Inside the Refrigerator: Welfare Reform, Immigration Enforcement, and Chilling Effects in Immigrant Medicaid Participation
Roughly half of uninsured poor children fail to enroll in Medicaid; take-up rates are lower for children of non-citizens. Understanding why children do not enroll in public health insurance programs could improve program design and raise insurance rates. The sharp decline in Medicaid participation following the 1996 welfare reform, particularly pronounced among eligible children of noncitizen immigrants, offers an interesting case study. Previous literature on “chilling effects” surrounding welfare reform has largely focused on variation in state policy responses to welfare reform and ignored the potential role of immigration enforcement. Tara Watson, Assistant Professor of Economics at Williams College, is investigating whether enforcement of immigration law affects the decision to participate in Medicaid, and whether the sharp increase in enforcement activity in the mid-1990s explains the decline in participation that has been previously attributed to welfare reform. In particular, I plan to exploit temporal and geographic variation in newly collected enforcement data matched with information on almost 400,000 children in the Current Population Survey for the years 1993-2002. Preliminary analysis indicates that changes in local immigration enforcement are associated with substantial relative reductions in Medicaid participation among children of non-citizens, even when the children are themselves citizens. The project will analyze detailed enforcement data forthcoming from the Department of Homeland Security and media coverage of enforcement activity to identify the effect of perceptions of enforcement on Medicaid participation. The analysis will shed light on whether and how immigration policy affects participation in public poverty programs.