• Wassim Tarraf, Gail A Jensen, Yuyi Li, Mohammad Usama Toseef, Elham Mahmoudi, and Hector M Gonzalez.
• Institute of Gerontology & Department of Healthcare Sciences, Wayne State University, Room 240, Knapp Bldg, 87 East Ferry Street, Detroit, MI, USA. ai2483@wayne.edu.
• J Racial Ethn Health Disparities. 2021 Apr 1; 8 (2): 363-374.

ObjectivesImmigrants to the USA have disparate access to health insurance coverage and healthcare services. We evaluate the effects of gaining insurance following the January 2014 Affordable Care Act's (ACA) key provisions implementation on health services use among foreign- (FB) and US-born (USB) adults.MethodsLongitudinal data from two panels (2013/2014 and 2014/2015) of the Medical Expenditure Panel Survey on FB and USB adults, ages 26-64 (unweighted n = 15,232), and difference-in-differences analysis using generalized estimating equations were used to estimate the effects of insurance gain. The primary outcomes were five measures of healthcare utilization including yearly routine care appointment, annual number of physician office visits, annual number of prescription medications filled or refilled, use of the emergency department (ED) during the year, and having an inpatient hospital stay during the year.ResultsImmigrants were more likely to gain health insurance between 2013 and 2015 relative to USB adults (6.3% vs. 4.4%) but remained much more likely to be continuously uninsured by 2015 (20.8% vs. 6.4%). Controlling for sociodemographic and health characteristics, FB and USB adults who gained insurance increased their use of health services, including routine care (absolute change ΔFB = 15.7%; p < 0.001 and ΔUSB = 11.7%; p < 0.001), office-based doctor visits (ΔFB = 1.3; p < 0.001 and ΔUSB = 0.6; p < 0.001), prescribed medications (ΔFB = 2.5; p < 0.001 and ΔUSB = 1.6; p = 0.016), and inpatient hospitalizations (ΔFB = 3.6%; p = 0.017 and ΔUSB = 3%; p < 0.001). ED use increased only among the FB (ΔFB = 4.8%; p < 0.001). Gaining insurance eliminated the differences in health services use for all considered outcomes among the FB relative to the continuously insured USB.ConclusionsUS immigrants had notable gains in health insurance after the ACA provisions took full effect, but major disparities in coverage persist. If insurance continues to expand among immigrants, then the gains may reduce longstanding disparities in health services use and enhance primary and preventive healthcare.

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