Jordan Ross Herring

All Publications

• Indirect effects of immigration enforcement on health care utilization among lawfully present older Hispanics. Social science & medicine (1982) Herring, J., Barnow, B. 2025; 384: 118540

  Abstract

  Immigration enforcement can indirectly affect U.S. citizens and lawfully present immigrants though "chilling effects," where immigrants avoid public resources altogether because of ambiguous immigration law, public charge rules, and network effects. Indirect effects have been documented in take-up rates of public assistance programs, but there is a large gap in knowledge on how immigration enforcement could indirectly affect health care seeking behavior. We examined the impact of Secure Communities, an immigration enforcement program that began in 2008, on health care utilization among older lawfully present Hispanic immigrants and citizens. Using restricted geographic data from the Health and Retirement Study (HRS), we employed a staggered difference-in-differences model comparing U.S.-born Hispanic citizens and likely authorized Hispanic immigrants to a reference group of non-Hispanic, U.S.-born citizens. The main outcome was the probability of having an office visit with a health care provider. We estimate that Secure Communities led to a 16.9 % decline in the probability of having a visit with a health care provider for likely authorized Hispanic immigrants relative to non-Hispanic U.S.-born respondents. These declines are not driven by health insurance coverage, and are even larger among individuals with worse health status and less education. The declines in utilization relate to chilling effects and fear of putting others at risk as the respondents in our study are likely not at immediate risk of deportation or other immigration consequences. As immigration enforcement increases, further efforts should be made to protect access to health care.

  View details for DOI 10.1016/j.socscimed.2025.118540

  View details for PubMedID 40946596

• Medicaid Primary Care Utilization and Area-Level Social Vulnerability. JAMA health forum Herring, J., Park, Y. H., Luo, Q., Vichare, A., Erikson, C., Pittman, P. 2025; 6 (9): e253020

  Abstract

  The concentration of poverty and multidimensional disadvantage has been shown to limit access to health care in these communities. There is a growing interest in using area-level socioeconomic indexes to address the unequal geographic distribution of health care resources. However, the association of area-level socioeconomic indexes with access to primary care-a key area in health policy-has not been determined.To investigate the association of Medicaid primary care utilization with the concentration of poverty and multidimensional disadvantage at the zip code level.This cross-sectional study used the 2019 Transformed-Medicaid Statistical Information System to identify variations in primary care utilization among Medicaid and the Children's Health Insurance Program beneficiaries (age <65 years) by poverty and multidimensional disadvantage levels of their area of residence. Included beneficiaries were enrolled in Medicaid from January 1 to December 31, 2019, and were not dually eligible for Medicare. The zip code-level Social Vulnerability Index (SVI) was used to assess the likelihood of a beneficiary having an annual primary care visit, while controlling for individual beneficiary demographic and health characteristics. An activity-based approach was adopted to classify clinicians billing Medicaid for primary care and to identify primary care visits at federally qualified health centers (FQHCs). SVI results were compared with results using income-based poverty rates alone. Data analysis was performed from May 1, 2023, through February 28, 2025.Zip code-level deciles of the SVI and poverty rates.Regression analysis was performed at the beneficiary level, using a binary indicator for having a primary care visit on a set of dummy variables for SVI deciles, controlling for age and sex interactions, disability status, and indicators for having been diagnosed with behavioral health or chronic physical health conditions.The total population analyzed comprised 34 890 932 Medicaid beneficiaries (<65 years old; 54.2% female and 45.8% male), more than half of whom resided in the top 20% of socially vulnerable zip codes; approximately 33%, in the top 10%; and another 20%, in the ninth decile. Of the total, 68.1% had at least 1 primary care visit in 2019, at either a non-FQHC practice (61.1%) or a FQHC (12.7%). The probability of having a primary care visit was highest for children (age <18 years) but varied substantially by age. Compared to those residing in the first decile of the SVI (least socially vulnerable), beneficiaries in the tenth decile (most socially vulnerable) were 8.9 (95% CI, -9.9 to -7.9) percentage points (pp) less likely to have a primary care visit when not counting FQHC visits, but this increased to 4.7 (95% CI, -5.5 to -3.8) pp less likely when including FQHC visits. Beneficiaries in the tenth decile were 5.9 (95% CI, 4.9 to 6.8) pp more likely to have a FQHC visit than beneficiaries in the first decile. The SVI results identified more beneficiaries with disparities compared to the area-level poverty rate alone.The findings of this cross-sectional study suggest that Medicaid policy should focus on addressing geography-based disparities in access to care using new measures to target resources. The multidimensional SVI is likely a useful tool to identify small geographic areas with barriers to accessing adequate health care. The FQHC findings suggest that substantially increasing investments and support for FQHCs would address geographic inequities in access to health care.

