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

Background Insurance status among children with native parents (2005) 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) Insurance status among children with at least one foreign born parent (2005) – 48% private – 40% public – 12% uninsured

Background Children of immigrant parents are more likely to participate in public coverage than natives by 12 percentage points 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 Public issue – Cost implications for Medicaid and SCHIP – Lack of coverage prevents access to care among children => future burden?

Key Issue Does a child’s participation in public coverage depend on his/her parent’s stay in the U.S? 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)

Study Objectives Does a parent’s length of stay in the U.S affect eligible children’s propensities to 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? 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? 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 How do immigration characteristics affect a child’s participation in public coverage in the steady state

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

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

Data Information about immigrants is extracted from National Health Interview Survey Information about immigrants is extracted from National Health Interview Survey In all models we control for 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 All models are estimated separately for two and one parent households

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

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 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 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 To find element in matrix P, solve The effect of the binary covariate, X, on steady-state probability is simply 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 The expression informs us of the long run effects of a specific covariate on the likelihood of being in public coverage

Parent Characteristics of Eligible Children by Parental Nativity & Stay in the U.S. Parent Characteristics of Eligible Children by Parental Nativity & Stay in the U.S. Both Native All Immig Immig <5 yrs <5 yrsImmig 5-10 yr Immig yr Immig >15 yr Mother Offer **0.16**0.20**0.25** 0.39* 0.39* HS deg **0.36**0.28**0.34**0.44** Empl **0.34**0.33**0.37**0.46** Father Offer **0.43**0.43**0.49**0.59** **0.41**0.30**0.33**0.44** Empl ** **0.90**0.86 Significantly different from Both Native: * 10% **5% ***1%

Transition Matrix Mean Probability of Transition Transition Matrix Mean Probability of Transition Both Native Immig < 5 yrs Immig 6-10 yrs Immig yr Immig >15 yrs Mother is an Immigrant Entry into Public Coverage **0.06**0.07**0.05** Retention of Public Coverage ** Father is an Immigrant Entry into Public Coverage **0.07**0.06**0.05** Retention of Public Coverage

Discrete Hazard Results: Father’s Stay - 2 Parent HH Citizen Immigrant Father Non-Citizen Immigrant Father EntryRetentionEntryRetention <5 years years years ** >15 years * & Comparison group: Children with two Native Parents

Discrete Hazard Results: Mother’s Stay - 2 Parent HH Citizen Immigrant Mother Non-Citizen Immigrant Mother EntryRetentionEntryRetention <5 years years years *-0.030** >15 years * ** & Comparison group: Children with two Native Parents

Discrete Hazard Results: Other Characteristics - 2 Parent HH EntryRetention Child Immigrant Citizen * Immig Non-Citizen ** ** Father High School Education ** ** College Education *** *** Mother High School Education *** *** ** ** College Education *** ***-0.009

Discrete Hazard Results: Parent Stay - 1 Parent HH Citizen Immigrant Parent (&) Non-Citizen Immigrant Parent (&) EntryRetentionEntryRetention <5 years * 5-10 years * years >15 years Comparison group: Native Parent

Steady State (Probability Enrolled) by Parent’s Stay: 2 Parent HH Citizen Immigrant Father Non-Citizen Immigrant Father Citizen Immigrant Mother Non-Citizen Immigrant Mother <5 yrs yrs yr ** >15 yrs **

Steady State (Probability Enrolled) by Parent Stay: 1 Parent HH Citizen Immigrant Parent Non-Citizen Immigrant Parent <5 years * 5-10 years years ** >15 years *

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

Conclusions and Policy Implications Higher parental education and being an immigrant child affect entry into and retention of public coverage 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 No evidence of assimilation into public coverage among children with foreign born parents – Contrary to the literature on adult immigrants’ participation in welfare programs