Friday, 14 January 2005 - 8:00 AM

This presentation is part of: Immigrants

The Effects of State Immigrant Provisions on the Uninsured among Children of Immigrants after Welfare Reform

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) imposed various restrictions on federal programs for immigrants. Thus, children in immigrant households are more likely disadvantaged than any other group of American children. Moreover, PRWORA authorized states to determine eligibility of immigrants. The access to health care for children in immigrant families now depends on a state government's generosity toward immigrants.

This study examines variations in state immigrant provisions under PRWORA and estimates the impact on the risk of being uninsured for children in immigrant families. Two programs designed to provide public health care to low income children are selected for the study: Medicaid, and state Child Health Insurance Program (CHIP). In theory, states that have made Medicaid, and/or state CHIP available for ineligible immigrants using state funds are expected to decrease the uninsured among children of immigrants. Yet, the empirical question needs to be answered as to what extent state immigrant provisions have contributed to a decline in the uninsured among children in immigrant families.

Secondly, the study examines an effect of citizenship on the health care access among children of immigrants. Because PRWORA barred non-citizen immigrants from public assistance, a child's citizenship is expected to be a critical factor for the access. It is noteworthy that 3 quarters of children in immigrant households are actually native-born citizens, making them legally eligible for federal programs. Nonetheless, a few studies have reported that these eligible children of immigrants drop off welfare programs more rapidly than those in citizen households, and that immigrant families are increasingly reluctant to apply for public assistance, regardless of eligibility. Depending on the extent of these "chilling effects," children's citizenship may not be as critical as expected for the access to health care. This study estimates the relative effect of citizenship on the risk of being uninsured among children of immigrants.

The study has used logistic regression models and analyzed the 2002 Current Population Survey. The study finds that state-funded Medicaid and state CHIP made available to ineligible immigrants under PRWORA significantly decrease the risk of being uninsured among children of immigrants --by 9 and 3 percentage point, respectively--while controlling all other socio economic variables. A child's citizenship is also found to be significant--a non-citizen child is 10 percent more likely to be uninsured than the average citizen child of immigrant. Among other state variables, the general level of state safety net for low income households, the proportion of immigrants in the state population, and state unemployment rate are found to have the significant impact. Finally, the study finds that children of color in immigrant families are far more likely to be uninsured, holding other variables constant.

The findings of this study show the importance of state policy under PRWORA. It suggests that state policy makers can mitigate the negative impact of PRWORA on the uninsured rate for children of immigrants. It also suggests that states need to target children of color in immigrant families in their outreach efforts to expand the access to health care.

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