The 131st Annual Meeting (November 15-19, 2003) of APHA

The 131st Annual Meeting (November 15-19, 2003) of APHA

4221.0: Tuesday, November 18, 2003 - 3:32 PM

Abstract #53449

Differences in health insurance transitions between immigrants and the native-born

Julia C Prentice, MSPH and Anne R Pebley, PhD. Dept. of Community Health Sciences, UCLA School of Public Health, University of California Los Angeles, Mail Box 951772, Los Angeles, CA 90095-1772, 310-825-1349,

Cross-sectional studies have reported large disparities in health insurance coverage between immigrants and the native born. Yet, immigration status has not been considered in longitudinal studies that examine the length of time people spend in an uninsured or insured state, and little is known about how long immigrants stay in a health insurance state compared to the native born. This paper examines health insurance transitions among citizens, non-citizens, undocumented immigrants and the native-born. Data from the Los Angeles Family and Neighborhood Survey (L.A.FANS), which interviewed approximately 3,000 adults in 65 census tracts in Los Angeles, was analyzed. The survey collected an event history calendar (EHC) for the two-year period preceding the interview that includes all changes in health insurance coverage, employment status and public assistance during this period. Detailed information on other individual characteristics, such as educational attainment, income, and the year respondents came to the United States, was also collected. Importantly, information not collected in most previous studies on legality status, including whether immigrants were undocumented, was recorded. Two binary logistic regressions predict the probability of moving onto health insurance during the two-year period among the uninsured and the probability of losing health insurance during this period among the insured. Both time invariant characteristics, such as education, and time-varying characteristics, such as employment status, are included in the models to assess which characteristics are most important for predicting health insurance transitions. Analyses indicate that immigration status has a significant effect on health insurance status. Among respondents who entered the two-year EHC uninsured, 84% of undocumented immigrants never gained health insurance compared to 79% of non-citizens, 73% of naturalized citizens and 57% of native-born respondents. In multivariate analyses that control for several socio-demographic characteristics, such as employment, undocumented immigrants have 71% lower odds and non-citizens have 53% lower odds of exiting an uninsured spell compared to the native-born. Among respondents who entered the two-year EHC insured, only 78% of undocumented immigrants remained on the same health insurance coverage throughout the two-year period compared to 84% of non-citizens, 89% of naturalized citizens and 84% of the native-born. Undocumented immigrants were over two times more likely to lose their health insurance compared to the native born in multivariate analyses. Effective policies that recognize the different health insurance coverage patterns among immigrants are needed to protect immigrants from health insurance loss.

Learning Objectives:

Keywords: Access Immigration, Health Insurance

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Access to Health Insurance (Health Services Research Contributed Papers #2)

The 131st Annual Meeting (November 15-19, 2003) of APHA