Health Insurance and the Impact of Citizenship Status, Employment Status, and Poverty Status

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The Patient Protection and Affordable Care Act’s expanded access to health insurance in 2014 did not guarantee access to health insurance for low-income and undocumented immigrants living in the U.S. While employment status and poverty status are estimated to play a major role in the prediction of health insurance status, this study hypothesized that citizenship status predicts health insurance status the most. Using secondary data from the 2017 California Health Interview Survey (CHIS), this study examined a random 10% sample of the adult respondents. Dichotomous variables were created from the HMO Status, Citizenship Status Employment status, and Poverty level status variables of the CHIS. A chi-square test of independence was performed to determine the relationship between health insurance and citizenship, employment, poverty. A Binary logistic regression was performed to identify the strongest predictor of health insurance status among citizenship, employment, poverty. A significant association between citizenship status and health insurance status was found, (X2 (1) = 40.37, p < .001). The odds of being insured were 4.3 times higher among citizens, compared to non-citizens. Citizenship status had the greatest significant influence on health insurance status (p = .001). Those who are non-citizens are 71% less likely to have health insurance compared to citizens. The findings of this study suggest that policy interventions should include further expansion of health insurance eligibility for immigrants. A wider net of eligibility would improve the uptake in health insurance, leading to better health outcomes with the improved access to healthcare. In order to minimize the barriers to accessible healthcare and for improved health outcomes of our nation as a whole, policymakers must understand the current relationship and impact of citizenship status on health insurance status. This study contributes to that understanding.
A thesis submitted in partial fulfillment of the requirements for the degree Master of Public Health
Public Health, Public Policy, Health Care