Demography

, Volume 48, Issue 2, pp 725–747 | Cite as

Medicaid Expansions and Fertility in the United States

  • Thomas DeLeire
  • Leonard M. Lopoo
  • Kosali I. Simon
Article

Abstract

Beginning in the mid-1980s and extending through the early to mid-1990s, a substantial number of women and children in the United States gained eligibility for Medicaid through a series of income-based expansions. Using natality data from the National Center for Health Statistics, we estimate fertility responses to these eligibility expansions. We follow Currie and Gruber (2001) and measure changes in state Medicaid-eligibility policy by simulating the fraction of a standard population that would qualify for benefits in different states and different time periods. From 1985 to 1996, the fraction of women aged 15–44 who were eligible for Medicaid coverage for a pregnancy increased more than 20 percentage points. When we use a state and year fixed-effects model with a limited set of covariates, our estimates indicate that fertility increases in response to Medicaid expansions. However, after we include fixed effects for demographic characteristics, the estimated relationship diminishes substantially in size and is no longer statistically significant. We conclude that there is no robust relationship between Medicaid expansions and fertility.

Keywords

Medicaid Fertility 

Notes

Acknowledgement

We are grateful to Dan Black, Robert Kaestner, Melissa Kearney, Jeffrey Kubik, and seminar participants at Indiana University and RAND for helpful comments. We also thank Jonathan Gruber for sharing the Medicaid eligibility programs used in his previous research as well as Melissa Kearney for sharing her data on family caps, welfare waivers, and TANF implementation.

Supplementary material

13524_2011_31_MOESM1_ESM.doc (46 kb)
Table 10Estimates for Medicaid eligibility for teens, high school dropouts, and unmarried women, 1989–1997 (DOC 46 kb)
13524_2011_31_MOESM2_ESM.doc (46 kb)
Table 11Estimates for Medicaid eligibility for teens and high school dropouts, 1989–1997 (DOC 46 kb)
13524_2011_31_MOESM3_ESM.doc (47 kb)
Table 12Estimates for Medicaid eligibility for the full sample, 1986–1997, first birth only (DOC 47 kb)
13524_2011_31_MOESM4_ESM.doc (46 kb)
Table 13Estimates for Medicaid eligibility for the full sample, 1986–1997, new weights (DOC 46 kb)
13524_2011_31_MOESM5_ESM.doc (46 kb)
Fig. 2Proportion eligible for Medicaid: White women (DOC 46 kb)
13524_2011_31_MOESM6_ESM.doc (46 kb)
Fig. 3Proportion eligible for Medicaid: African American women (DOC 46 kb)

