Authors 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. In this study, authors 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. Data were collected on each indicator for California's 58 counties. Each indicator was coded and counties scored to construct two indices. The county data were merged with a sample of Latino adults and youth in the 2021 American Community Survey (n = 249,979). Authors 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.  

Findings: 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 U.S. 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.