 Overall, analyses indicate that after factors such as health status, income, and race and ethnicity are controlled for, citizenship status plays a significant role in determining one's medical care access.Since the enactment of the Personal Responsibility and Work Opportunity Act (PRWORA) in 1996, the gap in health coverage between immigrants and citizens has grown considerably.Immigrants and their children are less likely to be insured, and the lack of insurance consequently reduces their ability to receive care.