Stanford Study Finds no Link Between Immigrant Health Coverage and In-Migration Rates
Extending insurance coverage to immigrant children and pregnant women did not appear to influence whether they crossed state borders (known as in-migration) to acquire care, according to survey data.
Among 36,438 lawful permanent residents with children, the average in-migration rate 1 year before public health insurance was expanded to cover immigrants was 3.9% and 1 year after the implementation, the rate remained essentially unchanged at 3.7%, reported Vasil Yasenov, PhD, MA, of the Immigration Policy Lab at Stanford University in California, and colleagues.
Similarly, among 87,418 women of reproductive age, the in-migration rate 1 year before expansion was 2.7% and 1 year after it was 4.6%, the team wrote in JAMA Pediatrics.
“No Discernable Association” Between In-Migration and Insurance Expansion
“If an expansion of health insurance coverage was associated with in-migration to another state, the probability of in-migration would have increased in the treatment group compared with the control group,” the researchers wrote. “There was no discernable association between the in-migration from any state among the treatment group relative to the control group and public health insurance expansion.”
The authors compared the group of immigrants with children with a control group of lawful permanent residents without children. The proportion that migrated among immigrants without children was slightly higher before and after expansion (4.0% and 5.9%, respectively), but not significantly different from immigrants with children, Yasenov and his team reported.
Meanwhile, among a control group of post-reproductive women, the rate of in-migration was 3.5% and 3.9% in the years before and after expansion, respectively, which was also not significantly different than the group of women of reproductive age, the researchers added.
“We hope policy makers concerned with spiraling costs and people flooding in from other states will have the evidence they need to make a decision when thinking about extending public healthcare benefits for legal immigrants in the U.S.,” Yasenov told MedPage Today.
Findings Indicate Immigrants are Fleeing Violence and Corruption, Not Chasing Health Coverage
As of 2016, immigrants with children were covered by public insurance in 31 states and pregnant immigrants were covered in 32 states. Many Democratic candidates for the 2020 election support extending healthcare to undocumented immigrants, a policy that has been suggested will increase the flow of immigration within the U.S.
These null findings make sense in the context in which most U.S. immigration takes place, wrote Jonathan Miller, JD, of the Office of the Massachusetts Attorney General in Boston, and Elora Mukherjee, JD, of the Immigrants’ Rights Clinic of Columbia Law School in New York City, in an accompanying editorial.
Namely, many people coming to the U.S. are fleeing from violence or political corruption in their home countries, and “do not seek refuge in the [U.S.] because of potential access to healthcare,” Miller and Mukherjee said.
“Making it easier for immigrant communities to connect to and seek care from physicians will not radically shift migration patterns. Instead, allowing access to the basic human right of health care shows a common commitment to human decency for all who are in the [U.S.],” the editorialists stated.
Immigrants Sampled Were Below 200% of Fed Poverty Thresholds
For this study, data were collected from individuals residing in the U.S. from 1 to 6 years — but who were not born in the U.S. and were not citizens — from the American Community Survey. Notably, the sample was restricted to individuals who were below 200% of the federal poverty thresholds to identify people who would qualify for public insurance if it were extended, the authors noted. Immigrants on student visas, veterans, or those married to U.S.-born citizens were excluded because they qualify for other healthcare benefits, the team added.
The data were controlled for personal characteristics like age, race/ethnicity, and marital status, as well as things that varied by state and time such as cash assistance and economic conditions.
In total, 208,060 immigrants — mean age of 33 years, 47% of whom were female — were included. About two-thirds were Hispanic (63%), and the in-migration rate among the entire sample was 3%.
“Near-Zero” Likelihood
Overall, the likelihood that lawful permanent residents would migrate to a state where public health insurance has been expanded to cover immigrants was practically zero before and after expansion was implemented (percentage change from -1.21 to 1.78), the authors reported.
The likelihood was also close to zero among lawful permanent-resident women of reproductive age when compared with a control group of lawful permanent-resident post-reproductive women (percentage change from -1.20 to 1.38).
In a model specifically looking at whether public health insurance expansion would bring in migrants from a neighboring state, no association was found between policy implementation and the rates of in-migration of immigrants with children (–0.03 percentage points, 95% CI –0.5 to 0.44) or pregnant women (–0.02 percentage points, 95% CI –0.48 to 0.09), the researchers reported.
The primary limitation of the study, they said, was the inability to account for time-varying factors that could undermine the analysis, and it was also not possible to isolate states among the border and determine whether there was an association between in-migration and health policy specifically in these states. Lastly, the investigators said, the association was not analyzed among county-level or city-level programs.
The study was funded by the Stanford Child Health Research Institute.
The authors and editorialists reported having no conflicts of interest.
Primary Source
JAMA Pediatrics
- Secondary Source
JAMA Pediatrics
by Elizabeth Hlavinka, Staff Writer, MedPage Today
This story was originally published by MedPage Today.
