The Impact of State Immigration Enforcement and Public Health Insurance Policies on the Health Outcomes of Children of Immigrants

The research team is examining the effect of immigration enforcement policies, including restricting driver’s licenses for unauthorized immigrants, and public health insurance expansions on health outcomes among children of unauthorized and legal immigrants. Beginning in the early 2000s, states diverged in their levels of cooperation with federal immigration enforcement and their approaches to expanding public benefits to immigrants. The study takes advantage of the patterns of state immigration policy variations to measure the health impacts of different policy approaches to immigration regulation. In contrast to the punitive actions some states have taken for unauthorized status, many states have reduced federal restrictions on health insurance access by allowing legally present and, in some cases, unauthorized immigrants, access to state-funded public health care coverage. The analysis focuses on variation in receipt of preventive health care among children of immigrants across all 50 states and the District of Columbia from 2000-2016. Results will inform policymakers, public health officials, and state departments of health about the effects of these state policies and the potential consequences they pose to public health.


Analyses demonstrated that sanctuary policies and driver’s licenses for undocumented immigrants improved preventive health outcomes among children of immigrants. At varying levels of significance, these policies were shown to increase the likelihood that children, especially Latino children, living with non-citizen, immigrant parents have a usual source-of-care (USC) provider, and that they significantly reduce the likelihood that children in these households have unmet medical needs. The study also demonstrated that these policies significantly increase the likelihood that Latino children living with non-citizen, immigrant parents receive preventive dental care. This effect held regardless of whether the children were U.S. citizens.


Receipt of primary care: usual care provider, well-child visits, flu vaccination, dental visits, and emergency department use


To determine whether and how the strictness of state immigration enforcement impacts the likelihood that children of immigrants receive preventive care, the researchers are using difference-in-difference analysis for each of the outcome variables. To address whether more generous public health insurance policies for immigrants increase the chances that children of immigrants will receive preventive care, they are performing the same analysis with the index of public health insurance policies. Finally, to address whether there is an interaction between the generousness of public health insurance policies and the strictness of immigration enforcement in preventive care use, they are including both the immigration enforcement and public benefits policy indices in the analysis, as well as their interaction with each other and the immigrant status variables. This analysis will test whether the strictness of immigration enforcement policies moderates the impact of state public health policies.

A doctor examining a child
Grantee and Partner organizations

National Center for Children in Poverty, Columbia University Mailman School of Public Health 

Grant status
Principal investigators
Heather Koball, PhD
James Kirby, PhD
Start date
Award amount
18 months

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