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Welfare Reform and Health of Immigrant Women and their Children

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Abstract

We investigate the association between the 1996 welfare reform and health insurance, medical care use and health of low-educated, foreign-born, single mothers and their children. We find that welfare reform was associated with an eight to 11.5 percentage points increase in proportion uninsured among low-educated foreign-born, single mothers. We also find that the decline in welfare caseload since 1996 was associated with a 6.5 to 10 percentage points increase in the proportion of low-educated foreign-born, single mothers reporting delays in receiving medical care or receiving no care due to cost and a nine percentage points decline in visits to a health professional in the past 12 months. We do not find any consistent evidence that welfare reform affected the health insurance, medical care utilization and health of children living with single mothers.

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Notes

  1. Denying immigrants access to means-tested programs resulted in 44 percent of the total savings in PRWORA [5].

  2. In all states except Alabama legal pre-1996 immigrants (or those in the US for at least five years) have access to cash welfare; in all states except Wyoming they have access to Medicaid, in 17 states they are eligible to use food stamps and in 10 states they have access to SSI.

  3. Nineteen states that have substitute TANF programs for newly arrived immigrants during the five year federal ban are: CA, MA, MD, WA, PA, OR, CT, GA, MN, HI, WI, MO, UT, RI, TN, NE, ME, VT, WY. Fifteen states where new immigrants are eligible for Medicaid are: CA, IL, MA, MD, VA, WA, PA, CT, MN, HI, RI, NE, NY, DE and ME. Subsequent changes in federal policy restored Food Stamps and SSI benefits to certain vulnerable groups and in 2002 Congress restored Food Stamps to all legal immigrants who have been in the country for at least five year.

  4. Surveys by the National Health Law Program and the National Immigration Law Center indicate that fear of deportation from the US has discouraged immigrants from obtaining publicly subsidized health care even when they were entitled to it [12]. The Kaiser Commission on Medicaid and the Uninsured, also found that since 1996 many immigrants did not seek public health insurance because they feared that it would affect their immigration status or jeopardize opportunity to become a citizen [18]. Similarly, Kaushal and Kaestner [4] find that PRWORA affected the insurance of immigrants who have been in the US for more than five years as adversely as of those in the US for less than five years, even though the later were subject to more stringent provisions in a number of states.

  5. These studies are purely descriptive and do not address the question as to whether the transition off welfare caused a change in health.

  6. Basically, the specification of equation (1) is derived from a model in which the caseload is determined in a linear way by policy changes, macroeconomic factors, state-specific effects, and state-specific time trends [6]. Since most determinants of the caseload, except the policy indicators, are included in equation (1), the coefficient on the caseload variable measures the effect of policy changes.

  7. Given the evidence and concerns about the ``chilling effect” of PRWORA, we believe a dummy variable indicating TANF implementation is more likely to capture the effect of welfare reform and its “chilling effect,” than the specific aspects of the law.

  8. In the NHIS public use data for 1997 the nativity variable is only provided in the Sample Adult file, which is a small set of the adult sample. The variable on nativity is missing in the Person and Sample Child files.

  9. When we use the welfare caseload to measure reform, we can include separate year effects. And it is in this case that we test the restrictions imposed by using year dummy variables, which are rejected in favor of models using state-specific trends to account for unmeasured time trends.

  10. It is possible that welfare reform affected fertility and marriage, so selecting the sample on these characteristics may result in changes in sample composition. Based on existing evidence, however, we believe the bias due to sample selection will be insignificant [44].

  11. We repeat the analysis by restricting the sample to the top 14 states where 87 percent of the immigrants in NHIS lived during the period of analysis. The results were similar to those obtained using the national sample.

  12. The difference-in-difference estimate for bed days is the difference between the estimate for single mothers and married mothers. We did not estimate a pooled regression because of the non-linear form of the Poisson regression model. The standard error of the difference-in-difference estimate assumes that the covariance of the two estimates is zero.

  13. We note that the sample of school going children of single mothers is small consisting of only 2629 observations, which results in imprecise estimates.

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Acknowledgments

This project was partly funded by the Foundation for Child Development. We thank the Research Data Center of the National Center for Health Statistics for allowing us to use their research facilities to conduct part of the analysis.

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Authors and Affiliations

  1. School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA

    Neeraj Kaushal

  2. Department of Economics, University of Illinois at Chicago, 601 South Morgan 2108UH M/C 144, Chicago, IL, 60607, USA

    Robert Kaestner

Authors
  1. Neeraj Kaushal
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  2. Robert Kaestner
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Correspondence to Neeraj Kaushal.

Appendix 1

Appendix 1

  Test of Difference-in-difference Methodology: DinD Estimates of the Association between Log Caseload and Health Insurance, Health and Medical Care Utilization of Low-educated Foreign-born Single Mothers and their Children in the pre-PRWORA period
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Kaushal, N., Kaestner, R. Welfare Reform and Health of Immigrant Women and their Children. J Immigrant Health 9, 61–74 (2007). https://doi.org/10.1007/s10903-006-9021-y

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