Top

Journal of Immigrant and Minority Health

Published in:

01-04-2007 | Original Paper

Welfare Reform and Health of Immigrant Women and their Children

Authors: Neeraj Kaushal, Robert Kaestner

Published in: Journal of Immigrant and Minority Health | Issue 2/2007

Abstract

We investigate the association between the 1996 welfare reform and health insurance, medical care use and health of low-educated, foreign-born, single mothers and their children. We find that welfare reform was associated with an eight to 11.5 percentage points increase in proportion uninsured among low-educated foreign-born, single mothers. We also find that the decline in welfare caseload since 1996 was associated with a 6.5 to 10 percentage points increase in the proportion of low-educated foreign-born, single mothers reporting delays in receiving medical care or receiving no care due to cost and a nine percentage points decline in visits to a health professional in the past 12 months. We do not find any consistent evidence that welfare reform affected the health insurance, medical care utilization and health of children living with single mothers.

Available only for authorised users

Denying immigrants access to means-tested programs resulted in 44 percent of the total savings in PRWORA [5].

In all states except Alabama legal pre-1996 immigrants (or those in the US for at least five years) have access to cash welfare; in all states except Wyoming they have access to Medicaid, in 17 states they are eligible to use food stamps and in 10 states they have access to SSI.

Nineteen states that have substitute TANF programs for newly arrived immigrants during the five year federal ban are: CA, MA, MD, WA, PA, OR, CT, GA, MN, HI, WI, MO, UT, RI, TN, NE, ME, VT, WY. Fifteen states where new immigrants are eligible for Medicaid are: CA, IL, MA, MD, VA, WA, PA, CT, MN, HI, RI, NE, NY, DE and ME. Subsequent changes in federal policy restored Food Stamps and SSI benefits to certain vulnerable groups and in 2002 Congress restored Food Stamps to all legal immigrants who have been in the country for at least five year.

Surveys by the National Health Law Program and the National Immigration Law Center indicate that fear of deportation from the US has discouraged immigrants from obtaining publicly subsidized health care even when they were entitled to it [12]. The Kaiser Commission on Medicaid and the Uninsured, also found that since 1996 many immigrants did not seek public health insurance because they feared that it would affect their immigration status or jeopardize opportunity to become a citizen [18]. Similarly, Kaushal and Kaestner [4] find that PRWORA affected the insurance of immigrants who have been in the US for more than five years as adversely as of those in the US for less than five years, even though the later were subject to more stringent provisions in a number of states.

These studies are purely descriptive and do not address the question as to whether the transition off welfare caused a change in health.

Basically, the specification of equation (1) is derived from a model in which the caseload is determined in a linear way by policy changes, macroeconomic factors, state-specific effects, and state-specific time trends [6]. Since most determinants of the caseload, except the policy indicators, are included in equation (1), the coefficient on the caseload variable measures the effect of policy changes.

Given the evidence and concerns about the ``chilling effect” of PRWORA, we believe a dummy variable indicating TANF implementation is more likely to capture the effect of welfare reform and its “chilling effect,” than the specific aspects of the law.

In the NHIS public use data for 1997 the nativity variable is only provided in the Sample Adult file, which is a small set of the adult sample. The variable on nativity is missing in the Person and Sample Child files.

When we use the welfare caseload to measure reform, we can include separate year effects. And it is in this case that we test the restrictions imposed by using year dummy variables, which are rejected in favor of models using state-specific trends to account for unmeasured time trends.

It is possible that welfare reform affected fertility and marriage, so selecting the sample on these characteristics may result in changes in sample composition. Based on existing evidence, however, we believe the bias due to sample selection will be insignificant [44].

We repeat the analysis by restricting the sample to the top 14 states where 87 percent of the immigrants in NHIS lived during the period of analysis. The results were similar to those obtained using the national sample.

The difference-in-difference estimate for bed days is the difference between the estimate for single mothers and married mothers. We did not estimate a pooled regression because of the non-linear form of the Poisson regression model. The standard error of the difference-in-difference estimate assumes that the covariance of the two estimates is zero.

We note that the sample of school going children of single mothers is small consisting of only 2629 observations, which results in imprecise estimates.

