Dylan H. Roby

This study examines health care access, utilization, and experiences among Latino children in California by parental citizenship and household language analyzing merged data from the 2021–2022 California Health Interview Survey and the follow-up Latino Youth Health Study of the same years. Primary outcomes were parental reports of children's health care access, utilization, and experiences in the past year. The main predictors were variables stratified by parental citizenship status (both citizen parents versus one citizen and one noncitizen parent versus both noncitizen parents) and household language (English-only versus English and Spanish versus Spanish-only). Multivariable analyses adjusted for parental education, family income, parent-reported child's health status, child's age, and child's insurance.

Findings: Findings showed no significant differences in health care access across groups. However, children with both noncitizen parents and from Spanish-only households were more likely to have had well-child visits and general doctor visits than children with both citizen parents and in English-only households. Additionally, parents of children with both noncitizen parents were more likely to feel respected by doctors than those with both citizen parents. Conversely, compared to parents with both citizen parents, parents of children with one citizen and one noncitizen parent were less likely to report that doctors spent enough time with their children and less likely to express high satisfaction with their children's health care.

Patterns of health care access, utilization, and experiences among Latino children in immigrant families in California are improving, which are likely associated with recent inclusive health policies in the state.
 

Adverse childhood experiences (ACEs) have been associated with poor health and underuse of preventive health services. However, less is known about how ACEs are associated with quality of care that children receive, like care that involves shared decision-making. Using data from the 2021–2022 National Survey of Children's Health, authors analyzed the association between ACEs, both individual and cumulative, and (1) needing medical decisions made in the past 12 months and (2) three different measures of always receiving care that involved shared decision-making.

Findings: After accounting for confounders, the number of ACEs experienced and most individual ACE items were associated with higher odds of needing medical decisions made, and lower odds of receiving health care that involved providers always engaging in the three measures of shared decision-making. This study expands the research showing a deleterious impact of ACEs on utilization of health care by showing that ACEs are associated with lower quality health care. This can be particularly detrimental to children with a history of ACEs because they have a greater need for health care and are less likely to use many types of health care. Efforts to improve health care quality for all children will be of particular benefit to vulnerable groups, like those with a history of ACEs.
 

Authors studied patterns in health care access between Latino and non-Latino white adults according to citizenship status before and after the American Rescue Plan Act (ARPA) of 2021 was enacted to determine whether inequities changed. This study used 2019–2022 National Health Survey Interview data. Differences in predicted probabilities from logistic regression models were used to estimate changes in health care access outcomes (any insurance coverage, private insurance coverage, delaying care due to cost, and having a usual source of care) among Latino citizens, Latino noncitizens, and non-Latino white citizens in periods before and after ARPA's enactment (2019–2020 vs. 2021–2022).

Findings: Adjusted models observed that inequities in health care access did not change between Latino and non-Latino white citizens from the 2019–2020 period to the 2021–2022 period. Moreover, the health insurance gap widened by 5.8 percentage points between Latino noncitizens and non-Latino white citizens and by 5.2 percentage points between Latino noncitizens and Latino citizens from the 2019–2020 period to the 2021–2022 period. The private insurance coverage gap widened by 6.8 percentage points between Latino noncitizens and non-Latino white citizens and by 6.9 percentage points between Latino noncitizens and Latino citizens from the 2019–2020 period to the 2021–2022 period.

ARPA may have helped increase white citizens' insurance coverage, but this benefit did not extend to Latinos, regardless of citizenship status. Developing more inclusive health policies that do not have restrictions based on citizenship and legal authorization status is an important step toward reducing health care inequities.
 

The Inflation Reduction Act of 2022 (IRA) included additional federal subsidies to make health insurance more affordable in the individual market, but these expire at the end of 2025. If Congress does not extend the expanded subsidies and levels revert to those in the original Affordable Care Act, all 2.37 million Californians in the individual market — including those not receiving subsidies — would face higher health insurance premiums and be forced to choose between more expensive coverage, less generous coverage, or forgoing coverage altogether and going uninsured. Under this scenario, authors project that in 2026:

• 1,558,000 Californians would pay an average of $967 more per year but maintain coverage despite having their subsidies reduced or eliminated;
• 740,000 Californians enrolled in unsubsidized coverage would pay an average of $253 more per year due to the worse risk-mix of the individual market if the IRA subsidies were eliminated;
• 69,000 additional Californians would become uninsured.

Authors conclude that maintaining IRA-level subsidies in the individual market would protect 2.37 million Californians from insurance premium increases and keep 69,000 Californians covered. For these subsidies to continue, Congress must act in 2024 or 2025. In early 2025, insurers will develop their rates for the 2026 coverage year, and rates will be finalized by the middle of 2025. Congressional action before then could help avoid premium increases.