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Affordability of and Access to Information About Health Insurance Among Immigrant and Non-immigrant Residents After Massachusetts Health Reform

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Abstract

Immigrants’ perceptions of affordability of insurance and knowledge of insurance after health reform are unknown. We conducted face-to-face surveys with a convenience sample of 1124 patients in three Massachusetts safety net Emergency Departments after the Massachusetts health reform (August 2013–January 2014), comparing immigrants and non-immigrants. Immigrants, as compared to non-immigrants, reported more concern about paying premiums (30 vs. 11 %, p = 0.0003) and about affording the current ED visit (38 vs. 22 %, p < 0.0001). Immigrants were also less likely to report having unpaid medical bills (24 vs. 32 %, p = 0.0079), however this difference was not present among those with any hospitalization in the past year. Insured immigrants were less likely to know copayment amounts (57 vs. 71 %, p = 0.0018). Immigrants were more likely to report that signing up for insurance would be easier with fewer plans (53 vs. 34 %, p = 0.0443) and to lack information about insurance in their primary language (31 vs. 1 %, p < 0.0001) when applying for insurance. Immigrants who sought insurance information via websites or helplines were more likely to find that information useful than non-immigrants (100 vs. 92 %, p = 0.0339). Immigrants seeking care in safety net emergency departments had mixed experiences with affordability of and knowledge about insurance after Massachusetts health reform, raising concern about potential disparities under the Affordable Care Act that is based on the MA reform.

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Author information

Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    Ye jin Kang, Danny McCormick & Leah Zallman

  2. Cambridge Health Alliance, Cambridge, MA, USA

    Danny McCormick & Leah Zallman

  3. Institute for Community Health, Malden, MA, USA

    Leah Zallman

Authors
  1. Ye jin Kang
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  2. Danny McCormick
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  3. Leah Zallman
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Corresponding author

Correspondence to Leah Zallman.

Appendix

Appendix

See Tables 4, 5, 6 and 7.

Table 4 Perceived affordability of insurance and medical care among publicly insured (Medicaid or Commonwealth Care) individuals
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Table 5 Understanding of insurance and experiences obtaining insurance among publicly insured (Medicaid or Commonwealth Care) individuals
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Table 6 Perceived affordability of insurance and medical care, controlling for demographic factors and insurance
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Table 7 Understanding of insurance and experiences obtaining insurance, controlling for demographic factors and insurance
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Kang, Y.j., McCormick, D. & Zallman, L. Affordability of and Access to Information About Health Insurance Among Immigrant and Non-immigrant Residents After Massachusetts Health Reform. J Immigrant Minority Health 19, 929–938 (2017). https://doi.org/10.1007/s10903-016-0479-y

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  • DOI: https://doi.org/10.1007/s10903-016-0479-y

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