Population Research and Policy Review

, Volume 37, Issue 3, pp 461–484 | Cite as

Pregnancy Medicaid Expansions and Fertility: Differentiating Between the Intensive and Extensive Margins

  • Lincoln H. Groves
  • Sarah Hamersma
  • Leonard M. Lopoo


The theoretical and empirical links between public health insurance access and fertility in the United States remain unclear. Utilizing a demographic cell-based estimation approach with panel data (1987–1997), we revisit the large-scale Medicaid expansions to pregnant women during the 1980s to estimate the heterogeneous impacts of public health insurance access on childbirth. While the decision to become a parent (i.e., the extensive margin) appears to be unaffected by increased access to Medicaid, we find that increased access to public health insurance positively influenced the number of high parity births (i.e., the intensive margin) for select groups of women. In particular, we find a robust, positive birth effect for unmarried women with a high school education, a result which is consistent across the two racial groups examined in our analysis: African American and white women. This result suggests that investigating effects along both the intensive and extensive margin is important for scholars who study the natalist effects of social welfare policies, and our evidence provides a more nuanced understanding of the influence of public health insurance on fertility.


Medicaid Fertility Parity 

JEL Classification

I1 J13 J18 

Supplementary material

11113_2018_9465_MOESM1_ESM.pdf (196 kb)
Supplementary material 1 (PDF 196 kb)


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Lincoln H. Groves
    • 1
  • Sarah Hamersma
    • 2
  • Leonard M. Lopoo
    • 3
  1. 1.Institute for Research on PovertyUniversity of Wisconsin-MadisonMadisonUSA
  2. 2.Public Administration and International Affairs, Center for Policy ResearchSyracuse UniversitySyracuseUSA
  3. 3.Public Administration and International Affairs, Maxwell X Lab, Center for Policy ResearchSyracuse UniversitySyracuseUSA

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