State Immigrant Policies and Intersectional Inequalities in Health

Abstract State legislatures have played an increasingly central role in governing the social, political, and economic contexts where immigrants live and work. This study merges the 2004 and 2008 panels of the Survey on Income and Program Participation (SIPP), spanning from 2004–05 and 2009–11, respectively, with data on state immigrant policies and policy contexts to investigate the links between state contexts and population patterns of health. We use two- and three-way fixed effects linear probability models to: 1) document patterns of health at the intersections of race-ethnicity, nativity, and both individual- and household-level citizenship status; and 2) investigate how changes in state-level immigrant policy shape these intersectional health disparities. Findings document staggering intersectional health inequities—including especially high health risks among US-born Black and Hispanic groups and foreign-born Hispanic citizens. Results further highlight the central role of state policy contexts in shaping those gaps: while increasingly restrictive or hostile policy climates increase health risks, results also underscore the potential of accommodating immigrant policies—including those governing immigrant access to health care—in promoting health equity. The links between state immigrant policy contexts were largely consistent across race-ethnicity, nativity, and both individual- and household-level citizenship and legal status. Taken together, findings from this study add to a growing body of work showing the critical role of divergent state contexts in patterning population health in the U.S.