The determinants of immigrant health insurance in the United States: Understanding the role of health care in origin societies.

We examine how immigrants' health insurance in the United States is shaped by institutional traits of the health care systems in their origin societies. Conditional on a wide range of individual, country-of-origin, state-level, and temporal controls, we find the affordability of health care back home helps explain immigrants' US health coverage. Specifically, low- and middle-income migrants from countries with less affordable health care are more likely to get private insurance once in the United States and, correspondingly, less likely to have public coverage, relative to migrants from countries with more affordable care. The relationship conforms to multiple hypotheses. As predicted by the institutional beliefs hypothesis, migrants from countries with less affordable care might anticipate equally expensive health services in the United States and, in turn, insure themselves against high medical bills. Likewise, as predicted by the endogenous preferences hypothesis, migrants from countries with less affordable care might be accustomed to paying more for health care and, in turn, be less reluctant to pay for private health insurance. Overall, the findings underscore the relevance of migrants' past health care experiences in their origin societies in informing their health insurance in the United States even years after migration.