Address correspondence to Neeraj Kaushal, School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027. Robert Kaestner is with the Department of Economics, University of Illinois at Chicago, 601 South Morgan 2108UH M/C144, Chicago, IL 60607.
Welfare Reform and Health Insurance of Immigrants
Article first published online: 24 MAY 2005
Health Services Research
Volume 40, Issue 3, pages 697–722, June 2005
How to Cite
Kaushal, N. and Kaestner, R. (2005), Welfare Reform and Health Insurance of Immigrants. Health Services Research, 40: 697–722. doi: 10.1111/j.1475-6773.2005.00381.x
- Issue published online: 24 MAY 2005
- Article first published online: 24 MAY 2005
- Access to healthcare;
- social policy;
Objective. To investigate the effect of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) on the health insurance coverage of foreign- and U.S.-born families headed by low-educated women.
Data Source. Secondary data from the March series of the Current Population Surveys for 1994–2001.
Study Design. Multivariate regression methods and a pre- and post-test with comparison group research design (difference-in-differences) are used to estimate the effect of welfare reform on the health insurance coverage of low-educated, foreign- and U.S.-born unmarried women and their children. Heterogenous responses by states to create substitute Temporary Aid to Needy Families or Medicaid programs for newly arrived immigrants are used to investigate whether the estimated effect of PRWORA on newly arrived immigrants is related to the actual provisions of the law, or the result of fears engendered by the law.
Principal Findings. PRWORA increased the proportion of uninsured among low-educated, foreign-born, unmarried women by 9.9–10.7 percentage points. In contrast, the effect of PRWORA on the health insurance coverage of similar U.S.-born women is negligible. PRWORA also increased the proportion of uninsured among foreign-born children living with low-educated, single mothers by 13.5 percentage points. Again, the policy had little effect on the health insurance coverage of the children of U.S.-born, low-educated single mothers. There is some evidence that the fear and uncertainty engendered by the law had an effect on immigrant health insurance coverage.
Conclusions. This research demonstrates that PRWORA adversely affected the health insurance of low-educated, unmarried, immigrant women and their children. In the case of unmarried women, it may be partly because the jobs that they obtained in response to PRWORA were less likely to provide health insurance. The research also suggests that PRWORA may have engendered fear among immigrants and dampened their enrollment in safety net programs.