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Changes in Insurance Coverage and Healthcare Use Among Immigrants and US-Born Adults Following the Affordable Care Act

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Objectives

Immigrants to the USA have disparate access to health insurance coverage and healthcare services. We evaluate the effects of gaining insurance following the January 2014 Affordable Care Act’s (ACA) key provisions implementation on health services use among foreign- (FB) and US-born (USB) adults.

Methods

Longitudinal data from two panels (2013/2014 and 2014/2015) of the Medical Expenditure Panel Survey on FB and USB adults, ages 26–64 (unweighted n = 15,232), and difference-in-differences analysis using generalized estimating equations were used to estimate the effects of insurance gain. The primary outcomes were five measures of healthcare utilization including yearly routine care appointment, annual number of physician office visits, annual number of prescription medications filled or refilled, use of the emergency department (ED) during the year, and having an inpatient hospital stay during the year.

Results

Immigrants were more likely to gain health insurance between 2013 and 2015 relative to USB adults (6.3% vs. 4.4%) but remained much more likely to be continuously uninsured by 2015 (20.8% vs. 6.4%). Controlling for sociodemographic and health characteristics, FB and USB adults who gained insurance increased their use of health services, including routine care (absolute change ΔFB = 15.7%; p < 0.001 and ΔUSB = 11.7%; p < 0.001), office-based doctor visits (ΔFB = 1.3; p < 0.001 and ΔUSB = 0.6; p < 0.001), prescribed medications (ΔFB = 2.5; p < 0.001 and ΔUSB = 1.6; p = 0.016), and inpatient hospitalizations (ΔFB = 3.6%; p = 0.017 and ΔUSB = 3%; p < 0.001). ED use increased only among the FB (ΔFB = 4.8%; p < 0.001). Gaining insurance eliminated the differences in health services use for all considered outcomes among the FB relative to the continuously insured USB.

Conclusions

US immigrants had notable gains in health insurance after the ACA provisions took full effect, but major disparities in coverage persist. If insurance continues to expand among immigrants, then the gains may reduce longstanding disparities in health services use and enhance primary and preventive healthcare.

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Author information

Authors and Affiliations

  1. Institute of Gerontology & Department of Healthcare Sciences, Wayne State University, Room 240, Knapp Bldg, 87 East Ferry Street, Detroit, MI, USA

    Wassim Tarraf

  2. Institute of Gerontology & Department of Economics, Wayne State University, Detroit, USA

    Gail A. Jensen

  3. Institute of Gerontology, Wayne State University, Detroit, USA

    Yuyi Li, Mohammad Usama Toseef & Elham Mahmoudi

  4. School of Medicine, University of Michigan, Ann Arbor, USA

    Elham Mahmoudi

  5. Department of Neurosciences, University of California San Diego, San Diego, USA

    Hector M. Gonzalez

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  1. Wassim Tarraf
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Correspondence to Wassim Tarraf.

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Tarraf, W., Jensen, G.A., Li, Y. et al. Changes in Insurance Coverage and Healthcare Use Among Immigrants and US-Born Adults Following the Affordable Care Act. J. Racial and Ethnic Health Disparities 8, 363–374 (2021). https://doi.org/10.1007/s40615-020-00790-y

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  • DOI: https://doi.org/10.1007/s40615-020-00790-y

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