Borjas G: Welfare Reform and Immigration. In: Blank R, Haskins R (ed). The New World of Welfare pp 369–390. Washington, DC: Brookings Institution; 2001

Kaestner R, Kaushal N: Welfare Reform and Immigrants: Does the Five-year Ban Matter? Res Labor Econ 2006; 25(2): (forthcoming)

Ku L, Blaney S: Health coverage for legal immigrant children: new census data highlight importance of restoring Medicaid and CHIP coverage. Washington, DC: Center for Budget and Policy Priorities; 2000

Kaushal N, Kaestner R: Welfare Reform and Health Insurance of Immigrants. Health Services Res 2005; 40(3):697–722(26)CrossRef

Congressional Budget Office: Immigration and welfare reform. Washington DC: CBO Papers; 1995

Kaestner R, Tarlov E: Changes in the Welfare Caseload and the Health of Low-educated Mothers. NBER Working Paper No. 10034, October 2003

Kaestner R, Lee WC: The Effect of Welfare Reform on Prenatal Care and Birth Weight. Health Econ 2005; 14(5):497–511PubMedCrossRef

Bitler MP, Gelbach JB, Hoynes HW: Welfare Reform and Health. J Human Res 2005; 40(2):309–334

Fix M, Passel J: Trends in Noncitizens’ and Citizens’ Use of Public Benefits Following Welfare Reform: 1994–97. Washington, DC: Urban Institute; 1999. Unpublished manuscript

10.

Lofstrom M, Bean F: Assessing Immigrant Policy Options: Labor Market Conditions and Post-Reform Declines in Welfare Receipt Among Immigrants. Demography 2002; 39(4):617–637PubMedCrossRef

11.

Kaestner R, Kaushal N: Immigrant and native responses to welfare reform. J Population Econ 2005; 18(1):69–92CrossRef

12.

Schlosberg C, Wiley D: The Impact of INS Public Charge Determinants on Immigrant Access to Health Care; 1998 http://www.healthlaw.org/pubs/19980522publiccharge.html

13.

Borjas G: Welfare Reform, Labor Supply and Health Insurance in the Immigrant Population. J Health Econ 2003; 22:933–958PubMedCrossRef

14.

Newacheck PW, Hughes DC, Stoddard JJ: Children’s access to primary care: differences by race, income, and insurance status. Pediatrics 1996; 97:26–32PubMed

15.

Newacheck PW, Stoddard JJ, Hughes DC, Pearl M: Health insurance and access to primary care for children. N Engl J Med 1998; 338:513–9PubMedCrossRef

16.

Newacheck PW, Brindis CD, Cart CU, Marchi K, Irwin C: Adolescent health insurance coverage: recent changes and access to care. Pediatrics 1999; 104:195–202PubMedCrossRef

17.

Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowitz A, Marquis MS: Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev 1987; 77:251–277PubMed

18.

Feld P, Power B: Immigrants’ access to healthcare after welfare reform: Findings from focus groups in four cities. Washington, DC: The Kaiser Commission on Medicaid and the Uninsured; 2000

19.

Haw MA: Women, Work and Stress: A Review and Agenda for the Future. J Health Social Beh 1982; 23:132–144CrossRef

20.

Rosenfield S: The Effects of Women’s Employment: Personal Control and Sex Differences in Mental Health. J Health Social Beh 1989; 30:77–91CrossRef

21.

Lennon MC, Rosenfield S: Women and Mental Health: The Interaction of Job and Family Conditions. J Health Social Beh 1992; 33:316–327CrossRef

22.

Lennon MC: Women, Work, and Well-Being: The Importance of Work Conditions. J Health Social Beh 1994; 35:235–247CrossRef

23.

Pugliesi K: Work and well-being: Gender Differences in the Psychological Consequences of Employment. J Health Social Beh 1995; 36:57–71CrossRef

24.

Ali J, Avison WR: Employment Transitions and Psychological Distress: The Contrasting Experiences of Single and Married Mothers. J Health Social Beh 1997; 38:345–362CrossRef

25.

Elliott M: Impact of Work, Family, and Welfare Receipt on Women’s Self-Esteem in Young Adulthood. Social Psychol Quarterly 1996; 59:80–95CrossRef

26.

Ensminger M: Welfare and Psychological Distress: A Longitudinal Study of Afircan American Urban Mothers. J Health Social Beh 1996; 36(4):246–359

27.

Sayette MA: Does Drinking Reduce Stress? Alcohol Res Health 1999; 23:250–255PubMed

28.

Frone MR: Work Stress and Alcohol Use. Alcohol Res Health 1999; 23:284–291PubMed

29.

