Public Health Insurance Expansion for Immigrant Children and Interstate Migration of Low-Income Immigrants | Pediatrics | JAMA Pediatrics | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.206.177.17. Please contact the publisher to request reinstatement.
1.
Passel  JS.  Demography of immigrant youth: past, present, and future.  Future Child. 2011;21(1):19-41. doi:10.1353/foc.2011.0001PubMedGoogle ScholarCrossref
2.
Minkoff  H, Bauer  T, Joyce  T.  Welfare reform and the obstetrical care of immigrants and their newborns.  N Engl J Med. 1997;337(10):705-707. doi:10.1056/NEJM199709043371011PubMedGoogle ScholarCrossref
3.
Kaushal  N, Kaestner  R.  Welfare reform and health insurance of immigrants.  Health Serv Res. 2005;40(3):697-721. doi:10.1111/j.1475-6773.2005.00381.xPubMedGoogle ScholarCrossref
4.
Department of Health and Human Services, Centers for Medicare and Medicaid Services.  State Children’s Health Insurance Program; eligibility for prenatal care and other health services for unborn children.  Fed Regist. 2002;67(191):61956-61974.Google Scholar
5.
Children’s Health Insurance Program Reauthorization Act of 2009. Pub L No. 111-3 (2009). https://www.govinfo.gov/content/pkg/PLAW-111publ3/pdf/PLAW-111publ3.pdf. Accessed October 10, 2019.
6.
Goodman  L.  The effect of the Affordable Care Act Medicaid expansion on migration.  J Policy Anal Manage. 2017;36(1):211-238. doi:10.1002/pam.21952PubMedGoogle ScholarCrossref
7.
Schwartz  AL, Sommers  BD.  Moving for Medicaid? recent eligibility expansions did not induce migration from other states.  Health Aff (Millwood). 2014;33(1):88-94. doi:10.1377/hlthaff.2013.0910PubMedGoogle ScholarCrossref
8.
Alm  J, Enami  A.  Do government subsidies to low-income individuals affect interstate migration? evidence from the Massachusetts Health Care Reform.  Reg Sci Urban Econ. 2017;66:119-131. doi:10.1016/j.regsciurbeco.2017.06.005Google ScholarCrossref
9.
Borjas  GJ.  Does immigration grease the wheels of the labor market?  Brookings Pap Econ Act. 2001;2001(1):69-133. doi:10.1353/eca.2001.0011Google ScholarCrossref
10.
Cadena  BC, Kovak  BK.  Immigrants equilibrate local labor markets: evidence from the Great Recession.  Am Econ J Appl Econ. 2016;8(1):257-290. doi:10.1257/app.20140095PubMedGoogle ScholarCrossref
11.
Borjas  GJ.  Immigration and welfare magnets.  J Labor Econ. 1999;17(4):607-637. doi:10.1086/209933Google ScholarCrossref
12.
Borjas  GJ, Hilton  L.  Immigration and the welfare state: immigrant participation in means-tested entitlement programs.  Q J Econ. 1996;111(2):575-604. doi:10.2307/2946688Google ScholarCrossref
13.
Dodson  ME.  Welfare generosity and location choices among new United States immigrants.  Int Rev Law Econ. 2001;21(1):47-67. doi:10.1016/S0144-8188(00)00040-5Google ScholarCrossref
14.
Kaushal  N.  New immigrants’ location choices: magnets without welfare.  J Labor Econ. 2005;23(1):59-80. doi:10.1086/425433Google ScholarCrossref
15.
Zavodny  M.  Determinants of recent immigrants’ locational choices.  Int Migr Rev. 1999;33(4):1014-1030. doi:10.2307/2547361Google Scholar
16.
The Henry J Kaiser Family Foundation. Disparities policy: health coverage of immigrants. https://www.kff.org/disparities-policy/fact-sheet/health-coverage-of-immigrants/. Published February 15, 2019. Accessed March 3, 2019.
17.
Sommers  BD, Gawande  AA, Baicker  K.  Health insurance coverage and health—what the recent evidence tells us.  N Engl J Med. 2017;377(6):586-593. doi:10.1056/NEJMsb1706645PubMedGoogle ScholarCrossref
18.
Simon  K, Soni  A, Cawley  J.  The impact of health insurance on preventive care and health behaviors: evidence from the first two years of the ACA Medicaid expansions.  J Policy Anal Manage. 2017;36(2):390-417. doi:10.1002/pam.21972PubMedGoogle ScholarCrossref
19.
Swartz  JJ, Hainmueller  J, Lawrence  D, Rodriguez  MI.  Expanding prenatal care to unauthorized immigrant women and the effects on infant health.  Obstet Gynecol. 2017;130(5):938-945. doi:10.1097/AOG.0000000000002275PubMedGoogle ScholarCrossref
20.
Saloner  B, Koyawala  N, Kenney  GM.  Coverage for low-income immigrant children increased 24.5 percent in states that expanded CHIPRA eligibility.  Health Aff (Millwood). 2014;33(5):832-839. doi:10.1377/hlthaff.2013.1363PubMedGoogle ScholarCrossref
21.
Wherry  LR, Fabi  R, Schickedanz  A, Saloner  B.  State and federal coverage for pregnant immigrants: prenatal care increased, no change detected for infant health.  Health Aff (Millwood). 2017;36(4):607-615. doi:10.1377/hlthaff.2016.1198PubMedGoogle ScholarCrossref
22.
Drewry  JH.  The Impact of the State Children’s Health Insurance Program’s Unborn Child Ruling on Foreign-Born Latina Prenatal Care Utilization and Birth Outcomes, 2000-2007. Birmingham, AL: The University of Alabama at Birmingham; 2012.
23.
Jarlenski  MP, Bennett  WL, Barry  CL, Bleich  SN.  Insurance coverage and prenatal care among low-income pregnant women: an assessment of states’ adoption of the “unborn child” option in Medicaid and CHIP.  Med Care. 2014;52(1):10-19. doi:10.1097/MLR.0000000000000020PubMedGoogle ScholarCrossref
24.
Finkelstein  A, Taubman  S, Wright  B,  et al; Oregon Health Study Group.  The Oregon health insurance experiment: evidence from the first year.  Q J Econ. 2012;127(3):1057-1106. doi:10.1093/qje/qjs020PubMedGoogle ScholarCrossref
25.
Howell  EM, Kenney  GM.  The impact of the Medicaid/CHIP expansions on children: a synthesis of the evidence.  Med Care Res Rev. 2012;69(4):372-396. doi:10.1177/1077558712437245PubMedGoogle ScholarCrossref
26.
López  G, Bialik  K, Radford  J.  Key Findings About U.S. Immigrants. Washington, DC: Pew Research Center; 2018.
27.
Gelatt  J, Bernstein  H, Koball  H, Runes  C, Pratt  E. State immigration policy resource. Urban Institute; May 2017. https://www.urban.org/features/state-immigration-policy-resource. Accessed May 25, 2018.
28.
Ruggles  S, Flood  S, Goeken  R,  et al.  IPUMS USA: Version 8.0 [data set] Minneapolis, MN: University of Minnesota; 2018.
29.
United States Census Bureau. Poverty thresholds by size of family and number of children. https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html. Accessed October 10, 2019.
30.
Cohn  JSPD, Passel  J.  A Portrait of Unauthorized Immigrants in the United States. Washington, DC: Pew Research Center; 2009.
31.
Rutstein  S, Shah  I.  Infecundity, Infertility, and Childlessness in Developing Countries. Calverton, Maryland: ORC Macro and the World Health Organization; 2004.
32.
Sommers  BD, Maylone  B, Blendon  RJ, Orav  EJ, Epstein  AM.  Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults.  Health Aff (Millwood). 2017;36(6):1119-1128. doi:10.1377/hlthaff.2017.0293PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Original Investigation
    Impact of Policy on Children
    November 18, 2019

