Skip to main content

Advertisement

SpringerLink
Log in

Variations in Access to Care After the Affordable Care Act Among Different Immigrant Groups

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

To assess how the Affordable Care Act (ACA) impacted changes in access and utilization of health care between groups by examining differences across groups of immigrants and by citizenship status. Data came from respondents of the 2011–2016 National Health Interview Survey aged 18 to 64 who were born outside of the U.S. or were native-born non-Latino whites (N = 119,198). Outcome measures included (all in the past 12 months): being currently uninsured, being insured via Medicaid, visiting the emergency department, visiting a doctor at least once, delaying care due to costs, not getting needed care because respondent was unable to afford it and being told by doctor office that they would not accept you as a new patient. The ACA was associated with greater healthcare access and utilization for some groups, but heterogeneously across all groups. For example, some immigrant groups had better access and utilization than others, and similar variation was revealed across citizenship groups. This study underscores the importance of disentangling how policies can affect immigrants from different regions of the world, which has implications for healthcare utilization and disparities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. N. (2016). Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act. Med Care, 54(2), 140–146.

    Article  Google Scholar 

  2. Livingston, G. (2016). 5 facts about immigrant mothers and U.S. fertility trends: Pew Research Center; [cited 2017 February 20]. Retrieved from http://www.pewresearch.org/fact-tank/2016/10/26/5-facts-about-immigrant-mothers-and-u-s-fertility-trends/.

  3. Elsouhag, D., Arnetz, B., Jamil, H., Lumley, M. A., Broadbridge, C. L., & Arnetz, J. (2015). Factors associated with healthcare utilization among Arab immigrants and Iraqi refugees. Journal of Immigrant and Minority Health, 17(5), 1305–1312.

    Article  CAS  Google Scholar 

  4. Ye, J., Mack, D., Fry-Johnson, Y., & Parker, K. (2012). Health care access and utilization among US-Born and foreign-born Asian Americans. Journal of Immigrant and Minority Health, 14(5), 731–737.

    Article  Google Scholar 

  5. Lebrun, L. A. (2012). Effects of length of stay and language proficiency on health care experiences among Immigrants in Canada and the United States. Soc Sci Med, 74(7), 1062–1072.

    Article  Google Scholar 

  6. Richardson, L. D., & Norris, M. (2010). Access to health and health care: How race and ethnicity matter. Mount Sinai Journal of Medicine, 77(2), 166–177.

    Article  Google Scholar 

  7. Tarraf, W., Vega, W., & Gonzalez, H. M. (2014). Emergency department services use among immigrant and non-immigrant groups in the United States. Journal of Immigrant and Minority Health, 16(4), 595–606.

    Article  Google Scholar 

  8. Carman, K. G., Eibner, C., & Paddock, S. M. Trends in health insurance enrollment, 2013-15. Health Affairs (Project Hope), 34(6), 1044–8.

    Article  Google Scholar 

  9. Sommers, B. D., Musco, T., Finegold, K., Gunja, M. Z., Burke, A., & McDowell, A. M. (2014). Health reform and changes in health insurance coverage in 2014. New England Journal of Medicine, 371(9), 867–874.

    Article  CAS  Google Scholar 

  10. Blumenthal, D., & Collins, S. R. (2014). Health care coverage under the Affordable Care Act ‚Äî A progress report. New England Journal of Medicine, 371(3), 275–281.

    Article  CAS  Google Scholar 

  11. Alcalá, H. E., Chen, J., Langellier, B. A., Roby, D. H., & Ortega, A. N. (2017). Impact of the Affordable Care Act on health care access and utilization among Latinos. Journal of the American Board of Family Medicine (JABFM), 30(1), 52–62.

    Article  Google Scholar 

  12. Ortega, A. N., McKenna, R. M., Chen, J., Alcalá, H. E., Langellier, B. A., & Roby, D. H. (2018). Insurance coverage and well-child visits improved for youth under the Affordable Care Act, but Latino youth still lag behind. Academic Pediatrics, 18(1), 35–42.

    Article  Google Scholar 

  13. Chen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. N. (2016). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical care, 54(2), 140.

    Article  Google Scholar 

  14. Buchmueller, T. C., Levinson, Z. M., Levy, H. G., & Wolfe, B. L. (2016). Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. American Journal of Public Health, 106(8), 1416–1421.

    Article  Google Scholar 

  15. Brandy, J. L., Sandra, L. D., & Benjamin, D. S. The Affordable Care Act appears to have narrowed racial and ethnic disparities in insurance coverage and access to care among young adults. Medical Care Research and Review. https://doi.org/10.1177/1077558717706575.

    Google Scholar 

  16. Sanchez, G. R., Vargas, E. D., Juarez, M. D., Gomez-Aguinaga, B., & Pedraza, F. I. (2017). Nativity and citizenship status affect Latinos’ health insurance coverage under the ACA. Journal of Ethnic and Migration Studies, 43(12), 2037–2054.

    Article  Google Scholar 

  17. Creedon, T. B., & Cook, B. L. (2016). Access to mental health care increased but not for substance use, while disparities remain. Health Affairs, 35(6), 1017–1021.

    Article  Google Scholar 

  18. Yue, D., Rasmussen, P. W., & Ponce, N. A. (2018). Racial/ethnic differential effects of medicaid expansion on health care access. Health Services Research, 35(3), 3640–3656.

