Abstract
Immigrants’ access to public benefits, including healthcare coverage, has remained at the front and center of the debate on immigration and welfare policy in many host countries. As policymakers in the USA engage in ongoing discussions about expanding Medicaid, including extending access to immigrants, some concerns have been raised regarding the potential for insurance expansion to attract more immigrants who may relocate in search of free health insurance coverage. Using the Affordable Care Act (ACA) Medicaid expansions as a natural experiment setup, I examined the impact of the ACA Medicaid expansion on the interstate migration of low-income immigrants. Unlike previous papers that examined the effect of public insurance expansion on interstate movement of the low-income population in general, I specifically focus on the immigrant population. Using individual-level data from the American Community Surveys over 2009–2018, results from difference-in-difference analyses indicate that the expansion of the ACA in some states has no statistically significant effect on in-migration and a decrease in out-migration among the low-income immigrant population. This finding suggests that expanding Medicaid through ACA does not incur the large-scale added cost associated with increased in-migration of low-income immigrants. The results are robust to various sensitivity tests, including alternate policy variables of overall states’ Medicaid generosity index.
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Notes
Under PRWORA’s qualified aliens include lawful permanent residents, asylees, refugees, and some other groups. This baseline rule, which has some exceptions, bars nonqualified aliens such as holders of Temporary Protected Status (TPS), recipients of Deferred Action for Childhood Arrivals (DACA), and nonimmigrants from receiving federal public benefits.
There are few exceptions to this 5 year wait period. For example, refugees, asylees, or legal permanent residents who used to be refugees or asylees do not have to wait 5 years. However, states have the option to remove the 5-year waiting period and cover lawfully residing children and/or pregnant women in Medicaid or CHIP. For children and pregnant people, states can eliminate the 5-year wait and extend coverage to lawfully present immigrants without a qualified status. Currently, twenty-nine states, plus the District of Columbia, have chosen to provide Medicaid coverage to lawfully residing children and/or pregnant women without a 5-year waiting period.
I used a method developed by Borjas and Cassidy (2019) to differentiate between documented and potentially undocumented immigrants. Borjas and Cassidy (2019) identified foreign-born person as documented/legal if any of the following conditions hold: arrived before 1980; the person is a citizen; person receives Social Security benefits, SSI, Medicaid, Medicare, or Military Insurance; the person is a veteran, or is currently in the Armed Forces; that person works in the government sector; person resides in public housing or receives rental subsidies, or that person is a spouse of someone who resides in public housing or receives rental subsidies; that person was born in Cuba; that person's occupation requires some form of licensing; that person's spouse is a legal immigrant or citizen. For purpose of this paper, the condition of public insurance coverage (Medicaid) is relaxed in constructing potential undocumented immigrant population.
Local immigration enforcement policies under section 287(g) and the Secure Communities are taken from the Immigration and Customs Enforcement (ICE) website archives (ICE, 2009; ICE, 2013; ICE, 2018). Information on state policies specific to undocumented immigrants, namely, state dream act, eligibility for driver’s license, and E-Verify requirements are from Kaushal et al. (2018), and the National Conference of State Legislatures (NCSL) websites.
The results for the sample restricted to immigrants who are more likely to be documented are presented in the Appendix Table 10.
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Rigzin, T. Medicaid Expansion Through the Affordable Care Act and Interstate Mobility of Low-Income Immigrants: Welfare Magnet or Myth?. Int. Migration & Integration (2023). https://doi.org/10.1007/s12134-023-01105-w
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DOI: https://doi.org/10.1007/s12134-023-01105-w