County-Level Immigration Policy and Health Insurance Among Latino Adults and Youth

Policy Points Local jurisdictions have some policymaking discretion related to immigration. Local immigration policy contexts are associated with differences in health insurance coverage among US-born, naturalized, and noncitizen Latinos. Entrenched immigration policy-related social inequities may have a greater influence on health insurance disparities than local policymaking.

Federal and state immigration policies influence access to health insurance for Latino populations. Local jurisdictions also have immigration-related policymaking power, but there has been limited study of their influence on health care access. We examined the relationship between county-level immigration policy contexts and health insurance coverage of Latino adults and youth in California using two measures that capture local-level policy decisions and immigration policy-related social inequity.

We constructed two measures of local-level immigration policy contexts by developing seven indicators of local policy enactment and implementation and 11 indicators of immigration-related social inequity. We collected data on each indicator for California's 58 counties. We coded each indicator and scored counties to construct two indices. We merged the county data with a sample of Latino adults and youth in the 2021 American Community Survey (n = 249,979). We then conducted mixed-effects modeling to test the associations between the local policymaking and social inequity indices and health insurance and tested interactions by citizenship for both adults and youth. Predicted probabilities were estimated.

There were no significant associations or interactions by citizenship between county-level policymaking and health insurance for Latino adults or youth. In contrast, there were significant associations and interactions by citizenship between immigration-related social inequity and health insurance. Among adults, naturalized and US citizens had higher predicted probabilities of being uninsured in counties with high compared with low social inequity, but there were no differences for noncitizens. Among youth, noncitizens and those with noncitizen parents had higher predicted probabilities of being uninsured in counties with high social inequity.

Local policy contexts and social inequity related to immigration policymaking are associated with differences in health insurance coverage among US-born, naturalized, and noncitizen Latinos.