Pediatrics. 2022 Sep 1;150(3). doi: 10.1542/peds.2022-057034.
Expansion of insurance eligibility is associated with positive health outcomes. We compared uninsurance and health care utilization for (1) all children, and (2) children in immigrant families (CIF) and non-CIF who resided inside and outside of the seven US states/territories offering public health insurance to children regardless of documentation status ("extended-eligibility states/territories").
Using the cross-sectional, nationally representative National Survey of Children's Health-2019, we used survey-weighted, multivariable Poisson regression to assess the association of residence in nonextended- versus extended-eligibility states/territories with uninsurance and with health care utilization measures for (1) all children, and (2) CIF versus non-CIF, adjusting for demographic covariates.
Of the 29 433 respondents, the 4035 (weighted 27.2%) children in extended- versus nonextended-eligibility states/territories were more likely to be CIF (27.4% vs 20.5%, P < .001), 12 to 17 years old (37.2% vs 33.2%, P = .048), non-White (60.1% vs 45.9%, P < .001), and have a non-English primary language (20.6% vs 11.1%, P < .001).The relative risk of uninsurance for children in nonextended- versus extended-eligibility states/territories was 2.0 (95% confidence interval 1.4-3.0), after adjusting for covariates. Fewer children in extended- versus nonextended-eligibility states/territories were uninsured (adjusted prevalence 3.7% vs 7.5%, P < .001), had forgone medical (2.2% vs 3.1%, P = .07) or dental care (17.1% vs 20.5%, P = .02), and had no preventive visit (14.3% vs 17.0%, P = .04). More CIF than non-CIF were uninsured, regardless of residence in nonextended- versus extended-eligibility states/territories: CIF 11.2% vs 5.7%, P < .001; non-CIF 6.1% vs 3.1% P < .001.
Residence in nonextended-eligibility states/territories, compared with in extended-eligibility states/territories, was associated with higher uninsurance and less preventive health care utilization.
保险资格的扩大与健康结果呈正相关。我们比较了（1）所有儿童，以及（2）居住在美国七个提供公共医疗保险的州/地区（无论身份文件如何）的移民家庭（CIF）和非 CIF 儿童的无保险和医疗保健利用率，这些州/地区扩大了儿童的保险资格。
使用全国代表性的横断面全国儿童健康调查-2019，我们使用调查加权多变量泊松回归来评估居住在非扩展与扩展资格州/地区与无保险和以下方面的关联：（1）所有儿童，以及（2）CIF 与非 CIF，调整人口统计学协变量。
在 29433 名受访者中，与居住在非扩展资格州/地区相比，在扩展资格州/地区的 4035 名（加权 27.2%）儿童更有可能是 CIF（27.4%比 20.5%，P <.001），年龄在 12 至 17 岁（37.2%比 33.2%，P =.048），非白人（60.1%比 45.9%，P <.001），并且母语不是英语（20.6%比 11.1%，P <.001）。在调整协变量后，非扩展资格州/地区儿童无保险的相对风险为 2.0（95%置信区间 1.4-3.0）。与非扩展资格州/地区相比，更多的扩展资格州/地区的儿童没有保险（调整后的患病率为 3.7%比 7.5%，P <.001），放弃了医疗保健（2.2%比 3.1%，P =.07）或牙科保健（17.1%比 20.5%，P =.02），并且没有进行预防访问（14.3%比 17.0%，P =.04）。无论居住在非扩展资格州/地区还是扩展资格州/地区，CIF 的无保险人数都多于非 CIF：CIF 为 11.2%比 5.7%，P <.001；非 CIF 为 6.1%比 3.1%，P <.001。
与居住在扩展资格州/地区相比，居住在非扩展资格州/地区与更高的无保险和更少的预防保健利用率相关。
