Do Children of Immigrant Parents Assimilate into Public Health Insurance? A Dynamic Analysis (Text Version)

Slide presentation from the AHRQ 2009 conference.

On September 15, 2009, Julie Hudson and Yuriy Pylypchuk made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (741 KB) (Plugin Software Help).


Slide 1

Slide 1. Do Children of Immigrant Parents Assimilate into Public Health Insurance? A Dynamic Analysis

Do Children of Immigrant Parents Assimilate into Public Health Insurance? A Dynamic Analysis

By
Julie Hudson
Yuriy Pylypchuk

Slide 2

Slide 2. Background

Background

  • 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)
    • 48% private.
    • 40% public.
    • 12% uninsured.

Slide 3

Slide 3. Background

Background

  • 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
    • Cost implications for Medicaid and SCHIP.
    • Lack of coverage prevents access to care among children => future burden?

Slide 4

Slide 4. Key Issue

Key Issue

  • 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).

Slide 5

Slide 5. Study Objectives

Study Objectives

  • 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?
  • 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.

Slide 6

Slide 6. Literature

Literature

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

Slide 7

Slide 7. Data

Data

  • Medical Expenditures Panel Survey (MEPS), Years 1996-2005, panels 1-9.
  • 0-17 year old children.
  • Eligible for Medicaid or CHIP.
  • Model quarterly transitions from and to public coverage over two year period
    • Exclude
      • Children with missing coverage for 3 months in a row.
      • Children who appeared in survey for 3 months or less.
      • Children without any parent or head of the household.
    • Eligibility criteria varies annually.

Slide 8

Slide 8. Data

Data

  • Information about immigrants is extracted from National Health Interview Survey.
  • 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.

Slide 9

Slide 9. Model

Model

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

Slide 10

Slide 10. Steady state

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 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.
  • 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.

Slide 11

Slide 11. Parent Characteristics of Eligible Children by Parental Nativity and Stay in the U.S.

Parent Characteristics of Eligible Children by Parental Nativity & Stay in the U.S.

 Both NativeAll ImmigImmig
<5 yrs
Immig
5-10 yr
Immig
10-15 yr
Immig
>15 yr
Mother
Offer0.430.29**0.16**0.20**0.25**0.39*
HS deg0.680.36**0.36**0.28**0.34**0.44**
Empl0.530.39**0.34**0.33**0.37**0.46**
Father
Offer0.710.52**0.43**0.43**0.49**0.59**
HS deg0.650.36**0.41**0.30**0.33**0.44**
Empl0.830.87**0.810.88**0.90**0.86

Significantly different from Both Native: * 10% **5% ***1%

Slide 12

Slide 12. Transition Matrix: Mean Probability of Transition

Transition Matrix Mean Probability of Transition

 Both NativeImmig
<5 yrs
Immig
5-10 yr
Immig
10-15 yr
Immig
>15 yr
 Mother is an Immigrant
Entry into Public Coverage0.030.05**0.06**0.07**0.05**
Retention of Public Coverage0.950.96**0.950.950.95
 Father is an Immigrant
Entry into Public Coverage0.030.06**0.07**0.06**0.05**
Retention of Public Coverage0.950.960.950.950.95

Slide 13

Slide 13. Discrete Hazard Results: Fathers Stay - 2 Parent HH

Discrete Hazard Results: Father's Stay - 2 Parent HH

 Citizen Immigrant FatherNon-Citizen Immigrant Father
 EntryRetentionEntryRetention
<5 years-0.013-0.0150.002-0.004
5-10 years-0.012-0.0120.002-0.002
10-15 years-0.023**-0.010-0.013-0.001
>15 years-0.019*-0.014-0.008-0.004

& Comparison group: Children with two Native Parents.

Slide 14

Slide 14. Discrete Hazard Results: Mothers Stay - 2 Parent HH

Discrete Hazard Results: Mother's Stay - 2 Parent HH

 Citizen Immigrant FatherNon-Citizen Immigrant Father
 EntryRetentionEntryRetention
<5 years0.0110.0120.0090.002
5-10 years0.019-0.0000.018-0.013
10-15 years0.029-0.0140.027*-0.030**
>15 years0.019-0.028*0.017-0.048**

& Comparison group: Children with two Native Parents.

Slide 15

Slide 15. Discrete Hazard Results: Other Characteristics - 2 Parent HH

Discrete Hazard Results: Other Characteristics - 2 Parent HH

 EntryRetention
Child
Immigrant Citizen-0.015*0.007
Immig Non-Citizen-0.015**-0.003
Father
High School Education-0.013**-0.005
College Education-0.027***-0.023
Mother
High School Education-0.016***-0.012**
College Education-0.035***-0.009

Slide 16

Slide 16. Discrete Hazard Results: Parent Stay - 1 Parent HH

Discrete Hazard Results: Parent Stay - 1 Parent HH

 Citizen Immigrant Parent (&)Non-Citizen Immigrant Parent (&)
 EntryRetentionEntryRetention
<5 years0.0480.0820.0190.020*
5-10 years0.0490.083*0.0110.012
10-15 years0.0030.0270.0070.009
>15 years0.0030.026-0.0020.001

Comparison group: Native Parent.

Slide 17

Slide 17. Steady State (Probability Enrolled) by Parent's Stay: 2 Parent HH

Steady State (Probability Enrolled) by Parent's Stay: 2 Parent HH

 Citizen Immigrant FatherNon-Citizen Immigrant FatherCitizen Immigrant MotherNon-Citizen Immigrant Mother
<5 years-0.007-0.0010.0060.003
5-10 years-0.006-0.0010.0050.001
10-15 years-0.009**-0.0040.004-0.001
>15 years-0.009**-0.003-0.0030.008

Slide 18

Slide 18. Steady State (Probability Enrolled) by Parent Stay: 1 Parent HH

Steady State (Probability Enrolled) by Parent Stay: 1 Parent HH

 Citizen Immigrant ParentNon-Citizen Immigrant Parent
<5 years0.0020.007*
5-10 years0.0010.006
10-15 years-0.0010.005**
>15 years-0.0010.006*

Slide 19

Slide 19. Conclusions and Policy Implications

Conclusions and Policy Implications

  • 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
    • Hazard of Entry into public coverage.
      • Decreases for children with citizen immigrant father.
      • Increases for children with non-citizen immigrant mother.
    • Hazard of Retaining public coverage
      • Does not depend on the nativity status of child's father.
      • Decreases for children with non-citizen immigrant mother.
  • For one parent households, children with a foreign born parent exhibit assimilation out of public coverage.

Slide 20

Slide 20. Conclusions and Policy Implications

Conclusions and Policy Implications

  • 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
    • Contrary to the literature on adult immigrants' participation in welfare programs.
Current as of December 2009
Internet Citation: Do Children of Immigrant Parents Assimilate into Public Health Insurance? A Dynamic Analysis (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2009/hudson-plylpchuk/index.html