The Patient Protection and Affordable Care Act (ACA) of 2010 expands health insurance coverage to a substantial number of persons without health insurance. In California, Latinos, especially Mexican immigrants, have one of the highest rates of uninsurance, making the ACA particularly important for that group. Using the 2007 California Health Interview Survey, this study examines how the generation in the U.S. of individuals of Mexican-origin is associated with their access to health insurance, doctor visits, and emergency room visits in California compared to that of U.S.-born non-Latino Whites. Results indicate that third generation Mexican Americans have similar levels of being insured, having a doctor visit, and having an ER visit compared to Whites, controlling for demographic, socioeconomic, and health status. First generation (immigrant) Mexicans have the least access to health care services with lower odds than Whites of accessing care across all measures. Second generation Mexican Americans also have lower odds than Whites, however, the differences are not as pronounced as for the first generation. This study finds that there are important differences in access to health care among Mexican Americans by generational status, with the greatest disparities for the generations closest to the immigrant experience. Implementation of the ACA will benefit Mexican Americans across generational statuses, but gaps will likely remain for first and second generation Mexican Americans. © Author(s) 2013.

The Centers for Disease Control and Prevention recommends routine human immunodeficiency virus (HIV) testing of every client presenting for services in venues where HIV prevalence is high. Because older adults (aged ≥50 years) have particularly poor prognosis if they receive their diagnosis late in the course of HIV disease, any screening provided to younger adults in these venues should also be provided to older adults. We examined aging-related disparities in recent (past 12 months) and ever HIV testing in a probability sample of at-risk adults (N = 1238) seeking services in needle exchange sites, sexually transmitted disease clinics, and Latino community clinics that provide HIV testing. Using multiple logistic regression with generalized estimating equations, we estimated associations between age category (<50 years vs. ≥50 years) and each HIV testing outcome. Even after controlling for covariates such as recent injection drug use, older adults had 40% lower odds than younger adults did of having tested in the past 12 months (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.40-0.90) or ever (OR = 0.6; 95% CI = 0.40-0.90). Aging-related disparities in HIV testing exist among clients of these high HIV prevalence venues and may contribute to known aging-related disparities in late diagnosis of HIV infection and poor long-term prognosis.