Health Expenditure Inequality among Foreign-Born and U.S.-Born Adults: Examining Education Gradients in Health Care and Structural Assimilation Indicators

Stephanie Howe Hasanali, Pennsylvania State University

Since the passage of the Immigration and Nationality Act of 1965 that dramatically altered the national origins of immigrants as well as the 1996 welfare reform law that restricted federal public benefits for non-citizens, immigrants have had a tenuous relationship with the health care system. Using linked data from the Medical Expenditure Panel Survey and National Health Interview Survey, the current study investigates this relationship, manifested by health care expenditure data. I consider both the moderating role of educational attainment and the mediating role of structural assimilation indicators (e.g., years in the U.S., citizenship status, language ability) in explaining immigrant-native inequality in health care expenditures. While health researchers have increasingly been interested in access to health care for immigrants, particularly as the immigrant population as increased and moved around the U.S., no previous study has considered education gradients in health care expenditures and taken advantage of the MEPS-NHIS linked data in this way.