Lopez Mercado Damaris, Mortensen Karoline, Rivera-González Alexandra C, Stimpson Jim P, Vargas Bustamante Arturo, Roby Dylan H, Chen Jie, Barajas Clara B, Ortega Alexander N
Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
Department of Health Management and Policy, Herbert Business School, University of Miami, Miami, FL.
Med Care. 2025 Apr 1;63(4):283-292. doi: 10.1097/MLR.0000000000002107. Epub 2024 Dec 27.
We studied patterns in health care access between Latino and non-Latino White adults according to citizenship status before and after the American Rescue Plan Act (ARPA) of 2021 was enacted to determine whether inequities changed.
This study used 2019-2022 National Health Survey Interview data. Differences in predicted probabilities from logistic regression models were used to estimate changes in health care access outcomes (any insurance coverage, private insurance coverage, delaying care due to cost, and having a usual source of care) among Latino citizens, Latino noncitizens, and non-Latino White citizens in periods before and after ARPA's enactment (2019-2020 vs 2021-2022).
Adjusted models observed that inequities in health care access did not change between Latino and non-Latino White citizens from the 2019-2020 period to the 2021-2022 period. Moreover, the health insurance gap widened by 5.8 percentage points between Latino noncitizens and non-Latino White citizens ( P < 0.01) and by 5.2 percentage points between Latino noncitizens and Latino citizens ( P < 0.05) from the 2019-2020 period to the 2021-2022 period. The private insurance coverage gap widened by 6.8 percentage points between Latino noncitizens and non-Latino White citizens ( P < 0.01) and by 6.9 percentage points between Latino noncitizens and Latino citizens ( P < 0.01) from the 2019-2020 period to the 2021-2022 period.
ARPA may have helped increase White citizens' insurance coverage, but this benefit did not extend to Latinos, regardless of citizenship status. Developing more inclusive health policies that do not have restrictions based on citizenship and legal authorization status is an important step toward reducing health care inequities.
我们研究了2021年《美国救援计划法案》（ARPA）颁布前后，拉丁裔和非拉丁裔白人成年人在医疗保健获取方面根据公民身份的模式，以确定不平等现象是否发生了变化。
本研究使用了2019 - 2022年全国健康调查访谈数据。逻辑回归模型预测概率的差异被用于估计在ARPA颁布前后（2019 - 2020年与2021 - 2022年）拉丁裔公民、拉丁裔非公民和非拉丁裔白人公民在医疗保健获取结果（任何保险覆盖、私人保险覆盖、因费用而推迟就医以及有常规医疗服务来源）方面的变化。
调整后的模型观察到，从2019 - 2020年到2021 - 2022年，拉丁裔和非拉丁裔白人公民在医疗保健获取方面的不平等没有变化。此外，从2019 - 2020年到2021 - 2022年，拉丁裔非公民和非拉丁裔白人公民之间的医疗保险差距扩大了5.8个百分点（P < 0.01），拉丁裔非公民和拉丁裔公民之间扩大了5.2个百分点（P < 0.05）。从2019 - 2020年到2021 - 2022年，拉丁裔非公民和非拉丁裔白人公民之间的私人保险覆盖差距扩大了6.8个百分点（P < 0.01），拉丁裔非公民和拉丁裔公民之间扩大了6.9个百分点（P < 0.01）。
ARPA可能有助于增加白人公民的保险覆盖，但这种益处并未扩展到拉丁裔，无论其公民身份如何。制定更具包容性、不基于公民身份和法律授权状态进行限制的健康政策是减少医疗保健不平等的重要一步。
