The Impact of the Affordable Care Act’s Medicaid Expansion on Medicaid Enrollment among Low-Income Asian Immigrants: The Roles of Length of Residency and Language Acculturation

The Affordable Care Act of 2010 enacted the largest expansion of Medicaid coverage for adults in recent history. Although this expansion had positive impacts on insurance coverage levels and health outcomes within the American population as a whole, there is less work analyzing the impacts of this policy change on immigrants, especially Asian immigrants. Asian immigrants are the fastest-growing population of immigrants with a large degree of intergroup variation, so it is important to understand their interactions with the U.S. social safety net to evaluate the efficacy of policy changes to expand the reach of the safety net. I use data from the 2006-2022 waves of the American Communities Survey to estimate the impact of Medicaid expansion on low-income Asian immigrants using difference-in-difference
and event models. Then, I investigate the role of residency-based and language-based acculturation factors on mediating these changes using an interaction model, and I perform these analyses on the six largest Asian ethnic subgroups. Although Medicaid expansion led to an increase in the probability of Medicaid enrollment for low-income Asian immigrants, I find a remarkable degree of heterogeneity between the groups, and I find that this increase is driven primarily by crowd out from private insurance. Furthermore, I find that those who have resided in the U.S. for a longer time experience a larger effect of Medicaid expansion on Medicaid enrollment compared to those who have been in the U.S. for a shorter time. This paper sheds light on the important ways that these Asian immigrant subgroups differ in their interaction with the healthcare social safety net.