The Affordable Care Act (ACA) allowed many in the U.S. who had never before had health insurance to finally be able to acquire that vital benefit. However, undocumented immigrants – who often turn to emergency rooms for care – are not eligible for coverage under the ACA.

Wilson Family LEO Assistant Professor Adrienne Sabety and a colleague from the Massachusetts Institute of Technology (MIT) partnered with the New York City Department of Health and Mental Hygiene to determine how access to primary care would affect both undocumented immigrants’ health and the use of emergency departments for routine care.

The intervention study provided nearly 2,500 undocumented immigrants access to nine primary care clinics in New York City. The 14-month project showed that average-risk patients increased their doctors’ office visits by 17 percent, which lowered emergency department visits by 21 percent, saving emergency departments nearly $200 per person. The results for high-risk individuals was even more dramatic, with a 42 percent decrease in emergency room use, which led to a 68 percent reduction in costs for non-admitted high-risk patients (equaling a savings of almost $500 per patient). The results of their research are available today as a NBER working paper.

Prior research shows that undocumented immigrants make up nearly a quarter of the uninsured in the U.S., and they have little chance of obtaining coverage. This lack of healthcare is not only affecting the current generation of undocumented immigrants, but also their children, many of them citizens by birth. While undocumented immigrants largely do not have access to health insurance, they can access primary care at safety-net clinics, like federally qualified health centers and community health clinics, although these care options are underused.

Sabety and her colleagues wanted to test their idea—of making initial appointments for patients at primary care, safety-net clinics—to relieve stress on already overburdened emergency departments. This provides access to healthcare while avoiding issues with insurance expansion.



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