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