Student Theses and Dissertations

Date of Award

Spring 5-26-2022

Document Type


Degree Name

Doctorate of Business Administration (DBA)

Program of Study

Business Administration



First Advisor

Alex Mills

Second Advisor

Cynthia Thompson


Research shows that many non-medical factors, called social determinants of health, impact health outcomes. These social determinants include both socioeconomic factors, such as income and education, and public policies, such as laws and regulations affecting access to healthcare. This study proposes that citizenship status is also a social determinant of health and supports this proposition by examining the impact of citizenship status on healthcare access and utilization in New York. The study data consist of enrollments, disenrollments, and paid medical expenses incurred by patients enrolled in Medicaid or the Essential plan, both of which are government-sponsored health plans. In addition to studying differences between citizens and non-citizens, the study leverages a 2019 policy change in U.S. immigration regulations, known as the Public Charge rule, as a natural experiment. The change in the Public Charge rule explicitly tied the use of public health benefits to non-citizen recipients’ ability to remain in the United States. Compared with U.S. citizens, non-citizens were more likely to disenroll from healthcare coverage after the implementation of the rule change. Among those who remained enrolled, there was little difference in plan utilization between citizens and non-citizens. The change in policy linking immigration to healthcare appears to have created a new barrier for non-citizens to access healthcare service



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