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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
Article

Abstract

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.

Keywords

Medicaid Fertility Parity 

JEL Classification

I1 J13 J18 

Supplementary material

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

References

  1. Aaronson, D., Lange, F., & Mazumder, B. (2014). Fertility transitions along the extensive and intensive margins. American Economic Review, 104(11), 3701–3724.CrossRefGoogle Scholar
  2. Almond, D., Hoynes, H. W., & Schanzenbach, D. W. (2001). Inside the war on poverty: The impact of food stamps on birth outcomes. Review of Economics and Statistics, 93(2), 387–403.CrossRefGoogle Scholar
  3. Anderson, E. (1990). Streetwise: Race, class, and change in an urban community. Chicago: University of Chicago Press.Google Scholar
  4. Antwi, Y. A., Moriya, A. S., & Simon, K. I. (2015). Access to health insurance and the use of inpatient medical care: Evidence from the affordable care act young adult mandate. Journal of Health Economics, 39, 171–187.CrossRefGoogle Scholar
  5. Baughman, R., & Dickert-Conlin, S. (2009). The earned income tax credit and fertility. Journal of Population Economics, 22(3), 537–563.CrossRefGoogle Scholar
  6. Becker, G. S. (1960). An economic analysis of fertility. In National Bureau of Economic Research (Ed.) Demographic and economic change in developed countries (pp. 225–256). Princeton, NJ: Princeton University Press.Google Scholar
  7. Becker, G. S. (1991). A treatise on the family (Enlarged ed.). Cambridge, MA: Harvard University Press.Google Scholar
  8. Becker, G. S., & Lewis, H. G. (1973). On the interaction between the quantity and quality of children. Journal of Political Economy, 81(2, part 2), S279–S288.CrossRefGoogle Scholar
  9. Buckles, K., Hungerman, D., & Lugauer, S. (2017). Fertility is a leading economic indicator. Manuscript dated October 2017. Retrieved 12 June, 2017, from https://www3.nd.edu/~kbuckles/BHL_fertility.pdf.
  10. Currie, J., & Gruber, J. (1996). Saving babies: The efficacy and cost of recent changes in Medicaid eligibility of pregnant women. Journal of Political Economy, 104(6), 1263–1296.CrossRefGoogle Scholar
  11. Cutler, D. M., & Gruber, J. (1996). Does public insurance crowd out private insurance? Quarterly Journal of Economics, 111(2), 391–430.CrossRefGoogle Scholar
  12. DeLeire, T., Lopoo, L. M., & Simon, K. I. (2011). Medicaid expansions and fertility in the United States. Demography, 48(2), 725–747.CrossRefGoogle Scholar
  13. Duncan, G. J., & Hoffman, S. D. (1990). Welfare benefits, economic opportunities, and out-of-wedlock births among black teenage girls. Demography, 27(4), 519–535.CrossRefGoogle Scholar
  14. Garfinkel, I., Huang, C.-C., McLanahan, S. S., & Gaylin, D. S. (2003). The role of child support enforcement and welfare in non-marital childbearing. Journal of Population Economics, 16(1), 55–70.CrossRefGoogle Scholar
  15. Guttmacher Institute. nd. State funding of abortion under Medicaid. Retrieved from https://www.guttmacher.org/print/state-policy/explore/state-funding-abortion-under-medicaid.
  16. Hamersma, S., & Kim, M. (2013). Participation and crowd out: Assessing the effects of parental Medicaid expansions. Journal of Health Economics, 32(1), 160–171.CrossRefGoogle Scholar
  17. Hau, L., & Cherlin, A. J. (2004). Welfare reform and teenage pregnancy, childbirth, and school dropout. Journal of Marriage and Family, 66(1), 179–194.CrossRefGoogle Scholar
  18. Health Insurance Association of America. (1989). The cost of maternity care and childbirth in the United States, 1989. Washington, DC: Health Insurance Association of America.Google Scholar
  19. Hill, I. (1992). The Medicaid expansions for pregnant women and children: A state program characteristics information base. Washington, DC: Health Systems Research Inc.Google Scholar
  20. Hoynes, H. W. (1997). Does welfare play any role in female headship decisions? Journal of Public Economics, 65, 89–117.CrossRefGoogle Scholar
