When states expand public health insurance to include low-income, legal immigrants, it does not lead to out-of-state immigrants moving in search of benefits.
By Melissa De Witte
Immigrants, once settled in a particular state, will not move to another state in search of public health benefits, Stanford researchers find.
Their research, published Nov. 18 in the Journal of the American Medical Association: Pediatrics, put to test what some call a welfare “magnet effect”: a hypothesis that immigrants are attracted to states that will provide them with public benefits. According to the researchers’ data, expanding health insurance – specifically, pediatric and prenatal care – to immigrants does not lead them to move from state to state in search of aid.
“When states consider expanding health benefits to immigrants, a frequently raised concern is that it would create a “magnet effect,” leading to spiraling costs,” said Jens Hainmueller, who is a professor of political science at Stanford and a co-author on the paper. He is also the faculty co-director of the Stanford Immigration Policy Lab. “The data we examined doesn’t support the theory that immigrants who are already in the U.S. would relocate to other states for the benefits and create added fiscal challenges for these programs,” he said.
Studying a welfare ‘magnet effect’
To study whether expanding public health insurance to include immigrants – specifically for children and pregnant women who are lawful permanent residents – led to interstate moves, the researchers analyzed the effects of federal policy changes to the 1996 welfare reform law. Under the 1996 law, immigrants who were lawful permanent residents with less than five years of residency in the United States were barred from accessing Medicaid.
Only 18 states provided state-funded programs to cover immigrant children within the five-year restriction and 16 states had prenatal care plans for female immigrants unable to receive coverage because of the ban, the researchers said.
But after a series of federal policy changes in 2002 and 2009 – through the Children’s Health Insurance Program and the Child Health Insurance Program Reauthorization Act – coverage expanded to include 31 states that offer public health insurance to lawful permanent resident migrant children and 32 states to pregnant immigrant women.
These expansions provided the researchers with a benchmark to analyze whether immigrants might have made an interstate move to receive benefits.
In their analysis of 208,060 immigrants from the U.S. Census Bureau’s American Community Survey from 2000 to 2016, the researchers found that immigrants without health care coverage were not likely to move to another state – including a neighboring state – that would provide them with benefits.
“People move for a wide variety of reasons, perhaps because they want to be closer to family members or to pursue certain employment opportunities,” Hainmueller said. “Gaining access to publicly funded health benefits doesn’t seem to play a crucial role in motivating immigrants to move across states.”
Social determinants of health
For paper co-author Fernando S. Mendoza, a professor of pediatrics at Lucile Packard Children’s Hospital Stanford who has researched childhood health disparities in minority communities for 35 years, the study provided an opportunity to better understand the social determinants of a child’s health.
Social determinants arise from economic and social conditions and can affect access to health care, which can influence the health and stability of the family, Mendoza said.
“Children living in an unstable family or psychologically stressed family are more likely to have physical, behavior and developmental problems. Among those things that stress families is the lack of health care for children because of the lack of health insurance,” said Mendoza, who is also the associate dean for minority advising and programs in the Office of Student Affairs at Stanford University School of Medicine.
Mendoza said he hopes the study’s findings will help state legislators and policymakers who are considering improving health care for immigrant families in their community, but are concerned that it could draw immigrants from another state.
“States that elect to eliminate the five-year waiting period for health benefits do not have to worry about this policy action drawing documented immigrant families from other states and thereby increasing the cost to their state,” he said. “Indeed, providing preventive and timely care to documented children and their families would most likely cut overall cost by preventing their health conditions from becoming worse and thereby increasing the overall cost of health care.”
Other authors include Duncan Lawrence, who is the executive director of the Immigration Policy Lab. Vasil I. Yasenov, postdoctoral fellow at the Immigration Policy Lab, was first author. This study was funded by a grant from the Stanford Maternal & Child Health Research Institute to Mendoza, Hainmueller and Lawrence.