The Impact of Immigration Policies on Mental Health Morbidity and Access to Health Care Among U.S. Latinos: A 2016 State-Level Analysis

Abstract

Sources of structural racism, such as immigration policy exclusivity, play a crucial role in sustaining racial/ethnic health inequities but have been largely disregarded by public health interventions and the current literature on discrimination and Latino health in the United States. Consequently, the purpose of this study is to examine how state-level immigration policy climate is associated with mental health outcomes and access to health care among Latinos. Using data from the Urban Institute’s State Immigration Policy Resource, we developed a policy climate index with 16 policies in three domains: public benefits, enforcement and integration. We then examined the relation of this index and each policy domain to days of poor mental health, health insurance coverage before age 65, access to a personal doctor, and unmet health care need because of cost among Latinos and non-Latinos from all 50 states and D.C. in the 2016 Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey of non-institutionalized individuals aged 18 years or older. In the full sample, state-level policy exclusivity predicted lower odds of having health insurance, lower odds of having a personal doctor, and greater odds of having an unmet health care need because of cost. These associations were stronger among Latinos versus non-Latinos in at least one policy domain and were robust to individual- and state-level confounders. On the other hand, state-level policy exclusivity was not associated with a higher rate of poor mental health days among Latinos. Collectively, these results suggest that although restrictive immigration policies may contribute to several health care access barriers in the U.S. Latino population, other factors may moderate the relationship between these policies and Latino mental health. Alternative explanations, policy implications, limitations and directions for future research are discussed.