Essays on Health Economics and Immigration
Immigrants are more likely to be low income than their US-born peers, but they face more barriers to enrolling in government safety net programs. Children of immigrants, the majority of whom are US citizens, are less likely to enroll in some programs designed to protect their health and welfare. This dissertation explores issues of immigrant families’ engagement with public health insurance and nutritional assistance programs in three chapters.
The first chapter describes levels and time trends of immigrant families’ participation in key safety net programs. The study covers the years 1996 to 2013 using data from the Survey of Income and Program Participation (SIPP) and the New Immigrant Survey (NIS). For children, the study presents data and regression-adjusted estimates of the associations between being from an immigrant family, and having likely undocumented family members, and participation in each of five safety net programs: the Food Stamps Program; National School Lunch Program; School Breakfast Program; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and public health insurance.
The second chapter evaluates the effects of six state policies that implemented early Affordable Care Act (ACA) adult Medicaid expansions. The analysis focuses on citizen adults of immigrant and native families. It uses the American Community Survey (ACS) from 2008 to 2013 and a difference-in-differences method with synthetic control states to estimate the effects of the expansions on insurance coverage outcomes for citizen adults of immigrant and native family backgrounds. The policies produced a range of responses, from a 2 percentage point public insurance coverage increase in California to an 8 percentage point increase in Connecticut. There was some evidence of private insurance crowd-out in Connecticut, the District of Columbia, and Minnesota, but there were also net reductions in uninsurance for most states. Responses to the new policies were slightly lower among young adults than for the full adult population. In general, insurance coverage changes did not measurably differ among individuals from immigrant families as compared with those from native families.
The third chapter analyzes public health insurance expansions for children. Medicaid expansions have the potential to greatly increase coverage for children in immigrant families, who have low levels of private insurance and high uninsurance rates. However, take-up may be lower in immigrant families than native families due to poor information and “chilling” anti-immigrant sentiment. I estimate take-up from 1996 to 2013 using instrumental variables regression and data from the Survey of Income and Program Participation (SIPP). This study finds that new eligibility for public insurance produces a 9-to-13 percentage point increase in public coverage among children of immigrants, which is indistinguishable from the 11-to-12 percentage point increase among children of natives. These findings reject a strong chilling effect, although the question will be important to revisit in the changing policy environment.