Journal article
The Shifting Federal and State Policy Landscapes for Health Insurance Coverage of Noncitizen Immigrants: Where Are We Thirty Years After PRWORA?
Journal of health politics, policy and law, v 50(6)
20 Jun 2025
PMID: 40538327
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Since the 1996 passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), states have taken different approaches to noncitizen health coverage. California and Illinois expanded access using state funds, driven by policy innovation and advocacy coalitions, while Texas and Georgia maintained restrictive policies that reflected conservative politics and fiscal concerns. This study used the Policy Diffusion and Policy Contexts frameworks to analyze PRWORA influence on state decisions on immigrant health coverage. By examining the policy trajectories of California, Illinois, Texas, and Georgia, we highlighted the growing fragmentation in immigrant health coverage. The study reviewed trends in health insurance and Medicaid enrollment among noncitizens from 2008 to 2023 using data from the American Community Survey (ACS) and a RAND cost estimation tool. California and Illinois showed greater improvements in insurance coverage and Medicaid enrollment, while Texas and Georgia had lower gains. We found that restrictive policies led to higher uninsured rates and different tradeoffs in terms of cost and potential enrollment of noncitizens into Medicaid. Future policy developments will likely be influenced by federal policy changes, demographic shifts, and advocacy efforts. Understanding these dynamics is important for addressing disparities in immigrant health care access and informing policy debates.
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Details
- Title
- The Shifting Federal and State Policy Landscapes for Health Insurance Coverage of Noncitizen Immigrants: Where Are We Thirty Years After PRWORA?
- Creators
- Arturo Vargas Bustamante - University of California, Los AngelesAlexandra C Rivera González - University of California, MercedAresha Martinez-Cardoso - University of ChicagoClara B Barajas - Drexel UniversityMaria-Elena Young - University of California, MercedAlexander N Ortega - University of Hawaiʻi at Mānoa
- Publication Details
- Journal of health politics, policy and law, v 50(6)
- Publisher
- Duke University Press
- Number of pages
- 26
- Grant note
- National Institute on Minority Health and Health Disparities of the National Institutes of Health: R01MD018727
This article was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number R01MD018727. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Arturo Vargas Bustamante wants to acknowledge Ahmad Ismail for research support.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Health Management and Policy
- Web of Science ID
- WOS:001602872200006
- Scopus ID
- 2-s2.0-105019614141
- Other Identifier
- 991022059926504721
UN Sustainable Development Goals (SDGs)
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Health Care Sciences & Services
- Health Policy & Services
- Medicine, Legal
- Social Issues
- Social Sciences, Biomedical