State child health insurance policies and access to health care for immigrant children

Deborah Roempke Graefe, Pennsylvania State University
Gordon F. De Jong, Pennsylvania State University
Stephanie Howe Hasanali, Pennsylvania State University

Just as access to and utilization of health care among immigrant populations varies across the nations of the European Union (e.g., Stan 2015), nativity-based disparities in health care between the U.S. states are clear. Although recent legal permanent residents and undocumented immigrants are generally barred from accessing public health insurance, some U.S. states cover immigrant children through the Children’s Health Insurance Program (CHIP). In this study, we examine the contextual effect of U.S. state health insurance eligibility policy, particularly with respect to immigrant children, on race/ethnic and nativity-based disparities in children’s routine health care. Utilizing our original data on state CHIP eligibility policies and child-level data from the Survey of Income and Program Participation, we find that a significant portion of between-state variation in children’s routine health care results from diversity in CHIP eligibility rules for poor and foreign-born children. Immigrant-specific disparities are reduced when states do not require five years residency for CHIP participation. Our ongoing research expands upon the results presented here to include children from all U.S. states in the study sample; and the substitution in our models of race/ethnicity by immigrants’ global regions of origin; and the addition to our models of alternative contextual explanations for health care inequalities (characteristics of the local medical system infrastructure include the ratio of general practitioners/pediatritians to the population, availability of translation services at local hospitals, and availability of low-cost medical clinics). Findings regarding these additional characteristics will be presented, along with a discussion of their applicability to the EU situation.