Variations in Access to Care After the Affordable Care Act Among Different Immigrant Groups

Structural gendered racism as conceptualized by immigrant women in the United States

RATIONALE

Immigrants represent a rapidly growing proportion of the population, yet the many ways in which structural inequities, including racism, xenophobia, and sexism, influence their health remains largely understudied. Perspectives from immigrant women can highlight intersectional dimensions of structural gendered racism and the ways in which racial and gender-based systems of structural oppression interact.

OBJECTIVE

This study aims to show the multilevel manifestations of structural gendered racism in the health experiences of immigrant women living in New York City.

METHOD

Semi-structured, in-depth interviews were conducted in 2020 and 2021 with 44 cisgender immigrant women from different national origins in New York City to explore how immigrant women experienced structural gendered racism and its pathways to their health. Interviews were thematically analyzed using a constant comparative approach.

RESULTS

Participants expressed intersectional dimensions of structural gendered racism and the anti-immigrant climate through restrictive immigration policy and issues related to citizenship status, disproportionate immigration enforcement and criminalization, economic exploitation, and gendered interpersonal racism experienced across a range of systems and contexts. Participants weighed their concerns for safety and facing racism as part of their life course and health decisions for themselves and their families.

CONCLUSIONS

The perspectives and experiences of immigrant women are key to identifying multilevel solutions for the burdens of structural gendered racism, particularly among individuals and communities of non-U.S. national origin. Understanding how racism, sexism, xenophobia, and intersecting systems of oppression impact immigrant women is critical for advancing health equity.

The Intersection of State-Level Immigrant Policy Climates and Medicaid Expansion: an Examination Among Immigrants

States have broad discretion over the implementation of policies like Medicaid expansion and other policies that impact the well-being and integration of immigrants. While numerous studies document Medicaid expansion on immigrants' health insurance coverage and the role of state immigrant policy climates on immigrants' well-being, no research to date has studied whether the association between a state's Medicaid expansion on immigrants' health insurance coverage varies based on the inclusiveness or exclusiveness of a state's immigrant policy climate. We combine nationally representative data from the 2014-2018 American Community Survey (ACS) with state policy data and estimate multivariate regression models. The results reveal a state immigrant policy climate gradient whereby ACA Medicaid expansion on noncitizens is negative and most severe in exclusionary climates. This study highlights how state policies intersect as important structural forces that influence immigrant health and well-being.

Publicly-Funded Services Providing Sexual, Reproductive, and Maternal Healthcare to Immigrant Women in the United States: A Systematic Review

Sexual, reproductive, and maternal health (SRMH) care in the US is highly politicized, with restrictions that impede immigrant women's health. This review describes SRMH outcomes among immigrant women accessing publicly-funded services. We examined articles published from December 2007 to August 2020 in PubMed, PsycINFO, and Web of Science databases, following PRISMA guidelines. Included articles (n = 9) consisted of predominantly Latina immigrant samples. The majority included a subsample of women classified as vulnerable due to low income, low educational attainment, and/or documentation status. Our search strategy included a range of SRMH outcomes; however, the majority of articles focused on prenatal care (PNC). Over half of the articles revealed that underserved immigrant women with access to Medicaid/CHIP during expansion had higher rates of PNC adequacy compared to those without access. There is a need for more research on the impact of publicly-funded services other than Medicaid on outcomes beyond PNC.

Work in Progress: Immigrant Health Care from the Vantage of Cancer Testing and Screening

This letter offers a perspective from cancer testing and screening on the improvements in immigrant insurance coverage and care charted in Bustamante et al.'s April 2019 article in JOIH on "Health Care Access and Utilization Among U.S. Immigrants Before and After the Affordable Care Act." Supportive evidence for their data may be found in complementary literature drawing from both the National Health Interview Survey the authors use and the Medical Expenditure Panel Survey, while post-ACA surveys and state level information suggest disparities remain for lawfully present and undocumented immigrants ineligible for Medicaid and unable to secure insurance to pay medical costs. Existent options for cancer services are discussed. Further relevant reform depends on voter awareness and collaborative efforts between consumer advocates and legislators.

Racial and Citizenship Disparities in Health Care Among Middle Eastern Americans

OBJECTIVE

To assess differences in health access and utilization among Middle Eastern American adults by White racial identity and citizenship.

METHODS

Data from the 2011 to 2018 National Health Interview Surveys (N=1013) and survey-weighted logistic regression analyses compare Middle Eastern immigrants by race and citizenship on access and utilization of health care in the United States.

RESULTS

White respondents had 71% lower odds of delaying care [adjusted odds ratio (AOR)=0.34; 95% confidence interval (CI)=0.13, 0.71] and 84% lower odds of being rejected by a doctor as a new patient (AOR=0.16; 95% CI=0.03, 0.88) compared to non-White respondents. US citizens had higher odds of visiting the doctor in the past 12 months compared with noncitizens (AOR=1.76; 95% CI=1.25, 2.76).

CONCLUSION

Middle Eastern immigrants who do not identify as White and who are not US citizens are significantly less likely to access and utilize health care compared with those who identify as White and are US citizens.

POLICY IMPLICATIONS

This study shows that racial and citizenship disparities persist among Middle Eastern Americans at a national-level, playing a critical role in access to and use of health care.

Achieving equity in dialysis care and outcomes: The role of policies

Socially disadvantaged persons, including racial and ethnic minorities, individuals with low incomes, homeless persons, and non-US citizens bear a disproportionate burden of end-stage kidney disease (ESKD). Inequities in nephrology referral, vascular access, use of home dialysis modalities, kidney transplantation, and mortality are prominent. Public policies, including the Patient Protection and Affordable Care Act, end-stage renal disease Quality Incentive Program, and the Prospective Payment System, were enacted to improve healthcare access and dialysis care. Here, we highlight inequities in dialysis care and outcomes, how current ESKD and other public policies may influence or exacerbate these inequities, and gaps in the literature needed to inform future policies toward achieving equity in ESKD. We give special attention to the 2019 Advancing American Kidney Health Executive Order, which has high potential to radically transform dialysis care.