Immigration and Health

摘要 我们建议的目的是调查健康保险承保范围对 居住在美国的移民的医疗保健利用、健康行为和健康。我们利用这个机会 在政策引导下，非老年移民的保险覆盖率增加了约27% 2011-2013年和2015-2018年，并调查其对一系列医疗保健指标的影响 移民的利用、健康行为和健康。平价医疗法案(ACA)扩大了医疗补助 收入低于贫困线138%的成年人的资格，但并不是所有的州都遵守联邦法律 而那些在2014年之前扩张的企业在扩张的时间和程度上也有所不同。我们的研究策略依赖于 由于扩大医疗补助资格的时机，移民的医疗保险增加了 各州。 我们的建议与之前的研究有五个主要特点：第一，保险的增加 这项研究比以往基于类似自然实验的研究要大得多。两个，我们会掩护 大多数成果的实施后阶段为五年。ACA对血管紧张素转换酶活性影响的现有研究 一般人口是根据实施后一到两年的数据计算的，因此未能 捕捉长期影响。第三，我们将调查弱势群体，如老年人，是否患有慢性病 在ACA之前，受医疗保险覆盖范围的影响不同。第四，我们将根据 常规/预防性医疗护理使用与急诊室等极端健康后果之间的联系 探视和住院治疗。第五，我们建议使用纵向数据来识别更多的弱势群体 (例如，有既往病症的患者。此外，对于几个结果，我们将使用纵向数据来跟踪 相同的人在ACA扩展前后并比较这些人在医疗保健使用(和健康)方面的变化 那些经历了保险地位变化的人，变成了那些没有经历过的人。 我们的实证分析将主要基于三个数据集：全国健康访谈调查， 2011-2018年；医疗支出小组调查，2011-2018年；NHIS关联死亡率文件，2000-2016年。ACA是 极具争议性，其对移民保险覆盖面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它对移民的影响。我们提出的研究将在这方面架起桥梁 知识差距和提高科学知识这一里程碑式的立法对人民福祉的影响 一个高度脆弱的群体。

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.