The effect of immigration and welfare reform legislation on immigrants' access to health care, Cuyahoga, and Lorain Counties.

This study examined the effect of the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 on immigrants' ability to access health care in two counties in Northeastern Ohio. Semistructured interviews were conducted with 251 individuals of varying immigration status and ethnicity. Data collected included type of recent illness, type and location of care received, type of health insurance, if any, and problems encountered. Significant associations were found between birth in a former Soviet-controlled area and use of public insurance. We did not detect an adverse effect of the welfare and immigration reform laws on ability to access care, most likely because a large proportion of respondents were permanent residents or asylees and were eligible for publicly funded medical care under the reform laws. The most common problems in obtaining medical care included lack of insurance and/or money, transportation, language, dissatisfaction with the doctor's care, and long waits. Individuals born in former Soviet-controlled areas as well as those who spoke Spanish or Slavic languages at home or work reported more difficulties in accessing care. Many undocumented individuals indicated that they would delay or refrain from seeking care due to fear of immigration consequences.