Immigration and Health

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Abstract The objective of our proposal is to investigate the causal effect of health insurance coverage on healthcare utilization, health behavior, and health of immigrants living in the United States. We take advantage of a policy-induced increase in insurance coverage of approximately 27% among non-elderly immigrants between 2011-2013 and 2015-2018 and investigate its impact on a wide range of indicators of healthcare utilization, health behavior, and health of immigrants. The Affordable Care Act (ACA) expanded Medicaid eligibility to adults with incomes below 138% of the poverty line, but not all states complied with the federal law and those that did differed in timing and degree of expansion prior to 2014. Our research strategy relies on the increase in health insurance of immigrants resulting from the timing of expansion in Medicaid eligibility across states. Five key features distinguish our proposal from previous research: one, the increase in insurance we study is much larger than those in previous research based on similar natural experiments. Two, we will cover five years of the post-implementation phase for most outcomes. Extant studies on the effect of ACA on the general population are based on data from one or two years after its implementation, therefore have failed to capture long-term effects. Three, we will investigate if vulnerable groups, e.g. older, with chronic conditions prior to ACA, were differently affected by health insurance coverage. Fourth, we will draw inferences on the links between routine/preventive medical care use and extreme health outcomes such as emergency room visits and hospitalizations. Five, we propose to use longitudinal data to identify more vulnerable populations (e.g. those with preexisting conditions. Further, for several outcomes, we will use longitudinal data to follow the same individuals pre-to-post ACA expansion and compare changes in medical care use (and health) of those who experiened a change in insurance status to those who did not. Our empirical analyses will be based primarily on three datasets: the National Health Interview Survey, 2011–2018; Medical Expenditure Panel Survey, 2011–2018; NHIS linked Mortality file, 2000–2016. ACA is highly controversial and its impact on immigrant insurance coverage and healthcare use is widely criticized. Yet, few scientific studies have measured its impacts on immigrants. Our proposed research will bridge this knowledge gap and improve scientific knowledge of the impact of this landmark legislation on the well-being of a highly vulnerable population.