do children of immigrant parents assimilate into public health insurance? a dynamic analysis by...
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Do Children of Immigrant Parents Assimilate Do Children of Immigrant Parents Assimilate into Public Health Insurance? A Dynamic into Public Health Insurance? A Dynamic
AnalysisAnalysis
bybyJulie HudsonJulie Hudson
Yuriy PylypchukYuriy Pylypchuk
August 10, 2009August 10, 2009
BackgroundBackground
Insurance status among children with native parents (2005)Insurance status among children with native parents (2005)– 67% private67% private– 28% public28% public– 4% uninsured4% uninsured
Insurance status among children with at least one foreign born Insurance status among children with at least one foreign born parent (2005)parent (2005)– 48% private48% private– 40% public40% public– 12% uninsured12% uninsured
BackgroundBackground
Children of immigrant parents are more likely Children of immigrant parents are more likely to participate in public coverage than natives to participate in public coverage than natives by 12 percentage pointsby 12 percentage points
– consistent with immigrant participation in consistent with immigrant participation in other public programs (AFDC, Food other public programs (AFDC, Food Stamps)Stamps)
Public issue Public issue
– Cost implications for Medicaid and SCHIPCost implications for Medicaid and SCHIP
– Lack of coverage prevents access to care Lack of coverage prevents access to care among children => future burden?among children => future burden?
Key IssueKey Issue
Does a child’s participation in public coverage depend on Does a child’s participation in public coverage depend on his/her parent’s stay in the U.S?his/her parent’s stay in the U.S?– The propensity to participate can increase, decrease, or The propensity to participate can increase, decrease, or
remain the same with parents length of stay in the U.S.remain the same with parents length of stay in the U.S.– If decreases => children of immigrant parents assimilate If decreases => children of immigrant parents assimilate
out of public coverageout of public coverage– If increases => children of immigrant parents exhibit If increases => children of immigrant parents exhibit
increasing welfare dependence (increasing welfare dependence (found among adults for found among adults for AFDC/TANFAFDC/TANF))
Study ObjectivesStudy Objectives
Does a parent’s length of stay in the U.S affect Does a parent’s length of stay in the U.S affect eligible children’s eligible children’s propensities topropensities to– EnterEnter into public coverage into public coverage– RetainRetain public coverage public coverage
Are there differential effects of immigration- Are there differential effects of immigration- citizenship status of Mothers versus Fathers? citizenship status of Mothers versus Fathers?
What is the role of a child’s own immigration- What is the role of a child’s own immigration- citizenship status for citizenship status for entry/retention?entry/retention?
How do immigration characteristics affect a child’s How do immigration characteristics affect a child’s participation in public coverage in the steady stateparticipation in public coverage in the steady state
LiteratureLiterature
Borjas and Trejo (1991), Wei-Yin Hu (1997)Borjas and Trejo (1991), Wei-Yin Hu (1997)– Adult immigrants assimilate into welfare programs Adult immigrants assimilate into welfare programs
in the U.S.in the U.S. Hanson and Lofstrom., 2003Hanson and Lofstrom., 2003
– Immigrants assimilate out of welfare in SwedenImmigrants assimilate out of welfare in Sweden Currie 2000, Buchmuler et al., 2008Currie 2000, Buchmuler et al., 2008
– SCHIP expansion increased participation in public SCHIP expansion increased participation in public coverage among children with foreign born coverage among children with foreign born household headshousehold heads
Ham et al., 2008. Ham et al., 2008. – Transitions among private, pubic, and no Transitions among private, pubic, and no
insurance. No immigrants characteristics in the insurance. No immigrants characteristics in the model. Hispanics are more likely to enter public model. Hispanics are more likely to enter public coveragecoverage
DataData
Medical Expenditures Panel Survey (MEPS), Medical Expenditures Panel Survey (MEPS), Years 1996-2005, panels 1-9Years 1996-2005, panels 1-9
0-0-1717 year old children year old children Eligible for Medicaid or CHIP Eligible for Medicaid or CHIP Model quarterly transitions from and to public Model quarterly transitions from and to public
coverage over two year periodcoverage over two year period– Exclude Exclude
children with missing coverage for 3 months in a rowchildren with missing coverage for 3 months in a row children who appeared in survey for 3 months or lesschildren who appeared in survey for 3 months or less children without any parent or head of the householdchildren without any parent or head of the household
– Eligibility criteria varies annuallyEligibility criteria varies annually
DataData
Information about immigrants is extracted from Information about immigrants is extracted from National Health Interview Survey National Health Interview Survey
In all models we control forIn all models we control for– State quarterly unemployment rateState quarterly unemployment rate
– Cohort effectsCohort effects
– Parent education and health statusParent education and health status
– Children’s health status, region and MSA, race Children’s health status, region and MSA, race and ageand age
All models are estimated separately for two All models are estimated separately for two and one parent householdsand one parent households
ModelModel
Hazard of entering public coverageHazard of entering public coverage
M M - years of stay in the U.S- years of stay in the U.S Hazard of retaining public coverageHazard of retaining public coverage
– Do not control for initial conditionsDo not control for initial conditions
– Do not control for unobserved heterogeneityDo not control for unobserved heterogeneity
eXBAMPP eeeette )0|1(Pr 1
rrrrttr XBAMPP )1|1(Pr 1
Steady stateSteady state Let R be 2X2 transition matrix, where the element of the Let R be 2X2 transition matrix, where the element of the
matrix, represents the predicted probability of moving from matrix, represents the predicted probability of moving from state k to state j state k to state j
Let Let P P denote the row vector of participating in public denote the row vector of participating in public coverage or having other insurance status in steady statecoverage or having other insurance status in steady state
To find element in matrix P, solveTo find element in matrix P, solve
The effect of the binary covariate, X, on steady-state The effect of the binary covariate, X, on steady-state probability is simply probability is simply
The expression informs us of the long run effects of a The expression informs us of the long run effects of a specific covariate on the likelihood of being in public specific covariate on the likelihood of being in public coverage coverage
0)( IRP
)0()1( XPXPP d
Parent Characteristics of Eligible Children Parent Characteristics of Eligible Children by Parental Nativity & Stay in the U.S.by Parental Nativity & Stay in the U.S.