    Public Health Insurance Expansion for Immigrant Children and Interstate Migration of Low-Income Immigrants

    Author Affiliations
    • 1Immigration Policy Lab, Stanford University, Stanford, California
    • 2Institute of Labor Economics (IZA), Bonn, Germany
    • 3Department of Pediatrics, Stanford University School of Medicine, Stanford, California
    • 4Department of Political Science, Stanford University, Stanford, California
    • 5Graduate School of Business, Stanford University, Stanford, California
    JAMA Pediatr. 2020;174(1):22-28. doi:10.1001/jamapediatrics.2019.4241
    Key Points

    Question  Is state-level expansion of public health insurance coverage to non–US-born children and pregnant women associated with increased in-migration of eligible immigrant families from other states?

    Findings  In this difference-in-differences analysis of data on 208 060 immigrants from the American Community Survey from 2000 through 2016, no association was found between in-migration rates among this population and expansion of public health insurance coverage.

    Meaning  These findings suggest that states expanding health care benefits for immigrant children and pregnant women may be unlikely to experience changes in in-migration among eligible non–US-born adults from other states.

    Abstract

    Importance  Federal policy changes in 2002 and 2009 led some states to expand public health insurance coverage to non–US-born children and pregnant women who are lawful permanent residents during their first 5 years of residency in the United States. In other states, there were concerns that insurance expansion could attract immigrants to relocate to gain free health insurance coverage.

    Objective  To examine whether expansion of public health insurance to non–US-born, lawful permanent resident children and pregnant women during their first 5 years of residency is associated with increased interstate migration among these groups.

    Design, Setting, and Participants  This difference-in-differences analysis included data on 208 060 immigrants from the American Community Survey from 2000 through 2016, with analysis including all 50 states and the District of Columbia. The study sample included 2 treatment groups that became eligible under the expanded coverage: lawful permanent resident adults with at least 1 non–US-born child younger than 18 years (n = 36 438) and lawful permanent resident women of reproductive age (n = 87 418). Control groups that remained ineligible under the expanded coverage included lawful permanent resident adults without non–US-born children (n = 171 622), lawful permanent resident single men (n = 56 142), and lawful permanent resident postreproductive women (n = 15 129). A difference-in-differences design compared migration rates between eligible and ineligible immigrant groups before and after insurance coverage expansions. Data analysis was performed from November 3, 2018, to May 31, 2019.

    Exposures  Public health insurance coverage for immigrant women and children who were lawful permanent residents within 5 years of residency.

    Main Outcomes and Measures  Migration to a health expansion state from any other state and from a neighboring state.

    Results  Of 208 060 immigrants (47% women in the weighted sample; mean [SD] age, 32.97 [12.94] years; 63% Hispanic), the mean (SD) annual move rate across the entire sample was 3% (17%). Expansion of public health insurance to non–US-born children or pregnant women within their first 5 years of residency was not associated with interstate movement for health care benefits. Coverage expansion for non–US-born children of lawful permanent residents was not associated with a change in the rate of in-migration higher than 1.78 percentage points or lower than –1.28 percentage points. The corresponding estimate for coverage expansion of lawful permanent resident pregnant women was a change higher than 1.38 percentage points and lower than –1.20 percentage points.

    Conclusions and Relevance  The results suggest that states considering expanding health care benefits coverage to recently arrived immigrant children and pregnant women may be unlikely to experience in-migration of these persons from other states, which has important implications for understanding short- and long-term program costs.

    ×