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

Wassim Tarraf; Gail A Jensen; Yuyi Li; Mohammad Usama Toseef; Elham Mahmoudi; Hector M Gonzalez

doi:10.1007/s40615-020-00790-y

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

J Racial Ethn Health Disparities. 2021 Apr;8(2):363-374. doi: 10.1007/s40615-020-00790-y. Epub 2020 Jul 3.

Authors

Wassim Tarraf¹, Gail A Jensen², Yuyi Li³, Mohammad Usama Toseef³, Elham Mahmoudi^{3

4}, Hector M Gonzalez⁵

Affiliations

¹ Institute of Gerontology & Department of Healthcare Sciences, Wayne State University, Room 240, Knapp Bldg, 87 East Ferry Street, Detroit, MI, USA. ai2483@wayne.edu.
² Institute of Gerontology & Department of Economics, Wayne State University, Detroit, USA.
³ Institute of Gerontology, Wayne State University, Detroit, USA.
⁴ School of Medicine, University of Michigan, Ann Arbor, USA.
⁵ Department of Neurosciences, University of California San Diego, San Diego, USA.

PMID: 32621099
DOI: 10.1007/s40615-020-00790-y

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 Δ_FB = 15.7%; p < 0.001 and Δ_USB = 11.7%; p < 0.001), office-based doctor visits (Δ_FB = 1.3; p < 0.001 and Δ_USB = 0.6; p < 0.001), prescribed medications (Δ_FB = 2.5; p < 0.001 and Δ_USB = 1.6; p = 0.016), and inpatient hospitalizations (Δ_FB = 3.6%; p = 0.017 and Δ_USB = 3%; p < 0.001). ED use increased only among the FB (Δ_FB = 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.

Keywords: Affordable care act; Health services; Immigrant health; Insurance.

MeSH terms

Adult
Emigrants and Immigrants / statistics & numerical data*
Female
Humans
Insurance Coverage / statistics & numerical data*
Insurance, Health / statistics & numerical data*
Longitudinal Studies
Male
Middle Aged
Patient Acceptance of Health Care / statistics & numerical data*
Patient Protection and Affordable Care Act*
United States