Immigration and Health

摘要 我们的建议的目的是调查医疗保险覆盖范围的因果关系， 医疗保健利用率，健康行为和居住在美国的移民的健康。我们利用 非老年移民的保险覆盖率增加了约27% 在2011-2013年和2015-2018年之间，并调查其对广泛的医疗保健指标的影响 利用、健康行为和移民健康。《平价医疗法案》（ACA）扩大了医疗补助 收入低于贫困线138%的成年人也有资格获得这一权利，但并非所有州都遵守联邦法律。 而那些在2014年之前扩张的国家在时间和程度上有所不同。我们的研究策略依赖于 由于医疗补助资格扩大的时机，移民的健康保险增加 states. 我们的建议与以前的研究有五个关键特点：第一，保险的增加， 这项研究比以前基于类似自然实验的研究要大得多。第二，我们将覆盖 大多数成果的执行后阶段为五年。关于ACA对细胞增殖的影响的现有研究 一般人群是基于实施后一两年的数据，因此未能 获取长期影响。第三，我们将调查弱势群体，如老年人，慢性病患者， 在ACA之前，受健康保险覆盖范围的影响不同。四是举一反三， 常规/预防性医疗保健使用与极端健康结果（如急诊室）之间的联系 访问和住院。第五，我们建议使用纵向数据来识别更脆弱的人群 (e.g.那些已经存在的条件。此外，对于几个结果，我们将使用纵向数据来跟踪 相同的个人前到后ACA扩展，并比较医疗保健使用（和健康）的变化， 谁经历了保险状态的变化，那些谁没有。 我们的实证分析将主要基于三个数据集：国家健康访谈调查， 2011-2018;医疗支出小组调查，2011-2018; NHIS关联死亡率文件，2000-2016。ACA是 它对移民保险覆盖范围和医疗保健使用的影响受到广泛批评。 然而，很少有科学研究衡量其对移民的影响。我们提出的研究将弥合这一点 知识差距，并提高科学知识的影响，这一具有里程碑意义的立法的福祉 一个非常脆弱的群体。

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.