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 Federal policy changes in 2002 and 2009 led some states to expand
public health insurance coverage to some children born outside the
U.S. and to certain pregnant women. For the study, researchers
examined data on interstate moves between 2000 and 2016 for 208,060
immigrants who could qualify for health coverage in states that
expanded public insurance.
On average, 3% of the immigrants moved each year.
The proportion of immigrants making interstate moves within the
first five years of U.S. residency didn't appear to be influenced by
expanded public health benefits, the study found.
"Our study showed that recent public health insurance expansion was
not associated with a discernable increase in migration between
states among eligible immigrants," senior study author Jens
Hainmueller of Stanford University in California and colleagues
write in JAMA Pediatrics.
"Despite immigrant families being more responsive to economic
conditions and these health care programs having significant uptake,
results suggest that states considering expansion of health care
benefits to certain immigrant groups are unlikely to experience
large increases in immigrants from other states," Hainmueller and
colleagues write.
In the U.S., one in four children under age 18 were either born
outside the U.S. or have parents who are immigrants, researchers
note.
Federal welfare reform in 1996 for the most part barred legal
immigrants who were permanent residents from getting public health
benefits through Medicaid without five years of residency.
A total of 18 states funded programs to cover immigrant children
without five years of residency, and 16 states had prenatal care
options for pregnant women who had not yet been legal residents for
five years, researchers note.
After a series of federal policy changes in 2002 and 2009, 31 states
expanded public health benefits to children who were legal permanent
residents and 32 states offered coverage to pregnant women - even
when these people hadn't been legal residents for five years.
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In the year before certain states expanded coverage for immigrant
children, the migration rate was 3.9%, the study found. In the year
after coverage for these kids was added, the migration rate to these
states was 3.7%.
By comparison, in the year before this children's coverage
expansion, the migration rate to expansion states was 4% for lawful
permanent residents without kids, compared to 5.9% in the year after
new benefits were added for kids.
Over the year before certain states expanded coverage for pregnant
women, meanwhile, migration rates to these states was 2.7%, compared
with 4.6% the year afterward. Migration rates for lawful immigrants
without kids was 3.5% in the year before the pregnancy coverage
expansion and 3.9% in the year afterwards.
The study wasn't a controlled experiment designed to prove whether
or how health policy changes might have directly impacted migration
patterns for immigrants within the U.S.
"Immigrants do not uproot their lives and cross state borders to
access health care, even at critical life moments, such as pregnancy
and childhood development, and even if health care benefits across
state lines are more comprehensive," Jonathan Miller of the Office
of the Massachusetts Attorney General in Boston and Elora Mukherjee
of the Immigrants' Rights Clinic at Columbia Law School in New York
City write in an editorial accompanying the study.
"Making it easier for immigrant communities to connect to and seek
care from physicians will not radically shift migration patterns,"
they write. "Instead, allowing access to the basic human right of
health care shows a common commitment to human decency for all who
are in the United States."
SOURCE: http://bit.ly/2rWnrSC JAMA Pediatrics, online November 18,
2019.
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