Estimating the Impact of English Language Proficiency on Immigrant Health Care Utilization

Language proficiency remains a central determinant of healthcare access among immigrants in the United States. Although the Affordable Care Act (ACA) expanded insurance coverage, disparities in healthcare utilization may persist for individuals with limited English proficiency (LEP), suggesting that non-financial barriers continue to affect access to care. This paper examines whether English language proficiency, immigration status, and household language resources influence healthcare utilization among insured adults in the post-ACA period. Using pooled data from the 2013-2018 National Health Interview Survey, the analysis estimates regression models for three outcomes: having a usual source of care, physician visits, and emergency department use. The empirical framework follows Aday and Andersen's (1974) Behavioral Model of Health Services Use and controls for predisposing, enabling, and need factors. This paper finds that individuals with LEP initially appear less likely to have a usual source of care and fewer physician visits, but these differences largely diminish after accounting for immigration status, insurance coverage, and socioeconomic characteristics. In contrast, LEP is consistently associated with lower emergency department utilization. Additionally, result suggest household language resources do not significantly mitigate utilization gaps. Although the results suggest that differences in healthcare use are mostly driven by integration and structural factors rather than language barriers alone, there is an opportunity for targeted language-access policies in emergency departments to help reduce barriers to emergency care utilization among limited English proficient populations.