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

Project summary

The project team examined 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 approaches to expanding public benefits to immigrants. The study took advantage of the patterns of state immigration policy variations to measure the health impacts of different policy approaches to immigration regulation.

Research Question(s)

  • Does stricter state immigration enforcement reduce the likelihood that children of immigrants receive preventive care?
  • Do more generous public health insurance policies for immigrants increase the chances that children of immigrants will receive preventive care?
  • Are more generous public health insurance policies less effective in states with stricter immigration enforcement in increasing preventive care use?

Actionability

  • Inform public health insurance policy implementation and state immigration enforcement by providing evidence on their potential public health consequences to policymakers, public health officials, and state departments.

Results

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.

Outcomes

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

Methodology

To determine whether and how the strictness of state immigration enforcement impacts the likelihood that children of immigrants receive preventive care, the researchers used a 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 performed the same analysis with the index of public health insurance policies. Finally, to address whether there is an interaction between the generosity of public health insurance policies and the strictness of immigration enforcement in preventive care use, they included 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 tested 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 
Agency for Healthcare Research and Quality (AHRQ)

Grant status
Completed
Principal investigators
Heather Koball, PhD
James Kirby, PhD
Start date
Award amount
$127,424
Duration
18 months

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