Covering Undocumented Immigrants: The Effects of A Large-Scale Prenatal Care Intervention
Despite the large share of births in the U.S. to undocumented immigrants, they are ineligible for public health insurance coverage for routine prenatal care in the majority of states. In this paper, we examine the effects of a landmark policy in California that expanded Medicaid pregnancy coverage to undocumented immigrants. We use a novel dataset that links California birth and hospital records to the decennial Census and American Community Survey to examine changes in health insurance, health care utilization, and birth outcomes. Using these linked data, we are able to identify siblings born to immigrant mothers before and after the coverage expansion to estimate changes in outcomes resulting from the policy change using a mothers' fixed effects design. By comparing outcomes for children born to the same mother, we are able to isolate policy-induced changes from large changes in the composition of immigrants that occurred in California over the study period. We document increased insurance coverage for prenatal care and delivery, improved prenatal care utilization, and an increase in hospital delivery among pregnant immigrant women under the expansion, as well as increased likelihood of delivery by a physician. We also find significant increases in average gestation length and birth weight among the children who benefited from the policy change while in utero. These effects are larger for immigrant women identified as most likely to have undocumented status, and do not appear to be driven by policy-induced fertility changes. The results are robust to alternative specifications designed to rule out the role of concurrent immigration reforms or other Medicaid eligibility changes.
Co-author Sarah Miller
About Dr. Laura Wherry
Laura Wherry's primary area of research focuses on the changing role of the Medicaid program and its impact on access to health care and health. Recent work examines the early effects of the Affordable Care Act Medicaid expansions, as well as the longer-term effects of several large expansions in Medicaid targeting low-income pregnant women and children in the 1980s and 1990s. Prior to joining NYU, she was an assistant professor at the David Geffen School of Medicine at UCLA and a Robert Wood Johnson Foundation Health & Society Scholar at the University of Michigan.
Laura received her Ph.D. in Public Policy from the University of Chicago's Harris School and her B.A. from the College of William and Mary.