Both Both NativeNative
All All ImmigImmig
ImmigImmig
<5 yrs<5 yrs
ImmigImmig
5-10 yr5-10 yr
ImmigImmig
10-15 yr10-15 yr
ImmigImmig
>15 yr >15 yr MotherMother
Offer Offer 0.430.43 0.29**0.29** 0.16**0.16** 0.20**0.20** 0.25**0.25** 0.39*0.39*
HS degHS deg 0.680.68 0.36**0.36** 0.36**0.36** 0.28**0.28** 0.34**0.34** 0.44**0.44**
EmplEmpl 0.530.53 0.39**0.39** 0.34**0.34** 0.33**0.33** 0.37**0.37** 0.46**0.46**
FatherFather
OfferOffer 0.710.71 0.52**0.52** 0.43**0.43** 0.43**0.43** 0.49**0.49** 0.59**0.59**
HS degHS deg 0.650.65 0.36**0.36** 0.41**0.41** 0.30**0.30** 0.33**0.33** 0.44**0.44**
EmplEmpl 0.830.83 0.87**0.87** 0.81 0.81 0.88**0.88** 0.90**0.90** 0.860.86
Significantly different from Both Native: * 10% **5% ***1%
Transition Matrix Transition Matrix Mean Probability of TransitionMean Probability of Transition
Both Both NativeNative
Immig Immig
< 5 yrs< 5 yrs
Immig Immig
6-10 yrs6-10 yrs
Immig Immig
11-15 yr11-15 yr
ImmigImmig
>15 yrs>15 yrs
Mother is an ImmigrantMother is an Immigrant
Entry into Public Entry into Public CoverageCoverage
0.030.03 0.05**0.05** 0.06**0.06** 0.07**0.07** 0.05**0.05**
Retention of Retention of Public Coverage Public Coverage
0.950.95 0.96**0.96** 0.950.95 0.950.95 0.950.95
Father is an ImmigrantFather is an Immigrant
Entry into Public Entry into Public CoverageCoverage
0.030.03 0.06**0.06** 0.07**0.07** 0.06**0.06** 0.05**0.05**
Retention of Retention of Public Coverage Public Coverage
0.950.95 0.960.96 0.950.95 0.950.95 0.950.95
Discrete Hazard Results: Discrete Hazard Results: Father’s Stay - 2 Parent HHFather’s Stay - 2 Parent HH
Citizen Immigrant Citizen Immigrant FatherFather
Non-Citizen Immigrant Non-Citizen Immigrant FatherFather
EntryEntry RetentionRetention EntryEntry RetentionRetention
<5 years <5 years -0.013-0.013 -0.015-0.015 0.0020.002 -0.004-0.004
5-10 years 5-10 years -0.012-0.012 -0.012-0.012 0.0020.002 -0.002-0.002
10-15 10-15 years years
-0.023**-0.023** -0.010-0.010 -0.013-0.013 -0.001-0.001
>15 years >15 years -0.019*-0.019* -0.014-0.014 -0.008-0.008 -0.004-0.004
& Comparison group: Children with two Native Parents
Discrete Hazard Results: Discrete Hazard Results: Mother’s Stay - 2 Parent HHMother’s Stay - 2 Parent HH
Citizen Immigrant Citizen Immigrant MotherMother
Non-Citizen Immigrant Non-Citizen Immigrant MotherMother
EntryEntry RetentionRetention EntryEntry RetentionRetention
<5 years <5 years 0.0110.011 0.0120.012 0.0090.009 0.0020.002
5-10 years 5-10 years 0.0190.019 -0.000-0.000 0.0180.018 -0.013-0.013
10-15 10-15 years years
0.0290.029 -0.014-0.014 0.027*0.027* -0.030**-0.030**
>15 years >15 years 0.0190.019 -0.028*-0.028* 0.0170.017 -0.048**-0.048**
& Comparison group: Children with two Native Parents
Discrete Hazard Results: Discrete Hazard Results: Other Characteristics - 2 Parent HHOther Characteristics - 2 Parent HH
EntryEntry RetentionRetention
ChildChild
Immigrant CitizenImmigrant Citizen -0.015*-0.015* 0.0070.007Immig Non-CitizenImmig Non-Citizen -0.015**-0.015** -0.003-0.003FatherFather
High School EducationHigh School Education -0.013**-0.013** -0.005-0.005College EducationCollege Education -0.027***-0.027*** -0.023-0.023MotherMother
High School EducationHigh School Education -0.016***-0.016*** -0.012**-0.012**College EducationCollege Education -0.035***-0.035*** -0.009-0.009
Discrete Hazard Results: Discrete Hazard Results: Parent Stay - 1 Parent HHParent Stay - 1 Parent HH
Citizen Immigrant Citizen Immigrant Parent (&)Parent (&)
Non-Citizen Immigrant Non-Citizen Immigrant Parent (&)Parent (&)
EntryEntry RetentionRetention EntryEntry RetentionRetention