  View details for DOI 10.1001/jamahealthforum.2025.3020

  View details for PubMedID 40911326

  View details for PubMedCentralID PMC12413652

• Asian American, Native Hawaiian, And Pacific Islander Population Group Representation In The US Health Workforce. Health affairs (Project Hope) Ha, E., Dobkin, F., Portela Martinez, M., Herring, J., Salsberg, E. 2025; 44 (3): 333-341

  Abstract

  Although the Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population encompasses more than 50 ethnicities and 100 languages, it is often treated as a monolith in research and policy. Despite substantial heterogeneity, policy makers and researchers do not usually focus on AANHPI subgroups when discussing underrepresentation and health disparities. We provide insights on the representation of AANHPI populations by disaggregating the AANHPI racial category among the health workforce and examining the representation of AANHPI subgroups in health occupations. These data indicate that although the AANHPI population is well represented as a collective population, there are population groups that are underrepresented, including the other Southeast Asian and NHPI populations in general. There is also considerable underrepresentation of AANHPI populations in the behavioral health workforce. Policy and research addressing underrepresentation and gaps in health care, which usually do not focus on the "Asian" racial population groups, should disaggregate AANHPI population groups.

  View details for DOI 10.1377/hlthaff.2024.01069

  View details for PubMedID 40030114

• Medicaid billing for community health worker services growing, but remains low, 2016-2020. Health affairs scholar Erikson, C., Tiunn, H. L., Herring, J., Luo, E., Pittman, P. 2025; 3 (1): qxae164

  Abstract

  Despite the recognized value of Community Health Workers (CHWs) in improving health outcomes, the integration of CHWs into Medicaid continues to be a challenge. This study examines the trends in CHW billing for Medicaid services across states from 2016 to 2020. We conducted an exploratory descriptive analysis of the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) 2016-2020 to identify trends in direct billing for CHW services, including beneficiaries served, total services rendered, payment type, place of service, and procedure codes used for services billed by CHWs. The number of CHWs billing Medicaid increased by 638% between 2016 and 2020. However, by 2020, there were still only 731 CHWs billing Medicaid in the 9 states examined with one state (Ohio) accounting for 77.7% of all Medicaid beneficiaries identified with CHW direct billing. The total number of CHW services grew nearly 23-fold, with 37.7% overall provided in patient homes. Significant billing inconsistencies were observed, including the use of non-designated procedure codes. Overall CHW billing in Medicaid remained low as of 2020, with the exception of Ohio. Understanding factors associated with Ohio's expansion could yield important insights for current efforts to improve access to CHWs for Medicaid beneficiaries.

  View details for DOI 10.1093/haschl/qxae164

  View details for PubMedID 39811072

  View details for PubMedCentralID PMC11726829

• Assessing the Racial and Ethnic Diversity of Physician Assistant/Associate Program Graduates from 2010 to 2012 and 2019 to 2021. The journal of physician assistant education : the official journal of the Physician Assistant Education Association Ritsema, T. S., Herring, J. R., Straker, H. O., Salsberg, E. 2024; 35 (3): 252-261