    Article  Google Scholar 

  19. McMorrow, S., Long, S. K., Kenney, G. M., & Anderson, N. (2015). Uninsurance disparities have narrowed for black and Hispanic adults under the Affordable Care Act. Health Affairs, 34(10), 1774–1778.

    Article  Google Scholar 

  20. VanGarde, A., Yoon, J., Luck, J., & Mendez-Luck, C. A. (2018). Racial/Ethnic Variation in the Impact of the Affordable Care Act on Insurance Coverage and Access Among Young Adults. American Journal of Public Health, 108(4), 544–549.

    Article  Google Scholar 

  21. U.S. Centers for Medicare & Medicaid Services. Coverage for lawfully present immigrants 2012 [cited 2016 May 25]. Available from: https://www.healthcare.gov/immigrants/lawfully-present-immigrants/.

  22. Zuckerman, S., Waidmann, T. A., & Lawton, E. (2011). Undocumented immigrants, left out of health reform, likely to continue to grow as share of the uninsured. Health affairs (Project Hope), 30(10), 1997–2004.

    Article  Google Scholar 

  23. Joseph, T. D. (2017). Still left out: Healthcare stratification under the Affordable Care Act. Journal of Ethnic and Migration Studies, 43(12), 2089–2107.

    Article  Google Scholar 

  24. Blumenthal, D., & Collins, S. R. (2014). Health care aoverage under the Affordable Care Act — a progress report. New England Journal of Medicine, 371(3), 275–281.

    Article  CAS  Google Scholar 

  25. Zuckerman, S., Waidmann, T. A., & Lawton, E. (2011). Undocumented immigrants, left out of health reform, likely to continue to grow as share of the uninsured. Health Affair, 30(10), 1997–2004.

    Article  Google Scholar 

  26. Viruell-Fuentes, E. A., Miranda, P. Y., & Abdulrahim, S. (2012). More than culture: structural racism, intersectionality theory, and immigrant health. Social Science & Medicine, 75(12), 2099–2106.

    Article  Google Scholar 

  27. Bird, S. T., & Bogart, L. M. (2000). Perceived race-based and socioeconomic status (SES)-based discrimination in interactions with health care providers. ethnic discrimination, 11(3), 554–563.

    Google Scholar 

  28. Breland, H. L., & Ellis, C. (2015). Perceived discrimination in healthcare settings among Latinos with limited English proficiency in South Carolina. Southern Medical Journal, 108(4), 203–206.

    Article  Google Scholar 

  29. Halim, M. L., Yoshikawa, H., & Amodio, D. M. (2013). Cross-generational effects of discrimination among immigrant mothers: Perceived discrimination predicts child's healthcare visits for illness. Health Psychology, 32(2), 203.

    Article  Google Scholar 

  30. Derose, K. P., Escarce, J. J., & Lurie, N. (2007). Immigrants and health care: Sources of vulnerability. Health Affair, 26(5), 1258–1268.

    Article  Google Scholar 

  31. Abraído-Lanza, A. F., Armbrister, A. N., Flórez, K. R., & Aguirre, A. N. (2006). Toward a theory-driven model of acculturation in public health research. American Journal of Public Health, 96(8), 1342–1346.

    Article  Google Scholar 

  32. Abraído-Lanza, A. F., Echeverría, S. E., & Flórez, K. R. (2016). Latino immigrants, acculturation, and health: Promising new directions in research. The Annual Review of Public Health, 37, 219–236.

    Article  Google Scholar 

  33. Viruell-Fuentes, E. A. (2007). Beyond acculturation: immigration, discrimination, and health research among Mexicans in the United States. Social Science & Medicine, 65(7), 1524–1535.

    Article  Google Scholar 

  34. Ward, C., & Geeraert, N. (2016). Advancing acculturation theory and research: The acculturation process in its ecological context. Current Opinion in Psychology, 8, 98–104.

    Article  Google Scholar 

  35. Yu, S. M., Huang, Z. J., & Singh, G. K. (2010). Health status and health services access and utilization Among Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese Children in California. American Journal of Public Health, 100(5), 823–830.

    Article  Google Scholar 

  36. Venters, H., & Gany, F. (2011). African immigrant health. Journal of Immigrant and Minority Health, 13(2), 333–344.

    Article  Google Scholar 

Download references

Funding

None to disclose.

Author information

Authors and Affiliations

  1. Center for Racism, Social Justice and Health, University of California, Los Angeles, Los Angeles, CA, USA

    Mienah Zulfacar Sharif

  2. Mailman School of Public Health, Columbia University, 60 Haven Avenue Suite B2 #212, 10032, New York, NY, USA

    Goleen Samari

  3. Department of Family, Population and Preventive Medicine, Stony Brook University, Level 3, Room 071, Stony Brook, NY, 11794-8338, USA

    Héctor E. Alcalá

Authors
  1. Mienah Zulfacar Sharif
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Goleen Samari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Héctor E. Alcalá
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mienah Zulfacar Sharif.

Ethics declarations

Conflict of interest

All three authors, Sharif, Samari and Alcalá, declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharif, M.Z., Samari, G. & Alcalá, H.E. Variations in Access to Care After the Affordable Care Act Among Different Immigrant Groups. J Community Health 45, 30–40 (2020). https://doi.org/10.1007/s10900-019-00708-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-019-00708-8

Keywords

Search

Navigation