The Integration of Immigrants into American Society (2015) / Chapter Skim
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9 Health Status and Access to Care
9 Health Status and Access to Care
Pages 377-412
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describes the association between some dimensions of immigrant integration and health; (c) focuses on the disparities in health care access between immigrants and the native-born, with an emphasis on health insurance coverage; (d)
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. Immigrants, compared to the native-born, are less likely to die from cardiovascular disease and all cancers combined and have a lower incidence of all cancers combined, fewer chronic health conditions, lower infant mortality rates, lower rates of obesity, lower percentages who are overweight, fewer functional limitations, and fewer learning disabilities.
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Hayward and colleagues (2014) found that both foreign-born and native-born Hispanics have lower mortality rates but higher disability rates than non-Hispanic whites; their disability rates are similar to the rates of non-Hispanic blacks.
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. The health of undocumented immigrants is more difficult to assess than immigrants as a whole because their legal status is generally not available on health administrative records or in community surveys.
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. Other studies have found that undocumented immigrants had higher rates on some negative health outcomes (Landale et al., 2015a; Wallace et al., 2012)
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. These poorer health outcomes are evident even for people with high incomes, college educations, health insurance, and healthy lifestyles compared to their peers in other wealthy countries (Woolf and Aron, 2013)
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take a different approach, comparing foreign-born Latino males and females with their foreign-born white counterparts. They find that Latino foreign-born have lower mortality rates than the white foreign-born, challenging the selection effect explanation for the immigrant health advantage.
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did not find evidence for a return bias in explaining the Latino mortality advantage. Social and cultural factors constitute another set of explanations for the immigrant health advantage, particularly in explaining why their health status may worsen over time.
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Moreover, existing datasets are unable to track immigrants to fully capture how health changes over time and what factors may contribute to these changes. There is evidence, however, that selection, return migration, and social and cultural factors contribute to some extent to the immigrant health advantage and the changes in health over time.
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. Lack of access to health insurance and adequate health care may also play a role, as discussed below.
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Proficiency in English allows immigrants to communicate with people who do not speak their ethnic language and to manage their daily routines, whereas inability to speak English can limit opportunities for jobs and schooling, reduce abilities to expand networks and communicate with others, and constrain access to social and health services. Given its importance for social interactions in the United States, it is not surprising that English proficiency has been found to be strongly associated with health among Asian, black, and Latino immigrants (Gee et al.
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, while others may encounter violence after immigration. Research has found that limited English proficiency, isolation from family and community members, uncertain legal status, lack of access to good and dignified jobs, and past experiences with authorities in the sending country and the United States are all factors that can prevent abused immigrant women from reporting the crime or from leaving the family situation (Erez, 2000; Menjívar and Salcido, 2002)
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ACCESS TO HEALTH CARE AMONG IMMIGRANTS Unlike the overall health advantage, immigrants are at a distinct disadvantage compared to the native-born when it comes to receiving adequate and appropriate care to meet their preventive and medical health needs (Derose et al., 2007)
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. The lack of health insurance or inadequate insurance coverage are often cited as a primary source of constraint preventing immigrants from using health care services in a timely manner.
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address immediate needs as an entry point to accessing broader services. Immigrants and the Affordable Care Act3 The ACA seeks to expand health insurance coverage through Medicaid expansions, the creation of health insurance exchanges (marketplaces)
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. • Health Insurance Exchanges and Federal Tax Credits.
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Nonetheless, the ACA creates major opportunities to increase health insurance coverage for legal-status noncitizen immigrants. The ACA makes millions of "lawfully present" immigrants eligible for the health exchanges and the federal tax credits on the same terms as citizens, which could greatly expand access to private insurance coverage (Ku, 2013)
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In general, these studies have found that, while health reform has led to substantial improvements in overall health insurance coverage, including gains for Latinos (Doty et al., 2014) and Asians (Ramakrishnan and Ahmad, 2014)
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Household surveys, based on self-reported insurance status, are another way to gain insights about changes in insurance coverage. Typically, these data are reported on an annual basis after a survey-year has ended.
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. Overall changes in the proportion of adults who were uninsured and the differences between Medicaid-expanding and non-expanding states in this survey were relatively 8 The Affordable Care Act Tracking Survey examined the effect if ACA's open enrollment by interviewing nationally representative samples of 19-to-64-year-old adults at various points in time before and after open enrollment began.
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The discrepancy in results across the surveys with respect to health insurance coverage of Latinos is puzzling and indicates that we will need to wait for more detailed analyses and longer survey periods to get clear insights into differences in insurance status changes by race or ethnicity or changes by immigrant status. 12% Reduction 45 40.6 40 35.7 35 19% Reduction 30 24.9 Percentage 25 4% Reduction 7% Reduction 20.2 20 16.3 15.7 14.5 13.5 15 10 5 0 Hispanic White Non-Hispanic Black Non-Hispanic Asian Non-Hispanic 2013 Q1 2014 FIGURE 9-3 Changes in percentage of uninsured among adults, ages 18-64, fol lowing ACA Insurance Expansions, National Health Interview Survey.
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First, eligibility and application policies and procedures about the new health insurance exchanges were complicated, and the rules about immigrant eligibility were especially complex. These rules were poorly understood not only by the public but even by public-sector and nonprofit-sector workers providing guidance on eligibility (Raymond-Flesch, 2015)
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The flip side of this condition is that immigrants are more likely to access health insurance and health care, the more integrated they are into American society. Early data indicate that the ACA will help provide health insurance to immigrants who had not been previously covered, with the exception of undocumented immigrants.
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Medicare is the federal health insurance program for people 65 years and older, for certain younger people with long-term disabilities, and for people who have permanent kidney failure requiring
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In comparison with native-born Americans, the foreign born are less likely to die from cardiovascular disease and all cancers combined; they experience fewer chronic health conditions, lower infant mortality rates, lower rates of obesity, fewer functional limitations, and fewer learning disabilities. Immigrants also have a lower prevalence of depression, the most common mental disorder in the world, and of alcohol abuse.
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. Use of mental health–related services among immigrant and native-born Asian Americans: Results from the National Latino and Asian American Study.
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. New estimates of racial/ ethnic differences in life expectancy with chronic morbidity and functional loss: Evidence from the National Health Interview Survey.
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. Health Insurance Coverage: Early Reports of Estimates from the National Health Interview Survey, January-March 2014.
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. English proficiency and language preference: Testing the equivalence of two measures. American Journal of Public Health, 100(3)
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. Immigrants' Access to Health Insurance and Care: The Role of Health Reform.
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. Immigrant perceptions of discrimination in health care: The California Health Interview Survey 2003.
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. Health Insurance Mar ketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period for the Period October 1, 2013–March 31, 2014, May 1, 2014.
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. Assessing health care services used by California's undocumented immigrant population in 2010.
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. Health reform and changes in health insurance coverage in 2014.
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. Undocumented and Uninsured: Barriers to Affordable Care for Immigrant Populations.
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