258325 Does legal status predict health insurance coverage of U.S. immigrants over time?

Tuesday, October 30, 2012 : 1:00 PM - 1:15 PM

Arturo Vargas Bustamante, PhD , Department of Health Services, UCLA School of Public Health, Los Angeles, CA
Jie Chen, PhD , Department of Political Science, Economics, and Philosophy, College of Staten Island/City University of New York, Staten Island, NY
Hai Fang, PhD , Department of Health Systems, Management and Policy, University of Colorado, Denver, Colorado School of Public Health, Aurora, CO
John Rizzo, PhD , Department of Economics, Stony Brook University, Stony Brook, NY
Alexander Ortega, PhD , Institute for Survey Research and School of Public Health, Temple University, Philadelphia, PA
Background: Previous research shows that legal status is a predictor of health insurance coverage among immigrants. However, it does not account for the evolution of immigrant characteristics over time.

Objective: We investigate whether legal status is a stable health insurance predictor over time among U.S. foreign-born residents (18-65 years of age) to analyze the possible consequences of the Affordable Care Act (ACA) on immigrant assimilation.

Methods: Foreign-born individuals from California households who responded to the 2009 California Health Interview Survey. Health insurance status and the main reasons to remain uninsured are the key dependent variables. Health insurance coverage predictors are first compared over time and by documentation status. We implement logistic-regression analyses using a two-part multivariate model to adjust for confounding factors. We use the decomposition technique to implement a dynamic analysis between short (≤10 years) and long (>10 years) term resident immigrants.

Results: Our logistic-regression analyses show that legal status is a strong health insurance predictor, particularly among the undocumented. Immigration status is the main reported reason for lacking health insurance. In contrast, the results of the dynamic analysis that accounts for return migration and the evolution of observed and unobserved immigrant characteristics over time reveal that legal status is not a stable health insurance predictor.

Conclusions: While the exclusion of the undocumented from the ACA may have different consequences for the U.S. foreign-born population, our study shows that the ACA would be unlikely to change immigrant assimilation trends if present trends continue.

Learning Areas:
Communication and informatics
Diversity and culture
Public health or related public policy
Public health or related research

Learning Objectives:
Discuss the potential effect of the ACA eligibility criteria among the immigrant resident population analyzing whether legal status is currently a stable health insurance predictor over time.

Keywords: Immigrants, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a faculty associate and an assistant professor in UCLA’s School of Public Health. My expertise includes cross-border health care and health care disparities among Latinos. My research into disparities focuses on groups – primarily Latinos – that are overwhelmingly uninsured or that have poor access to health care. My research has direct policy applications since it estimates the share of disparities related to socio-economic and demographic factors.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4198.0: The Affordable Care Act implementation: implications for immigrant and refugee