References

  1. An, C. B., Haveman, R., & Wolfe, B. (1993). Teen out-of-wedlock births and welfare receipt: The role of childhood events and economic circumstances. The Review of Economics and Statistics, 75, 195–208.CrossRefGoogle Scholar
  2. Becker, G. S. (1960). An economic analysis of fertility. In Demographic and economic change in developed countries, a conference of the Universities – National Bureau Committee for Economic Research. Princeton University Press for the National Bureau of Economic Research. Reprinted 1976 in G. S. Becker. The economic approach to human behavior. Chicago, IL: The University of Chicago Press.Google Scholar
  3. Becker, G. S. (1991). A treatise on the family (enlarged ed.). Cambridge, MA: Harvard University Press.Google Scholar
  4. Becker, G. S., & Lewis, H. G. (1973). On the interaction between quality and quantity. Journal of Political Economy, 81(part 2), S279–S288.CrossRefGoogle Scholar
  5. Bitler, M. P. (2006). Effects of increased access to infertility treatment on infant and child health: Evidence from health insurance mandates (Working Paper WR-330). Santa Monica, CA: RAND.Google Scholar
  6. Bitler, M. P., & Schmidt, L. G. (2006). Health disparities and infertility: Impacts of state-level insurance mandates. Fertility and Sterility, 85, 858–865.CrossRefGoogle Scholar
  7. Bitler, M. P., & Zavodny, M. (2010). The effect of Medicaid eligibility expansions on fertility. Social Science & Medicine, 71, 918–924.CrossRefGoogle Scholar
  8. Blank, R., George, C., & London, R. (1996). State abortion rates: The impact of policies, providers, politics, demographics, and economic environment. Journal of Health Economics, 15, 513–553.CrossRefGoogle Scholar
  9. Bundorf, K., Henne, M., & Baker, L. (2007). Mandated health insurance benefits and the utilization and outcomes of infertility treatments (NBER Working Paper No. 12820). Cambridge, MA: National Bureau of Economic Research.Google Scholar
  10. Card, D., & Shore-Sheppard, L. D. (2004). Using discontinuous eligibility rules to identify the effects of the federal Medicaid expansions on low-income children. The Review of Economics and Statistics, 86, 752–766.CrossRefGoogle Scholar
  11. Currie, J., & Gruber, J. (1996). Saving babies: The efficacy and cost of recent changes in the Medicaid eligibility of pregnant women. Journal of Political Economy, 104, 1263–1296.CrossRefGoogle Scholar
  12. Currie, J., & Gruber, J. (2001). Public health insurance and medical treatment: The equalizing impact of the Medicaid expansions. Journal of Public Economics, 82, 63–89.CrossRefGoogle Scholar
  13. Cutler, D. M., & Gruber, J. (1996). Does public insurance crowd out private insurance? Quarterly Journal of Economics, 111, 391–430.CrossRefGoogle Scholar
  14. Dickert-Conlin, S., & Chandra, A. (1999). Taxes and the timing of births. Journal of Political Economy, 107, 161–177.CrossRefGoogle Scholar
  15. Dubay, L. C., & Kenney, G. M. (1997). Did Medicaid expansions for pregnant women crowd-out private insurance? Health Affairs, 16, 185–193.CrossRefGoogle Scholar
  16. Duncan, G. J., & Hoffman, S. D. (1990). Welfare benefits, economic opportunities, and out-of-wedlock births among black teenage girls. Demography, 27, 519–535.CrossRefGoogle Scholar
  17. Espenshade, T. J. (1977). The value and cost of children. Population Bulletin, 32, 1–48.Google Scholar
  18. Foster, E. M. (2002). How economists think about family resources and child development. Child Development, 73, 1904–1914.CrossRefGoogle Scholar
  19. Gold, R. B., Richards, C. L., Ranji, U. R., & Salganicoff, A. (2007). Medicaid’s role in family planning (Women’s Issue Brief No. 7064–03). Menlo Park, CA, and New York: Henry J. Kaiser Foundation and Guttmacher Institute. Available online at http://www.kff.org/womenshealth/upload/7064_03.pdf
  20. Gruber, J. (2003). Medicaid. In R. A. Moffitt (Ed.), Means-tested transfer programs in the United States (pp. 15–77). Chicago, IL: University of Chicago Press.Google Scholar
  21. Gruber, J., & Simon, K. (2008). Crowd-out ten years later: Have recent public insurance expansions crowded out private health insurance? Journal of Health Economics, 27, 201–217.Google Scholar
  22. Hamilton, B. H., & McManus, B. (2005). Infertility treatment markets: The effects of competition and policy (Working paper). St. Louis, MO: Olin School of Business, Washington University.Google Scholar
  23. Hao, L., & Cherlin, A. J. (2004). Welfare reform and teenage pregnancy, childbirth, and school dropout. Journal of Marriage and Family, 66, 179–194.Google Scholar
  24. Hoffman, S. D., & Foster, E. M. (2000). AFDC benefits and nonmarital births to young women. The Journal of Human Resources, 35, 376–391.CrossRefGoogle Scholar
