Do Children of Immigrant Parents Assimilate into Public Health Insurance? A Dynamic Analysis

1. Do Children of Immigrant Parents Assimilate into Public Health Insurance? A Dynamic Analysis by Julie Hudson Yuriy Pylypchuk August 10, 2009

2. Background • Insurance status among children with native parents (2005) • 67% private • 28% public • 4% uninsured • Insurance status among children with at least one foreign born parent (2005) • 48% private • 40% public • 12% uninsured

3. Background • Children of immigrant parents are more likely to participate in public coverage than natives by 12 percentage points • consistent with immigrant participation in other public programs (AFDC, Food Stamps) • Public issue • Cost implications for Medicaid and SCHIP • Lack of coverage prevents access to care among children => future burden?

4. Key Issue • Does a child’s participation in public coverage depend on his/her parent’s stay in the U.S? • The propensity to participate can increase, decrease, or remain the same with parents length of stay in the U.S. • If decreases => children of immigrant parents assimilate out of public coverage • If increases => children of immigrant parents exhibit increasing welfare dependence (found among adults for AFDC/TANF)

5. Study Objectives • Does a parent’s length of stay in the U.S affect eligible children’s propensities to • Enter into public coverage • Retain public coverage • Are there differential effects of immigration- citizenship status of Mothers versus Fathers? • What is the role of a child’s own immigration- citizenship status for entry/retention? • How do immigration characteristics affect a child’s participation in public coverage in the steady state

6. Literature • Borjas and Trejo (1991), Wei-Yin Hu (1997) • Adult immigrants assimilate into welfare programs in the U.S. • Hanson and Lofstrom., 2003 • Immigrants assimilate out of welfare in Sweden • Currie 2000, Buchmuler et al., 2008 • SCHIP expansion increased participation in public coverage among children with foreign born household heads • Ham et al., 2008. • Transitions among private, pubic, and no insurance. No immigrants characteristics in the model. Hispanics are more likely to enter public coverage

7. Data • Medical Expenditures Panel Survey (MEPS), Years 1996-2005, panels 1-9 • 0-17 year old children • Eligible for Medicaid or CHIP • Model quarterly transitions from and to public coverage over two year period • Exclude • children with missing coverage for 3 months in a row • children who appeared in survey for 3 months or less • children without any parent or head of the household • Eligibility criteria varies annually

8. Data • Information about immigrants is extracted from National Health Interview Survey • In all models we control for • State quarterly unemployment rate • Cohort effects • Parent education and health status • Children’s health status, region and MSA, race and age • All models are estimated separately for two and one parent households

9. Model • Hazard of entering public coverage • M - years of stay in the U.S • Hazard of retaining public coverage • Do not control for initial conditions • Do not control for unobserved heterogeneity

10. Steady state • Let R be 2X2 transition matrix, where the element of the matrix, represents the predicted probability of moving from state k to state j • Let P denote the row vector of participating in public coverage or having other insurance status in steady state • To find element in matrix P, solve • The effect of the binary covariate, X, on steady-state probability is simply • The expression informs us of the long run effects of a specific covariate on the likelihood of being in public coverage

11. Parent Characteristics of Eligible Children by Parental Nativity & Stay in the U.S. Significantly different from Both Native: * 10% **5% ***1%

12. Transition Matrix Mean Probability of Transition

13. Discrete Hazard Results: Father’s Stay - 2 Parent HH & Comparison group: Children with two Native Parents

14. Discrete Hazard Results: Mother’s Stay - 2 Parent HH & Comparison group: Children with two Native Parents

15. Discrete Hazard Results: Other Characteristics - 2 Parent HH

16. Discrete Hazard Results: Parent Stay - 1 Parent HH Comparison group: Native Parent

17. Steady State (Probability Enrolled)by Parent’s Stay: 2 Parent HH

18. Steady State (Probability Enrolled) by Parent Stay: 1 Parent HH

19. Conclusions and Policy Implications • Overall, participation rates among children of immigrant and native born parents are very similar • Differences depend on household structure and nativity status of a mother or father • Hazard of Entry into public coverage • decreases for children with citizen immigrant father • increases for children with non-citizen immigrant mother • Hazard of Retaining public coverage • Does not depend on the nativity status of child’s father • Decreases for children with non-citizen immigrant mother • For one parent households, children with a foreign born parent exhibit assimilation out of public coverage

20. Conclusions and Policy Implications • Higher parental education and being an immigrant child affect entry into and retention of public coverage • Education – attitudes to public porgrams and/or job opportunities? • Foreign born child - Chilling effect? • Overall, results are robust to alternative specifications • No evidence of assimilation into public coverage among children with foreign born parents • Contrary to the literature on adult immigrants’ participation in welfare programs