Abstract
During the 1990s and early 2000s many states expanded Medicaid eligibility for parents particularly after the 1996 welfare reform. At the same time, welfare reform also put in place policies that limited the eligibility of recent immigrants for public programs including Medicaid. This paper evaluates the effects of these changes in Medicaid eligibility policy on the private and public health insurance coverage of immigrants as well as the overall insurance rate. It also looks at the effect on health care use and measures of health status. The findings indicate a significant increase in Medicaid coverage and an increase in the proportion insured overall with negligible crowd-out of private insurance. There is also an increase in the use of health care services. In the case of permanent residents, there is a diminished response to Medicaid eligibility changes possibly due to a “chilling effect”.
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References
Aizer, A., & Grogger, J. (2003). Parental Medicaid expansions and health insurance coverage. NBER Working Paper No. 9907.
Baicker, K., et al. (2013). The Oregon experiment: Effect of medicaid on clinical outcomes. New England Journal of Medicine, 368(18), 1713–1722.
Broaddus, M., et al. (2002). Expanding public coverage: States’ Medicaid eligibility policies for working families in the year 2000. Washington, DC: Center on Budget and Policy Priorities.
Bronchetti, E. T. (2014). Public insurance expansions and the health of immigrant and native children. Journal of Public Economics, 120, 205–219.
Buchmueller, T., Lo Sasso, A., & Wong, K. (2007). How did SCHIP affect the insurance coverage of immigrant children. NBER Working Paper No. 13261.
Buchmueller, T., Ham, J. C., & Shore-Sheppard, L. D. (2015). Medicaid. In R. Moffitt (Ed.), Means-tested transfer programs in the United States (Vol. 2). Cambridge: National Bureau for Economic Research.
Busch, S. H., & Duchovny, N. (2005). Family coverage expansions: Impact on insurance coverage and health care utilization of parents. Journal of Health Economics, 24, 876–890.
Camarota, S. A. (2001). Immigrants in the United States—2000: A snapshot of America’s Foreign-Born population. Washington: Center for Immigration Studies.
Currie, J., & Gruber, J. (1996). Health insurance eligibility, utilization of medical care and child health. Quarterly Journal of Economics, 111(2), 431–466.
Cutler, D., & Gruber, J. (1996). Does public insurance does public insurance crowd out private insurance. Quarterly Journal of Economics, 111(2), 391–430.
Dubay, L., & Kenney, G. (2003). Expanding public health insurance to parents: Effects on children’s coverage under Medicaid. Health Services Research, 38(5), 1283–1302.
Feld, P., & Power, B. (2000). Immigrants’ access to healthcare after welfare reform: Findings from focus groups in four cities. Suitland: The Kaiser Commision on Medicaid and the Uninsured.
Fremstad, S., & Cox, L. (2004). Covering new Americans: A review of federal and state policies related to immigrants’ eligibility and access to publicly funded health insurance. Suitland: The Kaiser Commision on Medicaid and the Uninsured.
Gruber, J. (2000). Medicaid. NBER Working Paper No. 7829.
Gruber, J., & Simon, K. (2008). Crowd-out 10 years later: Have recent public insurance expansions crowded out private health insurance? Journal of Health Economics, 27, 201–217.
Guyer, J., & Mann, C. (1999). Employed But Not Insured: A State-by-State Analysis of the Number of Low-Income Working Parents Who Lack Health Insurance. Washington, DC: Center on Budget and Policy Priorities.
Ham, J., & Shore-Sheppard, L. D. (2005). The effect of medicaid expansions for low income children on medicaid participation and private insurance coverage: Evidence from the SIPP. Journal of Public Economics, 89(1), 57–83.
Kaestner, R., & Kaushal, N. (2003). Welfare reform and health insurance coverage of low-income families. Journal of Health Economics, 22, 959–981.
Kaushal, N., & Kaestner, R. (2005). Welfare reform and health insurance of immigrants. Health Services Research, 40(3), 697–721.
Lurie, I. Z. (2008). Welfare reform and the decline in the health insurance coverage of children of non-permanent residents. Journal of Health Economics, 27, 786–793.
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.
Nwosu, C., Batalova, J., & Auclair, G. (2014) Frequently requested statistics on immigrants and immigration in the United States. Migration Policy Institute Newsletter.
Ross, D. C., & Cox, L. (2002). Enrolling children and families in health coverage: The promise of doing more. Suitland: The Kaiser Commision on Medicaid and the Uninsured.
Ross, D. C., & Cox, L. (2004). Beneath the surface: Barriers threaten to slow progress on expanding health coverage of children and families. Suitland: The Kaiser Commision on Medicaid and the Uninsured.
Schlosberg, C., & Wiley, D. (1998). The impact of INS public charge determinations on immigrant access to health care. Washington: National Immigration Law Center.
Watson, T. (2014). Inside the refrigerator: Immigration enforcement and chilling effects in Medicaid participation. American Economic Journal: Economic Policy, 6(3), 313–338.
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Unuigbe, A. Impact of medicaid policy changes on immigrant parents. Int J Health Econ Manag. 19, 395–417 (2019). https://doi.org/10.1007/s10754-019-09264-z
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DOI: https://doi.org/10.1007/s10754-019-09264-z