Left out: Immigrants' access to health care and insurance

Health Affairs

Volumn 20, Issue 1, 2001, Pages 247-256

  Ku, Leighton ^a   Matani, Sheetal ^b  

^a Center on Budget and Policy Priorities   (United States)

^b URBAN INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; CHILD; EMPIRICAL APPROACH; EPIDEMIOLOGY; ETHNIC GROUP; FAMILY HEALTH; HEALTH CARE AND PUBLIC HEALTH; HEALTH CARE DELIVERY; HUMAN; INSURANCE; MEDICAID; MIGRATION; PATIENT; POVERTY; STATISTICS; UNITED STATES;

EMPIRICAL APPROACH; HEALTH CARE AND PUBLIC HEALTH;

ADULT; CHILD; EMIGRATION AND IMMIGRATION; ETHNIC GROUPS; FAMILY HEALTH; HEALTH CARE SURVEYS; HEALTH SERVICES ACCESSIBILITY; HUMANS; INSURANCE COVERAGE; MEDICAID; MEDICALLY UNINSURED; POVERTY; UNITED STATES;

EID: 0035220130     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.20.1.247     Document Type: Article

References (27)

1. U.S. Commission on Civil Rights, The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality: Vol. 1, The Role of Governmental and Private Health Care Programs and Initiatives (Washington: U.S. Commission on Civil Rights, 1999); and K. Quinn, Working without Benefits: The Health Insurance Crisis Facing Hispanic Americans (Cambridge, Mass.: Abt Associates, 2000).
2. U.S. Commission on Civil Rights, The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality: Vol. 1, The Role of Governmental and Private Health Care Programs and Initiatives (Washington: U.S. Commission on Civil Rights, 1999); and K. Quinn, Working without Benefits: The Health Insurance Crisis Facing Hispanic Americans (Cambridge, Mass.: Abt Associates, 2000).
3. Kaiser Commission on Medicaid and the Uninsured, Immigrants' Health Care: Coverage and Access (Washington: Kaiser Family Foundation, August 2000).
4. Under PRWORA, refugees and asylees can receive Medicaid for their first seven years in the country, while other legal permanent residents (the most common legal immigration category) who entered the United States after August 1996 are barred from full Medicaid eligibility for their first five years. Other provisions, such as that the income of sponsors be "deemed available" to immigrants in determining income eligibility, will probably keep most legal permanent residents ineligible even after the five-year bar expires. Undocumented (or illegal) aliens have long been barred from full eligibility.
5. M.L Berk et al., "Health Care Use among Undocumented Latino Immigrants," Health Affairs (July/Aug 2000): 51-64; and C. Schlosberg and D. Wiley, The Impact of INS Public Charge Determinations on Immigrant Access to Health Care (Washington: National Health Law Program and National Immigration Law Center, May 1998).
6. M.L Berk et al., "Health Care Use among Undocumented Latino Immigrants," Health Affairs (July/Aug 2000): 51-64; and C. Schlosberg and D. Wiley, The Impact of INS Public Charge Determinations on Immigrant Access to Health Care (Washington: National Health Law Program and National Immigration Law Center, May 1998).
7. Private insurance coverage (not shown) stayed about the same throughout the period, about 25 percent for noncitizens and 36 percent for the overall lowincome population.
8. W. Zimmerman and M. Fix, Declining Immigrant Applications for Medi-Cal and Welfare Benefits in Los Angeles County (Washington: Urban Institute, July 1998); E.R. Brown, R. Wyn, and V. Ojeda, Access to Health Insurance and Health Care for Children in Immigrant Families (Los Angeles: UCLA Center for Health Policy Research, June 1999); and M. Fix and J. Passel, Trends in Noncitizens' and Citizens' Use of Public Benefits Following Welfare Reform: 1994-97 (Washington: Urban Institute, March 1999).
9. W. Zimmerman and M. Fix, Declining Immigrant Applications for Medi-Cal and Welfare Benefits in Los Angeles County (Washington: Urban Institute, July 1998); E.R. Brown, R. Wyn, and V. Ojeda, Access to Health Insurance and Health Care for Children in Immigrant Families (Los Angeles: UCLA Center for Health Policy Research, June 1999); and M. Fix and J. Passel, Trends in Noncitizens' and Citizens' Use of Public Benefits Following Welfare Reform: 1994-97 (Washington: Urban Institute, March 1999).
10. W. Zimmerman and M. Fix, Declining Immigrant Applications for Medi-Cal and Welfare Benefits in Los Angeles County (Washington: Urban Institute, July 1998); E.R. Brown, R. Wyn, and V. Ojeda, Access to Health Insurance and Health Care for Children in Immigrant Families (Los Angeles: UCLA Center for Health Policy Research, June 1999); and M. Fix and J. Passel, Trends in Noncitizens' and Citizens' Use of Public Benefits Following Welfare Reform: 1994-97 (Washington: Urban Institute, March 1999).
11. Unpublished analyses of the Current Population Survey by Jeff Passel of the Urban Institute.