<5 years <5 years 0.0480.048 0.0820.082 0.0190.019 0.020*0.020*
5-10 years 5-10 years 0.0490.049 0.083*0.083* 0.0110.011 0.0120.012
10-15 10-15 years years
0.0030.003 0.0270.027 0.0070.007 0.0090.009
>15 years >15 years 0.0030.003 0.0260.026 -0.002-0.002 0.0010.001
Comparison group: Native Parent
Steady State (Probability Enrolled)Steady State (Probability Enrolled) by Parent’s Stay: 2 Parent HHby Parent’s Stay: 2 Parent HH
Citizen Citizen Immigrant Immigrant
FatherFather
Non-Citizen Non-Citizen Immigrant Immigrant
FatherFather
Citizen Citizen Immigrant Immigrant
MotherMother
Non-Citizen Non-Citizen Immigrant Immigrant
MotherMother
<5 yrs <5 yrs -0.007-0.007 -0.001-0.001 0.0060.006 0.0030.003
5-10 yrs 5-10 yrs -0.006-0.006 -0.001-0.001 0.0050.005 0.0010.001
10-15 yr 10-15 yr -0.009**-0.009** -0.004-0.004 0.0040.004 -0.001-0.001
>15 yrs >15 yrs -0.009**-0.009** -0.003-0.003 -0.003-0.003 0.0080.008
Steady State (Probability Enrolled) Steady State (Probability Enrolled) by Parent Stay: 1 Parent HHby Parent Stay: 1 Parent HH
Citizen Immigrant Citizen Immigrant ParentParent
Non-Citizen Immigrant Non-Citizen Immigrant ParentParent
<5 years <5 years 0.0020.002 0.007*0.007*
5-10 years 5-10 years 0.0010.001 0.0060.006
10-15 years 10-15 years -0.001-0.001 0.005**0.005**
>15 years >15 years -0.001-0.001 0.006*0.006*
Conclusions and Policy Conclusions and Policy ImplicationsImplications
Overall, participation rates among children of immigrant Overall, participation rates among children of immigrant and native born parents are very similarand native born parents are very similar
Differences depend on household structure and nativity Differences depend on household structure and nativity status of a mother or fatherstatus of a mother or father– Hazard of Entry into public coverage Hazard of Entry into public coverage
decreases for children with citizen immigrant father decreases for children with citizen immigrant father increases for children with non-citizen immigrant increases for children with non-citizen immigrant mothermother
– Hazard of Retaining public coverage Hazard of Retaining public coverage Does not depend on the nativity status of child’s fatherDoes not depend on the nativity status of child’s father Decreases for children with non-citizen immigrant Decreases for children with non-citizen immigrant mothermother
For one parent households, children with a foreign born For one parent households, children with a foreign born parent exhibit assimilation out of public coverageparent exhibit assimilation out of public coverage
Conclusions and Policy Conclusions and Policy ImplicationsImplications
Higher parental education and being an immigrant child affect Higher parental education and being an immigrant child affect entry into and retention of public coverageentry into and retention of public coverage– Education – attitudes to public porgrams and/or job opportunities?Education – attitudes to public porgrams and/or job opportunities?
– Foreign born child - Chilling effect?Foreign born child - Chilling effect?
– Overall, results are robust to alternative specificationsOverall, results are robust to alternative specifications
No evidence of assimilation into public coverage among No evidence of assimilation into public coverage among children with foreign born parentschildren with foreign born parents– Contrary to the literature on adult immigrants’ participation in welfare Contrary to the literature on adult immigrants’ participation in welfare
programsprograms
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