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Susmita Pati, MD, MPH and Shooshan Danagoulian, MSc

Susmita Pati is with the Leonard Davis Institute of Health Economics and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, and the Children's Hospital of Philadelphia, Philadelphia. At the time of this study, Shooshan Danagoulian was with the Children's Hospital of Philadelphia, Philadelphia.

Correspondence: Requests for reprints should be sent to Susmita Pati, MD, MPH, CHOP North, Room 1534, 34th and Civic Center Boulevard, Philadelphia, PA 19104 (e-mail: pati{at}e-mail.chop.edu).

Objectives. We sought to determine whether the reversal of the public charge rule of the Illegal Immigration Reform and Immigrant Responsibility Act, which may have required families to pay for benefits previously received at no cost, led to immigrant children becoming increasingly reliant on public health insurance programs.

Methods. We conducted a secondary data analysis focusing on low-income children sampled in the 1997 through 2004 versions of the National Health Interview Survey.

Results. Between 1997 and 2004, public health insurance enrollments and the numbers of uninsured foreign-born children in the United States increased by 3.1% and 2.7%, respectively. Using multinomial logistic regression models to account for the substantial differences in socioeconomic status between foreign-born and US-born children, we found that low-income US-born children were just as likely as foreign-born children to have public health insurance coverage (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 0.89, 1.52) and that, after 2000, foreign-born children were 1.59 times (95% CI = 1.24, 2.05) more likely than were US-born children to be uninsured (vs publicly insured).

Conclusions. In the wake of the reversal of the public charge rule, immigrant children are increasingly likely to be uninsured as opposed to relying on public health insurance.