Cooper ML, Russell M, Skinner JB, Frone MR, Mudar P: Stress and Alcohol Use: Moderating Effects of Gender, Coping, and Alcohol Expectancis. J Abnormal Psychol 1992; 101:139–152CrossRef

30.

Frone MR, Russell M, Cooper ML: Relationship of Work-Family Conflict, Gender, and Alcohol Expectancies to Alcohol Use/Abuse. J Org Beh 1993; 14:545–558CrossRef

31.

Kassel JD, Paronis CA, Stroud LR: Smoking, Stress, and Negative Affect: Correlation, Causation, and Context Across Stages of Smoking. Psychol Bull 2003; 129:270–304PubMedCrossRef

32.

Greeno CG, Wing RR: Stress-Induced Eating. Psychol Bull 1994; 115:444–464PubMedCrossRef

33.

Wardle J, Steptoe A, Oliver G, Lipsey Z: Stress, Dietary Restraint and Food Intake. J Psychoso Res 2000; 48:195–202CrossRef

34.

Oliver G, Wardle J: Perceived Effects of Stress on Food Choice. Physiol Beh 1999; 66:511–515CrossRef

35.

Weinstein SE, Shide DJ, Rolls BJ: Changes in Food Intake in Response to Stress in Men and Women: Psychological Factors. Appetite 1997; 28:7–18PubMedCrossRef

36.

Mitchell SL, Perkins KA: Interaction of Stress, Smoking, and Dietary Restraint in Women. Physiol Beh 1998; 64:103– 109CrossRef

37.

Smith JP: Healthy Bodies and Thick Wallets: The Dual Relation Between Health and Economic Status. J Econ Perspectives 1999; 13:145–166CrossRef

38.

Acs G, Loprest P, Roberts T: Final Synthesis Report of Findings from ASPE ‘Leavers’ Grants. Washington, DC: Urban Institute Press; 2001. Available at http://aspe.hhs.gov/search/hsp/leavers99/synthesis02/index.htm

39.

Haskins R: Effects of Welfare Reform on Family Income and Poverty. In The New World of Welfare, eds. Rebecca Blank and Ron Haskins. Washington, DC: The Brookings Institution; 2001

40.

Grossman M: The Demand For Health: A Theoretical and Empirical Investigation. New York: Columbia University Press; 1972

41.

Mead L: Welfare Caseload Change: An Alternative Approach. Political Studies J 2003; 31(2):163–85

42.

Goldman DP, Smith JP, Sood S: Legal Status and Health Insurance Among Immigrants. Health Aff 2005; 24(6):1640–1653CrossRef

43.

Bitler M: Racial and Ethnic Health Disparities in Los Angeles: The Role of Immigration Status and Neighborhoods. Unpublished paper. Public Policy Institute of California 2005; September 23

44.

Grogger J, Karoly L, Klerman J: Consequences of Welfare Reform: A Research Synthesis. DRU-2676-Depatment of Health and Human Services; 2002

45.

Yelowitz A: Gateways into the Food Stamp Program. Mimeo, University of Kentucky, April 2002

46.

Passel J, Capps R, Fix M: Undocumented Immigrants: Facts and Figures. Washington, DC: Urban Institute; 2004

Title: Welfare Reform and Health of Immigrant Women and their Children
Authors: Neeraj Kaushal
Robert Kaestner
Publication date: 01-04-2007
Publisher: Springer US
Published in: Journal of Immigrant and Minority Health / Issue 2/2007
Print ISSN: 1557-1912
Electronic ISSN: 1557-1920
DOI: https://doi.org/10.1007/s10903-006-9021-y

At a glance: The STEP trials

Springer Medicine

Welfare Reform and Health of Immigrant Women and their Children

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2007

Using Theatrical Presentations as a Means of Disseminating Knowledge of HIV/AIDS Risk Factors to Migrant Farmworkers: An Evaluation of the Effectiveness of the Infórmate Program

Knowledge about Cervical Cancer Risk Factors, Traditional Health Beliefs, and Pap Testing Among Vietnamese American Women

Identifying Potential Risk and Protective Factors among Non-Metropolitan Latino Youth: Cultural Implications for Substance Use Research

Sexual Behavior and Drug Use Among Asian and Latino Adolescents: Association with Immigrant Status

Stressful Life Events, Culture, and Violence

Chernobyl Disaster Sequelae in Recent Immigrants to the United States from the former Soviet Union (FSU)