12. P. Brick et al., Survey Methods and Data Reliability, Report no. 1, NS AF Methodology Reports (Washington: Urban Institute, July 1999). NSAF was designed by staff of the Urban Institute and Child Trends and was conducted by Westat. More complete information about the survey, including methods and many data analyses, are at «newfederalism.urban.org/nsaf/cpuf/index.htm» (17 August 2000).
13. K. Rust and J.N.K. Rao, "Variance Estimation for Complex Surveys Using Replication Techniques," Statistical Methods in Medical Research 5, no. 3 (1996): 282-310.
14. For more detailed results, see L. Ku and S. Matani, "Immigrants' Access to Health Care and Insurance on the Cusp of Welfare Reform," Assessing the New Federalism Discussion Paper no. 00-03 (Washington: Urban Institute, June 2000).
15. In this paper, insurance groups are not mutually exclusive; a few have both Medicaid and job-based insurance.
16. S. Camarota and J. Edwards, Without Coverage: Immigration's Impact on the Size and Growth of the Population Lacking Health Insurance (Washington: Center for Immigration Studies, July 2000).
17. Models for both adults and children include the following as control variables: race/Hispanic ethnicity, age, sex, income (family income as a percentage of poverty and a dummy variable for those under 200 percent of poverty), self-reported health status (fair/poor, excellent/very good/good), the interaction of Hispanic and health status, and state of residence (thirteen NSAF states and the rest of the nation). Models for adults also include respondent's employment (full time, part time, none), educational level (less than high school, high school graduate, college graduate), family status (married with children, married without children, single with children, single without children), and having a health condition that limits work. The models for children also include parental employment (full time, part time, none), parental education (below high school, high school graduate, college graduate), and family structure (single- versus two-parent family). In models where health care use is the dependent variable, we also include insurance status variables.
18. S. Shetterly et al., "Self-Rated Health among Hispanic vs. Non-Hispanic White Adults: The San Luis Valley Health and Aging Study," American Journal of Public Health 86, no. 12 (1996): 1798-1801; and M. Weigers and S. Drilea, Health Status and Limitations: A Comparison of Hispanics, Blacks, and Whites, 1996, MEPS Research Findings no. 10, AHCPR Pub. no. 00-0001 (Rockville, Md.: Agency for Health Care Policy and Research, 1999).
19. S. Shetterly et al., "Self-Rated Health among Hispanic vs. Non-Hispanic White Adults: The San Luis Valley Health and Aging Study," American Journal of Public Health 86, no. 12 (1996): 1798-1801; and M. Weigers and S. Drilea, Health Status and Limitations: A Comparison of Hispanics, Blacks, and Whites, 1996, MEPS Research Findings no. 10, AHCPR Pub. no. 00-0001 (Rockville, Md.: Agency for Health Care Policy and Research, 1999).
20. The general variable for poor health status had a large positive effect on access and utilization, but the interaction of Hispanic and poor health status was significant and negative.
21. We also tested interactions of immigrant status and insurance coverage variables on access and utilization. Most of the interactions were not significant, and in the few cases where they were significant, they did not alter the general direction of findings. Because of the concerns that insurance coverage is affected by immigrant status and might be subject to endogeneity bias, we also tested models without the insurance variables. When insurance was not included, the magnitudes of the gaps between noncitizens and native citizens were slightly larger and still significant, so the effect is robust.
22. Brown et al., Access to Health Insurance and Health Care.
23. L. Ku and B. Kessler, The Number and Cost of Immigrants on Medicaid: National and State Estimates (Washington: Urban Institute, December 1997).
24. F. Leclere, L. Jensen, and A. Biddlecom, "Health Care Utilization, Family Context, and Adaptation among Immigrants to the United States," Journal of Health and Social Behavior 35, no. 4 (1994): 370-384.
25. Only 5 percent of the foreign-born adults in NSAF entered the United States in 1996 or 1997, indicating that very few should have been ineligible for Medicaid in light of the federal welfare reform changes. Even so, some of the pre-1996 entrants may have avoided Medicaid participation because of confusion about their eligibility status.
26. E.R. Brown, T. Rice, and L. Lara, "Access to Job-Based Insurance: Why Are So Many California Employees Uninsured?" (Presented at the Association for Health Services Research annual meeting, Los Angeles, 25 June 2000).
27. G. Flores et al., "Access Barriers to Health Care for Latino Children," Archives of Pediatric and Adolescent Medicine 152, no. 11 (1998): 1119-1125.