Health and care

 

Methods: 

This study used data from the 2011–2015 California Health Interview Survey to examine health care access and utilization and physical and behavioral health among a representative sample of all nonelderly Latino and US-born non-Latino white adults (N=51,386). Multivariable regressions estimated the associations between the dependent measures and citizenship/documentation status among Latinos (US-born, naturalized citizen, green card holder, and undocumented).

Results: 

Adjusted results from multivariable analyses observed worse access and utilization patterns among immigrant Latinos compared with US-born Latinos, with undocumented immigrants using significantly less health care. Undocumented Latinos had lower odds of self-reporting excellent/very good health status compared with US-born Latinos, despite them having lower odds of having several physical and behavioral health outcomes (overweight/obesity, physician-diagnosed hypertension, asthma, self-reported psychological distress, and need for behavioral health services). Among those reporting a need for behavioral health services, access was also worse for undocumented Latinos when compared with US-born Latinos.

Conclusions: 

Patterns of poor health care access and utilization and better physical and behavioral health are observed across the continuum of documentation status, with undocumented immigrants having the worst access and utilization patterns and less disease. Despite fewer reported diagnoses and better mental health, undocumented Latinos reported poorer health status than their US-born counterparts.

Access to publicly funded health services for immigrants, particularly for those who are undocumented, is a politically polarizing issue. Undocumented immigrants are explicitly excluded from the Patient Protection and Affordable Care Act’s (ACA) health insurance exchanges, cost-sharing reductions, health insurance mandate, tax credits, and the expansion of Medicaid’s traditional provisions. While the ACA has reduced racial/ethnic and income-based health care disparities, it has the potential to exacerbate disparities among undocumented immigrants.

Congress and the Trump Administration have discussed a range of policy and enforcement options that have the potential to impact both legally authorized (eg, reducing levels of legal immigration) and undocumented (eg, a pathway to citizenship for “Dreamers” and increased attention on deportation) immigrants. A key motivator is the belief among some constituents that immigrants overutilize resources, such as health care,^4,5 despite evidence that undocumented immigrants and immigrants without insurance use less health care than others. Similarly, an analysis by the nonpartisan Institute on Taxation and Economic Policy found that undocumented immigrants collectively pay nearly $12 billion per year in state and local taxes, including over $3 billion annually in California alone.¹¹ They also contribute $2 to $4 billion into the Medicare Trust Fund and $12 billion net into Social Security annually, even though they are unable to claim benefits from these programs.