Abstract
Immigrants' perceptions of affordability of insurance and knowledge of insurance after health reform are unknown. We conducted face-to-face surveys with a convenience sample of 1124 patients in three Massachusetts safety net Emergency Departments after the Massachusetts health reform (August 2013-January 2014), comparing immigrants and non-immigrants. Immigrants, as compared to non-immigrants, reported more concern about paying premiums (30 vs. 11%, p=0.0003) and about affording the current ED visit (38 vs. 22%, p<0.0001). Immigrants were also less likely to report having unpaid medical bills (24 vs. 32%, p=0.0079), however this difference was not present among those with any hospitalization in the past year. Insured immigrants were less likely to know copayment amounts (57 vs. 71%, p=0.0018). Immigrants were more likely to report that signing up for insurance would be easier with fewer plans (53 vs. 34%, p=0.0443) and to lack information about insurance in their primary language (31 vs. 1%, p<0.0001) when applying for insurance. Immigrants who sought insurance information via websites or helplines were more likely to find that information useful than non-immigrants (100 vs. 92%, p=0.0339). Immigrants seeking care in safety net emergency departments had mixed experiences with affordability of and knowledge about insurance after Massachusetts health reform, raising concern about potential disparities under the Affordable Care Act that is based on the MA reform.
Highlights
Immigrants’ perceptions of affordability of insurance and knowledge of insurance after health reform are unknown
Insured immigrants were less likely to know copayment amounts (57 vs. 71%, p=0.0018)
Immigrants seeking care in safety net emergency departments had mixed experiences with affordability of and knowledge about insurance after Massachusetts health reform, raising concern about potential disparities under the Affordable Care Act that is based on the MA reform
Summary
Immigrants’ perceptions of affordability of insurance and knowledge of insurance after health reform are unknown. The 2006 Massachusetts health reform, the model for the Affordable Care Act (ACA), aimed to achieve near universal health insurance coverage and thereby increase the affordability of care and broaden healthcare access, for vulnerable populations.[6] early evidence suggests that immigrants gained access to insurance at high rates.[7] Little is known, about immigrants’ perceptions of affordability of care or understanding of insurance after health reform. Because the ACA’s main expansion provisions were implemented in January, 2014 and effects of the reform may not be realized in early years, the full impact of the ACA may not be known for several years. The Massachusetts (MA) reform, in contrast, was implemented from 2006-2007 and provides an opportunity to examine the impact of a similar but more mature reform on immigrants’ experiences several years ahead of ACA data availability
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