health status and health service use of immigrants to Canada. Soc Sci Med. 2004;59(8):1613–27.

    Article  PubMed  Google Scholar 

  25. National Health Interview Survey [Internet]. National Center for Health Statistics, Centers for Disease Control and Prevention. 2016 [cited 8/09].

  26. Chen J, Vargas-Bustamante A, Novak P. Reducing young adults’ health care spending through the ACA expansion of dependent coverage. Health Serv Res. 2016;52(5):1835–57

    Article  PubMed  PubMed Central  Google Scholar 

  27. Karaca-Mandic P, Norton EC, Dowd B. Interaction terms in nonlinear models. Health Serv Res. 2012;47(1 Pt 1):255–274.

    Article  PubMed  Google Scholar 

  28. Krogstad JM, Passel JS, Cohn DV. Five facts about illegal immigration in the U.S. Washington: Pew Research Center; 2016

    Google Scholar 

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Funding

P30-AG021684 & UL1-TR000124 and 1R01MD011523-01.

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Authors and Affiliations

  1. Department of Health Policy & Management, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South Room 31-299C, Box 951772, Los Angeles, CA, 90095, USA

    Arturo Vargas Bustamante

  2. Department of Health Services Administration, University of Maryland, College Park, 3310A School of Public Health Building, College Park, MD, 20742-2611, USA

    Jie Chen

  3. Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Nesbitt Hall, Room 357, 3215 Market Street, Philadelphia, PA, 19104, USA

    Ryan M. McKenna

  4. Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market St Nesbitt Hall, Room 335, Philadelphia, PA, 19104, USA

    Alexander N. Ortega

Authors
  1. Arturo Vargas Bustamante
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  2. Jie Chen
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  3. Ryan M. McKenna
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  4. Alexander N. Ortega
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Contributions

AVB—study design, development and implementation of methods, data analysis, manuscript preparation. JC—study design, development and implementation of methdos, data analysis, and manuscript editing. RMM—Study design, manuscript editing. ANO—Manuscript editing.

Corresponding author

Correspondence to Arturo Vargas Bustamante.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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Bustamante, A.V., Chen, J., McKenna, R.M. et al. Health Care Access and Utilization Among U.S. Immigrants Before and After the Affordable Care Act. J Immigrant Minority Health 21, 211–218 (2019). https://doi.org/10.1007/s10903-018-0741-6

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  • DOI: https://doi.org/10.1007/s10903-018-0741-6

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