Indirect effects of immigration enforcement on health care utilization among lawfully present older Hispanics.

Immigration enforcement can indirectly affect U.S. citizens and lawfully present immigrants though "chilling effects," where immigrants avoid public resources altogether because of ambiguous immigration law, public charge rules, and network effects. Indirect effects have been documented in take-up rates of public assistance programs, but there is a large gap in knowledge on how immigration enforcement could indirectly affect health care seeking behavior. We examined the impact of Secure Communities, an immigration enforcement program that began in 2008, on health care utilization among older lawfully present Hispanic immigrants and citizens. Using restricted geographic data from the Health and Retirement Study (HRS), we employed a staggered difference-in-differences model comparing U.S.-born Hispanic citizens and likely authorized Hispanic immigrants to a reference group of non-Hispanic, U.S.-born citizens. The main outcome was the probability of having an office visit with a health care provider. We estimate that Secure Communities led to a 16.9 % decline in the probability of having a visit with a health care provider for likely authorized Hispanic immigrants relative to non-Hispanic U.S.-born respondents. These declines are not driven by health insurance coverage, and are even larger among individuals with worse health status and less education. The declines in utilization relate to chilling effects and fear of putting others at risk as the respondents in our study are likely not at immediate risk of deportation or other immigration consequences. As immigration enforcement increases, further efforts should be made to protect access to health care.