Content area
Full Text
We sought to evaluate the relationship between state-level implementation of the Patient Protection and Affordable Care Act (ACA) and resettlement patterns among refugees.We linked federal refugee resettlement data to ACA expansion data and found that refugee resettlement rates are not significantly different according to state-level insurance expansion or cost. Forty percent of refugees have resettled to states without Medicaid expansion. The wide state-level variability in implementation of the ACA should be considered by federal agencies seeking to optimize access to health insurance coverage among refugees who have resettled to the United States. (Am J Public Health. 2016;106: 662-663. doi:10.2105/AJPH.2015.303017)
With international crises occurring with greater frequency and intensity, millions of people around the world are being displaced. Approximately 65 000 refugees from more than 65 different countries are being resettled in the United States each year.1 This figure is set to rise to 100 000 per year as a result of to the humanitarian crisis in Syria. Refugees are more likely to have medical and psychiatric conditions than other immigrants,2-8 and insufficient preresettlement health care often results in acute decompensation of chronic illnesses and missed preventive care opportunities that necessitate health care attention upon resettlement.9-11 Unfamiliarity with the complex US social systems creates unique challenges for refugees, including gaps in state insurance programs, employer-based insurance restrictions, or simply insufficient income to pay for health service or prescription copayments.
US refugee resettlement involves coordination of services between federal agencies, nongovernmental organizations, and local service delivery organizations. As a result of the substantial variability in state social services provided to refugees, resettlement services have been described as a " lottery. " 14 Passage of the Patient Protection and Affordable Care Act (ACA; Pub L No. 111-148) was intended to expand access to comprehensive health insurance among vulnerable populations, particularly through the Medicaid program for eligible adult refugees and health insurance marketplaces (exchanges) for those not eligible for Medicaid. However, implementation of Medicaid expansion and the creation of exchanges have varied markedly between states, resulting in unanticipated gaps in health insurance access among refugees. The substantial variability in insurance premium costs among state-based exchanges has been cited as further impeding access to health care.15
We sought to describe the relationship between refugee resettlement patterns and state-level health...