Table 1.

Health Insurance Coverage and Access to and Utilization of Care by U.S. Immigration Status Before and After the ACA Implementation

	Uninsured		Delayed Care		Forgo Care		ED Use		MD Visit
	OR	p	OR	p	OR	p	OR	p	OR	p
Before ACA	REF
After ACA	0.62	<0.001	0.76	<0.001	0.76	<0.001	0.97	0.13	1.10	<0.001
U.S. born	REF
Nat U.S. Citizen	2.25	<0.001	0.99	0.94	0.99	0.90	0.63	<0.001	0.60	<0.001
Non-Citizen (5<)	3.02	<0.001	1.05	0.35	1.14	0.02	0.59	<0.001	0.66	<0.001
Non-Citizen (5≥)	1.16	<0.001	0.92	0.06	0.95	0.33	0.82	<0.001	1.00	0.91
African-American	0.98	0.54	0.75	<0.001	0.92	0.02	1.33	<0.001	1.01	0.73
Latino	1.40	<0.001	0.87	<0.001	0.99	0.76	0.99	0.78	0.89	<0.001
Other	0.93	0.14	0.72	<0.001	0.80	<0.001	0.88	0.01	0.87	<0.001
Age 25–34	1.98	<0.001	1.85	<0.001	1.92	<0.001	1.02	0.66	0.78	<0.001
Age 35–44	1.64	<0.001	1.72	<0.001	1.92	<0.001	0.85	<0.001	0.98	0.58
Age 45–54	1.47	<0.001	1.92	<0.001	2.01	<0.001	0.74	<0.001	1.19	<0.001
Age 55–64	1.11	0.04	1.58	<0.001	1.57	<0.001	0.72	<0.001	1.66	<0.001
Female	0.71	<0.001	1.17	<0.001	1.12	<0.001	1.31	<0.001	1.53	<0.001
Married	0.59	<0.001	0.48	<0.001	0.53	<0.001	0.97	0.23	1.23	<0.001
Federal Poverty
<100 FPL	REF		REF		REF		REF		REF
100–200	1.11	<0.001	1.27	0.00	1.14	<0.001	0.80	<0.001	0.97	0.20
200>	0.34	<0.001	0.54	0.00	0.40	<0.001	0.59	<0.001	1.32	<0.001
Education
<High school	REF		REF		REF		REF		REF
High school	0.95	<0.001	1.09	0.03	1.07	0.12	0.86	<0.001	1.09	<0.001
Some college	0.67	<0.001	1.36	<0.001	1.25	<0.001	0.88	<0.001	1.39	<0.001
College degree	0.48	<0.001	1.22	<0.001	1.02	0.62	0.74	<0.001	1.44	<0.001
College>	0.21	<0.001	0.95	0.39	0.71	<0.001	0.66	<0.001	1.76	<0.001
Health status
Excellent	REF		REF		REF		REF		REF
Very good	1.86	<0.001	0.21	<0.001	0.19	<0.001	0.13	<0.001	0.24	<0.001
Good	1.94	<0.001	0.36	<0.001	0.29	<0.001	0.18	<0.001	0.30	<0.001
Fair	2.11	<0.001	0.54	<0.001	0.50	<0.001	0.27	<0.001	0.36	<0.001
Poor	1.66	<0.001	0.83	<0.001	0.79	<0.001	0.53	<0.001	0.58	<0.001
Spanish response	1.38	<0.001	1.04	0.46	0.83	0.01	0.60	<0.001	0.76	<0.001
Urban	REF		REF		REF		REF		REF
Rural	1.26	0.09	0.65	0.02	0.65	0.02	0.68	0.06	1.11	0.38
U.S. region
Northeast	REF		REF		REF		REF		REF
Midwest	1.30	<0.001	1.32	<0.001	1.26	<0.001	0.97	0.38	0.85	<0.001
South	1.96	<0.001	1.34	<0.001	1.52	<0.001	0.89	<0.001	0.77	<0.001
West	1.54	<0.001	1.51	<0.001	1.51	<0.001	0.82	<0.001	0.72	<0.001
N*	113,439

SOURCE: 2011–2016 National Health Interview Survey

Notes: “Before” corresponds to mean values for years 2011–2013, period before the implementation of the ACA individual health insurance mandate. “After” corresponds to mean values for years 2014–2016, period after the implementation of the ACA individual health insurance mandate.

^*The weighted sample size corresponds to 48,839,629 adults.