Illustrating How Health Policy May Perpetuate Coverage and Access Disparities for Undocumented Immigrants

Background and Objectives: Evidence indicates significant disparities in access to health care for immigrants, but few studies have focused on changes in patterns of access to care by immigration status over time. We examined patterns of change in access and health indicators before and after the Affordable Care Act (ACA) for the undocumented and compared to US-born, naturalized, and documented residents. Methods: We examined indicators of usual source of care, service use, delays and self-reported health from 2005 to 2018 using a California Health Interview Survey sample of non-elderly adults ( n = 207,652). We used multinomial and logistic regression models to assess changes in access and health status within each immigration category and across ACA periods. Results: From early- to post-ACA periods, we found a widening gap in insurance coverage of undocumented vs. US-born residents, and a shift toward use of public settings as usual source of care for both groups. From the pre- to early-ACA periods, there was a greater reduction of delayed medical care, and an increase in any mental health visits for US-born vs. undocumented residents. Discussion: Findings portend exacerbation of disparities in access for undocumented residents due to the economic consequences of events such as the pandemic and continued exclusion of undocumented residents from federally-funded coverage.