  21. Joyce, T., Kaestner, R., Korenman, S., & Henshaw, S. (2004). Family cap provisions and changes in births and abortions. Population Research and Policy Review, 23, 475–511.CrossRefGoogle Scholar
  22. Joyce, T., Kaestner, R., & Kwan, F. (1998). Is Medicaid pronatalist? The effect of eligibility expansions on abortions and births. Family Planning Perspectives, 30(3), 108–113, 127.Google Scholar
  23. Kaestner, R., Korenman, S., & O’Neill, J. (2003). Has welfare reform changed teenage behavior? Journal of Policy Analysis and Management, 22(2), 225–248.CrossRefGoogle Scholar
  24. Kaiser Family Foundation. (2014). How is the ACA impacting Medicaid enrollment? Issue Brief. Retrieved from https://kaiserfamilyfoundation.files.wordpress.com/2014/05/8584-how-is-the-aca-impacting-medicaid-enrollment2.pdf.
  25. Kearney, M. S. (2004). Is there an effect of incremental welfare benefits on fertility behavior? A look at the family cap. Journal of Human Resources, 39(2), 295–325.CrossRefGoogle Scholar
  26. Kearney, M. S., & Levine, P. B. (2009). Subsidized contraception, fertility, and sexual behavior. The Review of Economics and Statistics, 91(1), 137–151.CrossRefGoogle Scholar
  27. Leibowitz, A. (1990). The response of births to changes in health care costs. The Journal of Human Resources, 25(4), 697–711.CrossRefGoogle Scholar
  28. Levine, P. B., Staiger, D., Kane, T. J., & Zimmerman, D. J. (1999). Roe v Wade and American fertility. American Journal of Public Health, 89, 199–203.CrossRefGoogle Scholar
  29. Lopoo, L. M., & DeLeire, T. (2006). Did welfare reform influence the fertility of young teens? Journal of Policy Analysis and Management, 25(2), 275–298.CrossRefGoogle Scholar
  30. Lopoo, L. M., & Raissian, K. M. (2012). Natalist policies in the United States. Journal of Policy Analysis and Management, 31(4), 905–946.CrossRefGoogle Scholar
  31. Lopoo, L. M., & Raissian, K. M. (2014). U.S. Social Policy and family complexity. Annals of the American Academy of Political and Social Science, 654(1), 213–230.CrossRefGoogle Scholar
  32. Markus, A. R., Andres, E., West, K. D., Garro, N., & Pellegrini, C. (2013). Medicaid covered births, 2008 to 2010, in the context of the implementation of health reform. Women’s Health Issues, 23(5), e273–e280.CrossRefGoogle Scholar
  33. Mathews, T. J., & Hamilton, B. E. (2002). Mean age of mother, 1970-2000. National Vital Statistics Reports, 51(1), 1–14.Google Scholar
  34. Mathews, T. J., & Ventura, S. J. (1997). Birth and fertility rates by educational attainment: United States, 1994. Monthly Vital Statistics Report. 45(10), supplement. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  35. Milligan, K. (2005). Subsidizing the stork: New evidence on tax incentives and fertility. The Review of Economics and Statistics, 87(3), 539–555.CrossRefGoogle Scholar
  36. 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: University of Chicago Press.CrossRefGoogle Scholar
  37. Plotnick, R. D., Garfinkel, I., McLanahan, S. S., & Ku, I. (2004). Better child support enforcement: Can it reduce teenage premarital childbearing? Journal of Family Issues, 25(5), 634–657.CrossRefGoogle Scholar
  38. Ruggles, S., Genadek, K., Goeken, R., Grover, J., & Sobek, M. (2015). Integrated public use microdata series: Version 6.0 [Machine-readable database]. Minneapolis: University of Minnesota.Google Scholar
  39. Singh, S., Gold, R. B., & Frost, J. J. (1994). Impact of the Medicaid eligibility expansions on coverage of deliveries. Family Planning Perspectives, 26(1), 31–33.CrossRefGoogle Scholar
  40. U.S. Bureau of the Census. nd. Online graph titled “Median age at first marriage, 1890 to present. Retrieved from https://www.census.gov/hhes/families/files/graphics/MS-2.pdf.
  41. Ventura, S. J., & Bachrach, C. A. (2000). Nonmarital childbearing in the United States, 1940-1999. National Vital Statistics Reports 48(16). Hyattesville, MD: National Center for Health Statistics.Google Scholar
  42. Zavodny, M., & Bitler, M. P. (2010). The effect of Medicaid eligibility expansions on fertility. Social Science and Medicine, 71(5), 918–924.CrossRefGoogle Scholar

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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