Medicaid Health Insurance Coverage Among the Foreign-Born Following ACA Implementation: Disparities by Migration Status

Estimating the impact of the Affordable Care Act’s (ACA) Medicaid expansion on health coverage in the foreign-born population is complicated by the inability of most national-level surveys to measure the migration status—and thus eligibility for public programs—of foreign-born residents, especially those who are not naturalized U.S. citizens. Using a combined-sample multiple imputation (CSMI) approach, we leverage the large sample of the American Community Survey (ACS) and impute migration status using the 2008 and 2014 panels of the Survey of Income and Program Participation (SIPP), the only nationally representative survey to include any proxies for migration status. Multivariate difference-in-differences models suggest that Medicaid expansion increased the odds of Medicaid coverage among eligible immigrants. Medicaid expansion, however, was not associated with changes in Medicaid coverage rates for non-Lawful Permanent Residents (non-LPRs, a group that consists overwhelmingly of unauthorized immigrants). Disparities in Medicaid coverage persist across migration status groups following the ACA, particularly as the unauthorized remain excluded from expansion, subsidies, and the ACA marketplace. The results have implications for health and immigration policy reform.