Covering Undocumented Immigrants: The Effects of a Large-Scale Prenatal Care Intervention
Undocumented immigrants are ineligible for public insurance for prenatal care in most states, despite their children representing a large fraction of births and having U.S. citizenship. In this paper, we examine the short- and long-term effects of a policy that expanded Medicaid pregnancy coverage to undocumented immigrants using a novel dataset that links California birth records to Census surveys and administrative records on mortality, earnings, educational attainment, and public program participation. Using these records, we identify siblings born to immigrant mothers before and after the policy and implement a mothers’ fixed effects design to estimate policy impacts. We find that the policy increased coverage for and use of prenatal care among pregnant immigrant women, and increased average gestation length and birth weight among their children. Later in life, these children experience better educational outcomes, are less likely to have children at young ages, and receive fewer public supports. The effects are robust to a variety of specification checks and are larger among women who are predicted to have undocumented status at the time of the policy change and their children. Placebo tests estimate effects among immigrants and later cohorts not affected by the policy change and find no effects, as expected. Calculations based on our estimates indicate that, over the long-run, the government more than recoups the cost of its initial investment of providing Medicaid coverage to these families.
We would like to thank Ellen Badley, Sandra Bannerman, Colin Chew, Heather Fukushima, Steven Hoang, Amanda Jackson, Michelle Miles, Eric Neuhauser, Jenn Rico, and other staff at the California Department of Public Health (CDPH) for their help in accessing restricted California birth records; Chris Crettol, Betty Henderson-Sparks, Jasmine Neeley, and other staff at the California Department of Health Care Access and Information for help in accessing hospital discharge data; Olivia Burke, Joshua Leake, and Tracy Locklin for help with access to National Student Clearinghouse data; and Victoria McCoy-Cosentino at NYU for help with data use agreements. We would also like to thank Ashley Austin, Casey Blalock, Scott Boggess, Clint Carter, Melissa Chiu, Diane Cronkite, Carrie Dennis, Barbara Downs, Denise Flanagan-Doyle, Adam Galemore, Katie Genadek, Katlyn King, Shawn Klimek, Shirley Liu, Kathryn Mcnamara, Bonnie Moore, John Sullivan and other staff at Census, as well as Robert Goerge and Leah Gjertson at Chapin Hall for their help with the linkages to Census data. We are grateful for invaluable guidance received from Priya Batra and for very helpful feedback from Sandy Black, Michel Boudreaux, Janet Currie, Richard Frank, Andreas Hagemann, Hilary Hoynes, Doug Miller, Maria Perez-Patron, Heather Royer, Adam Schickedanz, Dan Schmierer, Erin Strumpf, Andrea Velasquez, as well as comments received at the ASSA meetings, APPAM, American University School of Public Affairs, BU/Harvard/MIT Health Economics seminar, Brookings Institution, Columbia Population Research Center, Cornell University Health Economics, George Washington University, iHEA Early Career Researcher Pre-Congress Session, Institute for Research on Poverty, NBER Health Economics, NYU, Ohio State University, Pontificia Universidad Católica de Chile, Southern Economic Association, UC Berkeley, UCLA, UC Santa Barbara, University of Colorado Denver, University of Connecticut, University of Illinois Gies College of Business, University of Maryland SPH, University of Michigan’s Population Studies Center, University of New Hampshire, University of Wisconsin-Madison’s Center for Demography and Ecology, UVA Batten, U.S. Census Bureau’s Center for Economic Studies, and the Yale School of Public Health. We would like to thank Alex Hollingsworth for sharing helpful code for creating visuals and Zoey Chopra and Chris Hollrah for excellent research assistance. This research was supported by the National Institute on Aging under R01-AG059731 and by the Laura and John Arnold Foundation under their initiative to use linked data to advance evidence-based policymaking. Laura Wherry also gratefully acknowledges non-financial support from the California Center for Population Research at UCLA, which receives core support (R24-HD041022) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. This research was conducted as a part of the U.S. Census Bureau’s Evidence Building Project Series. Any opinions and conclusions expressed herein are those of the authors and do not represent the views of the U.S. Census Bureau. The Census Bureau has ensured appropriate access and use of confidential data and has reviewed these results for disclosure avoidance protection (Project P-7523134: CBDRB-FY19-532, CBDRB-FY20-045, CBDRB-FY20-183, CBDRBFY22- CES018-007, CBDRB-FY22-CES018-015, CBDRB-FY23-CES021-001, and CBDRB-FY23-CES021- 003). Any analyses, interpretations, or conclusions expressed herein are those of the authors and do not necessarily represent the views of the U.S. Census Bureau, the California Departments of Public Health or Health Care Access and Information, the National Student Clearinghouse, or other data providers. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
- Medicaid coverage for prenatal care has expanded considerably in recent decades. But in many states, undocumented immigrants remain...