  25. Horvath-Rose, A. E., & Peters, H. E. (2001). Welfare waivers and non-marital childbearing. In G. J. Duncan & P. L. Chase-Lansdale (Eds.), For better and for worse: Welfare reform and the well-being of children and families (pp. 222–244). New York: Russell Sage Foundation.Google Scholar
  26. Hoynes, H. (1997). Does Welfare play any role in female headship decisions? Journal of Public Economics, 65, 89–117.CrossRefGoogle Scholar
  27. Joyce, T., Kaestner, R., & Kwan, F. (1998). Is Medicaid pronatalist? The effect of eligibility expansions on abortions and births. Family Planning Perspectives, 30, 108–113. 127.CrossRefGoogle Scholar
  28. Kaestner, R., Korenman, S., & O’Neill, J. (2003). Has welfare reform changed teenage behavior? Journal of Policy Analysis and Management, 22, 225–248.CrossRefGoogle Scholar
  29. Kane, T., & Staiger, D. (1996). Teen motherhood and abortion access. Quarterly Journal of Economics, 111, 467–506.CrossRefGoogle Scholar
  30. Kearney, M. S. (2004). Is there an effect of incremental welfare benefits on fertility behavior? A look at the family cap. The Journal of Human Resources, 39, 295–325.CrossRefGoogle Scholar
  31. Kearney, M., & Levine, P. (2009). Subsidized contraception, fertility, and sexual behavior. The Review of Economics and Statistics, 91, 137–151.CrossRefGoogle Scholar
  32. Leibowitz, A. (1990). The response of births to changes in health care costs. The Journal of Human Resources, 25, 697–711.CrossRefGoogle Scholar
  33. Levine, P. B. (2004). Sex and consequences: Abortion, public policy, and the economics of fertility. Princeton, NJ: Princeton University Press.Google Scholar
  34. Levine, P. B., Trainor, A. B., & Zimmerman, D. J. (1996). The effect of Medicaid abortion funding restrictions on abortions, pregnancies, and births. Journal of Health Economics, 15, 555–578.CrossRefGoogle Scholar
  35. Lewit, E. M., & Monheit, A. C. (1992). Expenditures on health care for children and pregnant women. The Future of Children, 2, 95–114.CrossRefGoogle Scholar
  36. Lindrooth, R. C., & McCullough, J. S. (2007). The effect of Medicaid family planning expansions on unplanned births. Women’s Health, Issues, 17(2), 66–74.CrossRefGoogle Scholar
  37. Lino, M. (2000). Expenditures by families on children, 2000 annual report (Miscellaneous Publication No. 1528–2000). Washington, DC: U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. Available online at http://www.cnpp.usda.gov
  38. Lo Sasso, A. T., & Buchmueller, T. C. (2004). The effect of the State Children’s Health Insurance Program on health insurance coverage. Journal of Health Economics, 23, 1059–1082.CrossRefGoogle Scholar
  39. Lopoo, L. M., & DeLeire, T. (2006). Did welfare reform influence the fertility of young teens? Journal of Policy Analysis and Management, 25, 275–298.CrossRefGoogle Scholar
  40. Lundberg, S., & Plotnick, R. D. (1995). Adolescent premarital childbearing: Do economic incentives matter? Journal of Labor Economics, 13, 177–200.CrossRefGoogle Scholar
  41. Mayer, S. E. (1997). What money can’t buy: Family income and children’s life chances. Cambridge, MA: Harvard University Press.Google Scholar
  42. Mellor, J. (1998). The effect of family planning programs on the fertility of welfare recipients: Evidence from Medicaid claims. The Journal of Human Resources, 33, 866–895.CrossRefGoogle Scholar
  43. Moffitt, R. A. (2003). The temporary assistance for needy families program. In R. A. Moffitt (Ed.), Means-tested transfer programs in the United States (pp. 291–363). Chicago, IL: University of Chicago Press.Google Scholar
  44. Schmidt, L. (2007). Effects of infertility insurance mandates on fertility. Journal of Health Economics, 26, 431–446.CrossRefGoogle Scholar
  45. Tritz, K., Tilson, S., Stone, J., Peterson, C., O’Sullivan, J., Morgan, P. C., et al. (2006). Side-by-side comparison of Medicare, Medicaid, and SCHIP provisions in the Deficit Reduction Act of 2005 (CRS Report for Congress, Order Code RL33251). Washington, DC: Congressional Research Service, Library of Congress.Google Scholar
  46. Whittington, L. A., Alm, J., & Peters, H. E. (1990). Fertility and the personal exemption: Implicit pronatalist policy in the United States. The American Economic Review, 80, 545–556.Google Scholar
  47. Yazici, E., & Kaestner, R. (2000). Medicaid expansions and the crowding out of private health insurance among children. Inquiry, 37, 23–32.Google Scholar
  48. Yelowitz, A. S. (1998). Will extending Medicaid to two-parent families encourage marriage? The Journal of Human Resources, 33, 833–865.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2011

Authors and Affiliations

  • Thomas DeLeire
    • 1
  • Leonard M. Lopoo
    • 2
  • Kosali I. Simon
    • 3
  1. 1.University of Wisconsin–Madison and NBERMadisonUSA
  2. 2.Department of Public Administration, The Maxwell SchoolSyracuse UniversitySyracuseUSA
  3. 3.Indiana University and NBERBloomingtonUSA

Personalised recommendations