Immigrants and the Affordable Care Act: Changes in Coverage and Access to Care by Documentation Status
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ORIGINAL PAPER
Immigrants and the Affordable Care Act: Changes in Coverage and Access to Care by Documentation Status Thalia Porteny1 · Ninez Ponce2 · Benjamin D. Sommers3 Accepted: 17 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Little is known about the effects of the ACA’s coverage expansion among immigrant groups of differing immigration status. Using data from the California Health Interview Survey (2003–2016), we compare changes in health coverage and access to care among immigrants in California before and after implementation of the ACA. We find that the ACA has led to major gains in coverage for lawful permanent residents in California, similar in scope to changes among citizens. However, unauthorized immigrants have experienced only modest increases in coverage, with the result disparity in uninsured rates for this group relative to citizens and permanent residents widening considerably since 2014. Findings indicate a significant increase in having a usual source of care across all groups, but without a significant change in disparities for this outcome. Our results have important implications for the intersection of health policy, immigration, and health equity. Keywords Immigrants · Immigration status · ACA · Access to care · Coverage
Background In the U.S., a foreign-born individual’s immigration status is a key determinant of health insurance options, which in turn facilitates access to health care [1, 2]. The relationship between immigration status, coverage, and access has been difficult to study because there are limitations in data availability for ascertaining immigration status in the U.S. population [3]. Yet, unauthorized status is widely recognized as a major barrier to attaining health coverage and care [3–7]. Meanwhile, under the Affordable Care Act (ACA), incomeeligible lawful permanent residents (LPRs) or “green card holders” are eligible for subsidized insurance either via Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10903-020-01124-0) contains supplementary material, which is available to authorized users. * Thalia Porteny [email protected] 1
REACH Lab, Department of Occupational Therapy, Tufts University, 574 Boston Avenue, Medford, MA 02155, USA
2
Center for Health Policy Research, University of California, Los Angeles, Los Angles, CA, USA
3
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, USA
Medicaid expansion (if they have been LPRs for at least 5 years) or Marketplace coverage [8]. More than 30 states have expanded Medicaid, which is available to LPR’s who meet income criteria and have been legal residents for at least 5 years. While most states expanded Medicaid in 2014, some states including California—home to the nation’s largest foreign-born population— used a federal Medicaid waiver and expanded earlier. California’s early expansion was approved in November 2010 and coverage began to take effect in some
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