The welcome mat effect

Immigration status and insurance status: Two social factors that we know determine an individual’s ability to access health care. Yet the question remains, how do these two factors interact? Furthermore, how do these factors affect children in immigrant families?

In 2000, 36% of uninsured children lived in immigrant families. This number has risen to 42% in 2010, as per data collected from the American Community Survey. Language barriers have an additional effect on insurance coverage rates: an immigrant child in a Spanish-speaking household is 2.1% more likely to be uninsured than a child in a primarily English-speaking household.

In the report, Covering the Remaining Uninsured Children, Eric Seiber highlights the importance of providing all children, including those born to immigrant families, access to appropriate health care. Though the Affordable Care Act expanded eligibility for Medicaid and CHIP programs, many children in immigrant families that are were already eligible to access social safety networks providing health insurance were unable or fearful to do so. This leaves those following the roll-out of the ACA wondering, “What’s the point?” If these families were already eligible, how is expansion going to help?

However, something surprising happened. There have been positive effects from Medicaid expansion due to improved community outreach and enrollment education programs that began with the Affordable Care Act. The so-called “Welcome Mat” effect has lead to increased enrollment even among people who were eligible for Medicaid before the expansion.

Florida, Montana, and Idaho all saw significant increases in Medicaid enrollment (8.2%, 6.9% and 6.6% respectively) despite opting out of the Medicaid expansion. Policy experts have attributed these enrollment figures to increased awareness of available social resources by indigent communities, either provided through the federal government or by community organizations.

Commentary

Indeed, immigration status and associated problems with cultural literacy, language barriers, and worries of deportation have created significant barriers for immigrant families to access health care. In many cases, parents may not be willing to pursue federally subsidized health insurance for their children born in the United States because they are afraid of exposing their own immigration status.

However, whether immigration status has a causal relationship with insurance status is unclear, as many of the factors associated with immigrants, such as poverty, low educational attainment, and language and cultural barriers are themselves associated with lower levels of health insurance

The true solution lies not in any one policy decision, but in addressing the root causes of the various social disparities apparent within American society. Equity in healthcare cannot, and will not, be attained before resources are equally allocated across our social strata.

Only then will we all have a fair chance at attaining healthcare, among other measures of health and happiness.

Seiber, EE. Med Care. 2014; 52 (3): 202-207.