Subject(s)
Emigration and Immigration/statistics & numerical data , Health Services Accessibility/legislation & jurisprudence , Law Enforcement/methods , Patient Acceptance of Health Care/statistics & numerical data , Adult , Child , Cohort Studies , Emigration and Immigration/legislation & jurisprudence , Health Services Accessibility/statistics & numerical data , Hispanic or Latino/statistics & numerical data , Humans , Observational Studies as Topic , San Francisco/epidemiologyABSTRACT
Importance: Federal policy changes in 2002 and 2009 led some states to expand public health insurance coverage to non-US-born children and pregnant women who are lawful permanent residents during their first 5 years of residency in the United States. In other states, there were concerns that insurance expansion could attract immigrants to relocate to gain free health insurance coverage. Objective: To examine whether expansion of public health insurance to non-US-born, lawful permanent resident children and pregnant women during their first 5 years of residency is associated with increased interstate migration among these groups. Design, Setting, and Participants: This difference-in-differences analysis included data on 208â¯060 immigrants from the American Community Survey from 2000 through 2016, with analysis including all 50 states and the District of Columbia. The study sample included 2 treatment groups that became eligible under the expanded coverage: lawful permanent resident adults with at least 1 non-US-born child younger than 18 years (n = 36â¯438) and lawful permanent resident women of reproductive age (n = 87â¯418). Control groups that remained ineligible under the expanded coverage included lawful permanent resident adults without non-US-born children (n = 171â¯622), lawful permanent resident single men (n = 56â¯142), and lawful permanent resident postreproductive women (n = 15â¯129). A difference-in-differences design compared migration rates between eligible and ineligible immigrant groups before and after insurance coverage expansions. Data analysis was performed from November 3, 2018, to May 31, 2019. Exposures: Public health insurance coverage for immigrant women and children who were lawful permanent residents within 5 years of residency. Main Outcomes and Measures: Migration to a health expansion state from any other state and from a neighboring state. Results: Of 208â¯060 immigrants (47% women in the weighted sample; mean [SD] age, 32.97 [12.94] years; 63% Hispanic), the mean (SD) annual move rate across the entire sample was 3% (17%). Expansion of public health insurance to non-US-born children or pregnant women within their first 5 years of residency was not associated with interstate movement for health care benefits. Coverage expansion for non-US-born children of lawful permanent residents was not associated with a change in the rate of in-migration higher than 1.78 percentage points or lower than -1.28 percentage points. The corresponding estimate for coverage expansion of lawful permanent resident pregnant women was a change higher than 1.38 percentage points and lower than -1.20 percentage points. Conclusions and Relevance: The results suggest that states considering expanding health care benefits coverage to recently arrived immigrant children and pregnant women may be unlikely to experience in-migration of these persons from other states, which has important implications for understanding short- and long-term program costs.