We sought to evaluate the relationship between state-level implementation of the Patient Protection and Affordable Care Act (ACA) and resettlement patterns among refugees.We linked federal refugee resettlement data to ACA expansion data and found that refugee resettlement rates are not significantly different according to state-level insurance expansion or cost. Forty percent of refugees have resettled to states without Medicaid expansion. The wide state-level variability in implementation of the ACA should be considered by federal agencies seeking to optimize access to health insurance coverage among refugees who have resettled to the United States.

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refugee health care planning economics health care policy health insurance human Refugees statistics and numerical data State Government Health Plan Implementation United States Humans Patient Protection and Affordable Care Act population research organization and management legislation and jurisprudence Retrospective Studies government Censuses medicaid retrospective study Health Insurance Exchanges Health Services Accessibility health care delivery