  Abstract

  To assess the racial/ethnic diversity of graduates of US Physician Assistant/Associate (PA) programs compared with the diversity of the populations from which they draw students and to assess diversity changes over time among PA graduates.We calculated proportion of Black or Hispanic PA graduates nationally and by school between 2010 to 2012 and 2019 to 2021 using the Integrated Postsecondary Education Data System (IPEDS) and compared it with the diversity of the 20 to 35-year-old population using the American Community Survey. We created benchmark populations for each school based on whether the school was public or private, with in-state/out-of-state proportions provided by the Physician Assistant Education Association. A diversity index (DI) was calculated for each program. A DI of 0.5 means that the representation of Black/Hispanic graduates is half their representation in the benchmark population.Although the numbers of Black/Hispanic graduates increased from 2010 to 2012 to 2019 to 2021, the percentage of Black graduates decreased. Nationally, the DI for Black graduates decreased from 0.28 to 0.23 and the Hispanic DI increased from 0.28 to 0.37 between 2010 to 2012 and 2019 to 2021. Among 213 PA programs included in the 2019 to 2021 dataset, 5 schools had a DI >1.0 for Black graduates and 7 schools had a DI >1.0 for Hispanic graduates.Using the IPEDS data, we found that Black and Hispanic graduates are underrepresented among PA program graduates. The PA education community needs to develop new strategies for diversifying the profession consistent with the new US Supreme Court decision banning race-conscious admissions.

  View details for DOI 10.1097/JPA.0000000000000602

  View details for PubMedID 38838288

• Black and Hispanic Representation Declined After Increased Degree Requirements for Physician Assistants. The journal of physician assistant education : the official journal of the Physician Assistant Education Association Herring, J., Brantley, E., Ritsema, T. S., Luo, Q., Straker, H., Salsberg, E. 2024; 35 (3): 215-220

  Abstract

  The physician assistant (PA) profession is one of the least racially and ethnically diverse health professions requiring advanced education. New PA graduates are even less diverse than the current PA workforce and less diverse than professions requiring doctoral degrees. Between 1995 and 2020, the percent of all PA graduates that were Black individuals fell from 7% to 3.1%, while Hispanic representation increased from 4.5% to 7.9%.Using the federal Integrated Postsecondary Education Data System, we examine the impact of transitions to master's degrees for PAs on Black and Hispanic representation between 1995 and 2020, using individual universities as the unit of analysis.After adjusting for state and year effects, PA programs that transitioned from bachelor's to master's degrees experienced a 5.3% point decline in Black representation and a 3.8% point decline in Hispanic representation. Relative to the already low proportions of Black and Hispanic graduates in PA programs, these declines are significant.Steps should be taken to ensure that underrepresented populations have greater access to PA education.

  View details for DOI 10.1097/JPA.0000000000000572

  View details for PubMedID 38377275

• Association between state payment parity policies and telehealth usage at community health centers during COVID-19. Journal of the American Medical Informatics Association : JAMIA Erikson, C., Herring, J., Park, Y. H., Luo, Q., Burke, G. 2022; 29 (10): 1715-1721

  Abstract

  We study the association between payment parity policies and telehealth utilization at community health centers (CHCs) before, during, and after the onset of the pandemic.We use aggregated, de-identified data from FAIR Health for privately insured patients at CHC sites. Descriptive statistics and time trends are calculated. Logistic regression models were used to quantify the factors associated with telehealth utilization for each of our time periods: 1) pre-pandemic (March-June 2019), 2) immediate pandemic response (March-June 2020), and 3) sustained pandemic response (March-June 2021).Telehealth usage rates at CHC sites surged to approximately 61% in April 2020. By April 2021, only 29% of CHC sites in states without payment parity policies used telehealth versus 42% in states without. Controlling for other characteristics, we find that CHC sites in states with payment parity were more likely to utilize telehealth one year after the onset of the pandemic (OR:1.740, p<0.001) than states without, but did not find this association in 2019 or 2020.The public health emergency drove widespread use of telehealth, making the virtual care environment inherently different in 2021 than in 2019. Due to the unique fiscal constraints facing CHCs, the financial sustainability of telehealth may be highly relevant to the relationship between telehealth utilization and payment parity we find in this paper.Supportive payment policy and continued investments in broadband availability in rural and undeserved communities should enable CHCs to offer telehealth services to populations in these areas.

  View details for DOI 10.1093/jamia/ocac104

  View details for PubMedID 35864736

  View details for PubMedCentralID PMC9384471