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Immigrants and the Affordable Care Act: Changes in Coverage and Access to Care by Documentation Status

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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.

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Data Availability

The datasets generated during and/or analyzed during the current study are not publicly available due to there confidential nature around Californian residents’ immigration status but are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Joseph Viana for his excellent guidance on methods, developing and running of numerous rounds of code; the UCLA Center for Health Policy Research for their constant support; Margarita Alegria and Norman Daniels for their feedback on previous versions of the manuscript.

Funding

Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number T32MH1973323. This project was also supported by Grant Number T32HS000055 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. REACH Lab, Department of Occupational Therapy, Tufts University, 574 Boston Avenue, Medford, MA, 02155, USA

    Thalia Porteny

  2. Center for Health Policy Research, University of California, Los Angeles, Los Angles, CA, USA

    Ninez Ponce

  3. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, USA

    Benjamin D. Sommers

Authors
  1. Thalia Porteny
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  2. Ninez Ponce
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  3. Benjamin D. Sommers
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by TP under the supervision of BS with periodic input from NP. The first draft of the manuscript was written by TP with several rounds of revision from BS. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Thalia Porteny.

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The authors declare they have no competing interests.

Ethical Approval

The study has obtained Research Ethics Approval through University of California Los Angeles Review Board (IRB) IRB#16­001775. Harvard University IRB ceded review.

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Porteny, T., Ponce, N. & Sommers, B.D. Immigrants and the Affordable Care Act: Changes in Coverage and Access to Care by Documentation Status. J Immigrant Minority Health 24, 86–94 (2022). https://doi.org/10.1007/s10903-020-01124-0

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