Public Health · 2 h ago
Immigrants Had Smaller Insurance and Spending Gains After ACA Expansion
A serial cross-sectional analysis of 237,175 person-year observations from US adults aged 19 to 64 years examined insurance, health care use, and expenditures across three policy eras. Insurance coverage rose in later eras, but low-income immigrants had smaller relative coverage gains and no statistically significant increase in total expenditures after the Public Charge Rule Proposal era.
- Analysis included 237,175 person-year observations from 126,724 adults.
- Coverage rose in later eras for low-income adults of both nativity groups.
- Low-income immigrants had smaller relative coverage gains.
- Expenditure changes across policy eras do not establish causation.
Researchers analyzed nationally representative Medical Expenditure Panel Survey data from 2010 to 2023 for US adults aged 19 to 64 years. The serial cross-sectional study included 237,175 person-year observations from 126,724 adults, comparing insurance coverage, health care use, and annual medical expenditures across pre-ACA expansion (2010-2013), post-ACA expansion (2014-2018), and post-Public Charge Rule Proposal (PCRP) (2019-2023) periods. Analyses were stratified by income and nativity.
Among adults with low incomes, post-PCRP-era insurance coverage was higher for both US-born adults (adjusted odds ratio, 2.84; 95% CI, 2.55-3.17) and immigrants (2.29; 95% CI, 1.98-2.65), with smaller relative gains among immigrants. Total expenditures increased by $1,684.60 among low-income US-born adults, but the estimated $220.20 increase among low-income immigrants was not statistically significant. Among adults without low incomes, expenditures rose for both US-born adults ($1,788.60) and immigrants ($974.10).
The findings indicate persistent nativity-related differences in coverage, use, and spending, and suggest that insurance expansion alone may not eliminate access disparities. The study compares policy eras observationally and cannot establish that the PCRP caused the observed changes.
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JAMA Network Open: Health Care Costs and Immigration Status Among US Adults ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.