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The Chilling Effect: Anti-Immigrant Threat and Insurance Status

The Chilling Effect: Anti-Immigrant Threat and Insurance Status. Cassie Hartzog COEMH Workshop May 13-14, 2010. Why Insurance is Important. Better health outcomes Greater continuity of care More preventive care More timely care Financial protection Equity. Health Insurance Disparities .

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The Chilling Effect: Anti-Immigrant Threat and Insurance Status

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  1. The Chilling Effect: Anti-Immigrant Threat and Insurance Status Cassie Hartzog COEMH Workshop May 13-14, 2010

  2. Why Insurance is Important • Better health outcomes • Greater continuity of care • More preventive care • More timely care • Financial protection • Equity

  3. Health Insurance Disparities • Foreign-born are less likely to have health insurance • Less public, private, & employer insurance • Especially non-citizen immigrants • Employer and employee characteristics are important • Immigrants are less likely to work for employers who offer insurance • Unexplained gaps remain!

  4. Anti-Immigrant Threat • 1994 – Proposition 187 • Would have denied education and health care to undocumented immigrants • 1996 – PRWORA • Recent immigrants lost benefits; confusion about the consequences of using benefits • 2010 - Arizona

  5. Effects of Anti-Immigrant Laws • Anecdotal evidence that laws discourage use of public benefits • 50% drop in Medi-Cal enrollment in LA following PRWORA • Spillover effect – • Largest drop among green-card holders, not the undocumented

  6. Is There a Chilling Effect? • How much variation in the uninsured rate across counties? • How much of that variation is due to county composition, how much to county-level characteristics? • Does the social environment affect insurance status?

  7. Methods and Data • Multilevel logistic regression models • Dependent variables – uninsured, private insurance, public insurance • Level 1: 8,460 non-elderly adults (California Health Interview Survey 2005) • Level 2: 55 of California’s 58 counties

  8. Measures • County-level covariates • Pro-Prop. 187 vote (1994) • Immigration raid in 2004 • Distance to border, unemployment rate • Individual-level covariates • Age, gender, ethnicity • Education, log of family income • Employment status & occupation • Residency status, LEP, < 5yrs in US

  9. Results – No Individual Controls

  10. Adjusting for County Composition

  11. Adjusting for County Composition

  12. Individual Level Results

  13. Summary • There is county variation, and context matters • Anti-immigrant attitudes are associated with higher odds of uninsurance, lower odds of private insurance, but higher odds of public insurance • Raids increase the odds of uninsurance

  14. Future Research • Untangle economic and social context • Pro-immigrant context – immigrant organizations • Other outcomes – access to health care

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