Abstract
Objective
To examine time trends in disparities in low-income children's health insurance coverage
and access to care by family immigration status.
Methods
We used data from the National Survey of Children's Health in 2003 to 2011–2012, including
83,612 children aged 0 to 17 years with family incomes <200% of the federal poverty
level. We examined 3 immigration status categories: citizen children with nonimmigrant
parents; citizen children with immigrant parents; and immigrant children. We used
multivariable regression analyses to obtain adjusted trends in health insurance coverage
and access to care.
Results
All low-income children experienced gains in health insurance coverage and access
to care from 2003 to 2011–2012, regardless of family immigration status. Relative
to citizen children with nonimmigrant parents, citizen children with immigrant parents
had a 5 percentage point greater increase in health insurance coverage (P = .06), a 9 percentage point greater increase in having a personal doctor or nurse
(P < .01), and an 11 percentage point greater increase in having no unmet medical need
(P < .01). Immigrant children had significantly lower health insurance coverage than
other groups. However, the group had a 14 percentage point greater increase in having
a personal doctor or nurse (P < .01) and a 26 percentage point greater increase in having no unmet medical need
(P < .01) relative to citizen children with nonimmigrant parents.
Conclusions
Some disparities in access to care related to family immigration status have lessened
over time among children in low-income families, although large disparities still
exist. Policy efforts are needed to ensure that children of immigrant parents and
immigrant children are able to access health insurance and health care.
Keywords
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References
Harringon M, Smith K, Trenholm C, et al. CHIPRA mandated evaluation of the Children's Health Insurance Program: final findings. 2014. Report submitted to the Office of the Assistant Secretary for Planning and Evaluation. Available at: http://medicaid.gov/chip/downloads/chip_report_congress-2014.pdf. Accessed August 8, 2015.
- Access to care and utilization among children: estimating the effects of public and private coverage.Med Care. 2006; 44: I19-I26
- The impact of the Medicaid/CHIP expansions on children: a synthesis of the evidence.Med Care Res Rev. 2012; 69: 372-396
- The effect of child health insurance access on schooling: evidence from public insurance expansions. NBER Working Paper 20178.National Bureau of Economic Research, Cambridge, Mass2014
- Declining child mortality and continuing racial disparities in the era of the Medicaid and SCHIP insurance coverage expansions.Am J Public Health. 2010; 100: 2500-2506
- Covering the remaining uninsured children: almost half of uninsured children live in immigrant families.Med Care. 2014; 52: 202-207
- Immigrants and health care: sources of vulnerability.Health Aff (Millwood). 2007; 26: 1258-1268
- Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey.Am J Public Health. 2006; 96: 1300-1307
- Effect of expanding Medicaid for parents on children's health insurance coverage: lessons from the oregon experiment.JAMA Pediatr. 2015; 169: e143145
- The effect of parents' insurance coverage on access to care for low-income children.Inquiry. 2003; 40: 254-268
- Stuck between health and immigration reform—care for undocumented immigrants.N Engl J Med. 2013; 369: 593-595
- Health care for immigrants—implications of Obama's executive action.N Engl J Med. 2015; 372: 1187-1189
- Undocumented and uninsured: barriers to affordable care for immigrant populations.2013 (Available at:) (Accessed April 9, 2015)
- Getting Into Gear for 2014: Findings From a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP.Kaiser Commission on Medicaid and the Uninsured, Washington, DC2013 (Available at:) (Accessed August 8, 2015)
- Key facts on health coverage for low-income immigrants today and under the Affordable Care Act.2013 (Available at:) (Accessed October 1, 2014)
Karlamangla S, Terhune C. Healthcare quandary: many Latinos still lack insurance but shun Obamacare for fear that signing up will get relatives deported. Los Angeles Times, November 10, 2014.
- Maternal and Child Health Bureau in collaboration with the National Center for Health Statistics. 2003 National Survey of Children's Health. 2003 NSCH Stata indicator data set prepared by the Data Resource Center for Child and Adolescent Health, Child and Adolescent Health Measurement Initiative. 2003
- Maternal and Child Health Bureau in collaboration with the National Center for Health Statistics. 2011/12 National Survey of Children's Health. 2011/12 NSCH Stata indicator data set prepared by the Data Resource Center for Child and Adolescent Health, Child and Adolescent Health Measurement Initiative. 2012
- Maternal and Child Health Bureau in collaboration with the National Center for Health Statistics. 2007 National Survey of Children's Health. 2007 NSCH Stata indicator data set prepared by the Data Resource Center for Child and Adolescent Health, Child and Adolescent Health Measurement Initiative. 2007
- Design and operation of the National Survey of Children's Health, 2007.Vital Health Stat 1. 2012; : 1-149
- Design and operation of the National Survey of Children's Health, 2003.Vital Health Stat 1. 2005; : 1-131
Ryan C. Language use in the United States: 2011. American Community Survey Reports, 2011. Available at: https://www.census.gov/prod/2013pubs/acs-22.pdf. Accessed May 20, 2015.
National Center for Health Statistics. Frequently asked questions: 2011–2012 National Survey of Children's Health 2013; ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/slaits/nsch_2011_2012/01_Frequently_asked_questions/NSCH_2011_2012_FAQs.pdf. Accessed October 1, 2014.
- Preserving Recent Progress on Health Coverage of Children and Families. 2003; (Available at: http://kff.org/medicaid/report/preserving-recent-progress-for-health-coverage-of/. Accessed August 19, 2015)
- Resuming the Path to Health Coverage for Children and Parents. 2006; (Available at:http://kff.org/medicaid/poll-finding/resuming-the-path-to-health-coverage-for/. Accessed August 19, 2015)
- Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Proecdures, and Cost-Sharing Practices in Medicaid and CHIP. 2011; (Available at: http://kff.org/health-reform/report/holding-steady-looking-ahead-annual-findings-of/. Accessed August 19, 2015)
- Multiple imputation using chained equations: issues and guidance for practice.Stat Med. 2011; 30: 377-399
- Statistical Analysis With Missing Data.2nd ed. Wiley, Hoboken, NJ2002
- Coverage for low-income immigrant children increased 24.5 percent in states that expanded CHIPRA eligibility.Health Aff (Millwood). 2014; 33: 832-839
- Which states enroll their Medicaid-eligible, citizen children with immigrant parents?.Health Serv Res. 2013; 48: 519-538
- Improving health insurance and access to care for children in immigrant families.Ambul Pediatr. 2007; 7: 412-420
- The association of generation status and health insurance among US children.Pediatrics. 2014; 134: 307-314
- The impact of local immigration enforcement policies on the health of immigrant Hispanics/Latinos in the United States.Am J Public Health. 2015; 105: 329-337
- Children eligible for Medicaid or CHIP: who remains uninsured, and why?.Acad Pediatr. 2015; 15: S36-S43
- The Affordable Care Act and health insurance for Latinos.JAMA. 2014; 312: 1735-1736
- Senate Bill 4: health care coverage: immigration status.2015 (Available at:) (Accessed July 10, 2015)
- A successful program for training parent mentors to provide assistance with obtaining health insurance for uninsured children.Acad Pediatr. 2015; 15: 275-281
Article Info
Publication History
Published online: July 28, 2015
Accepted:
July 25,
2015
Received:
May 27,
2015
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
