title: The association of generation status and health insurance among U.S. children.
abstract: BACKGROUND
  The Patient Protection and Affordable Care Act (ACA) has the potential to reduce the number of uninsured children in the United States by as much as 40%. The extent to which immigrant families are aware of and interested in obtaining insurance for their children is unclear.
  
  
  METHODS
  Data from the 2011-2012 National Survey of Children's Health were analyzed to examine differences by immigrant generational status in awareness of children's health insurance options. Adjusted odds ratios (AORs) were calculated for each outcome variable that showed statistical significance by generation status.
  
  
  RESULTS
  Barriers to obtaining insurance for children in immigrant (first- and second-generation) families include awareness of and experience with various health insurance options, perceived costs and benefits of insurance, structural/policy restrictions on eligibility, and lower likelihood of working in large organizations that offer employee insurance coverage. Although noncitizen immigrants are not covered by ACA insurance expansions, only 38% of first-generation families report being uninsured because of the inability to meet citizenship requirements. Most families in this sample also worked for employers with <50 employees, making them less likely to benefit from expansions in employer-based insurance. In multivariate analyses, third-generation families have increased odds of knowing how to enroll in health insurance (AOR 7.1 [3.6-13.0]) and knowing where to find insurance information (AOR 7.7 [3.8-15.4]) compared with first-generation families.
  
  
  CONCLUSIONS
  ACA navigators and health services professionals should be aware of potential unique challenges to helping immigrant families negotiate Medicaid expansions and state and federal exchanges.
authors.affiliation: Department of Health Policy and Administration and Demography, The Pennsylvania State University, University Park, Pennsylvania rzb10@psu.edu.
authors.forename: Rhonda
authors.initials: R
authors.lastname: BeLue
authors.affiliation: Department of Health Policy and Administration and Demography, The Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Patricia Y
authors.initials: PY
authors.lastname: Miranda
authors.affiliation: Department of Health Policy and Administration and Demography, The Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Bilikisu Reni
authors.initials: BR
authors.lastname: Elewonibi
authors.affiliation: Department of Health Policy and Administration and Demography, The Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Hillemeier
mesh_terms: D002648:Child; D054242:Emigrants and Immigrants; D005260:Female; D062265:Health Insurance Exchanges; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured / Q000208:ethnology* / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act; D014481:United States
keywords: Affordable Care Act; immigrant; insurance