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The effect of Medicaid eligibility expansions on fertility


  • Zavodny, Madeline
  • Bitler, Marianne P.


In the United States, pregnant women and children's eligibility for Medicaid was expanded dramatically during the 1980s and early 1990s. By lowering pregnancy and child health care costs, the Medicaid expansions may have increased the incentives for women to have children. To investigate this possibility, we examine whether state-level birth and abortion rates are related to the extent of states' Medicaid eligibility expansions and the fraction of women eligible for Medicaid, controlling for economic and demographic factors, during the period 1982 to 1996. We examine birth rates by race, marital status and education as well as overall abortion rates. We find little evidence that the Medicaid expansions led to changes in birth rates or abortion rates. However, some results do suggest that the Medicaid expansions boosted the birth rate among white women who have not completed high school. We find that restrictions on Medicaid funding of abortions decrease abortion rates and increase birth rates. The results thus do not provide definitive evidence that expansions in public health insurance eligibility have sizable effects on women's fertility.

Suggested Citation

  • Zavodny, Madeline & Bitler, Marianne P., 2010. "The effect of Medicaid eligibility expansions on fertility," Social Science & Medicine, Elsevier, vol. 71(5), pages 918-924, September.
  • Handle: RePEc:eee:socmed:v:71:y:2010:i:5:p:918-924

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    References listed on IDEAS

    1. John C. Ham & Lara D. Shore-Sheppard, 2005. "Did Expanding Medicaid Affect Welfare Participation?," ILR Review, Cornell University, ILR School, vol. 58(3), pages 452-470, April.
    2. Theodore Joyce & Robert Kaestner, 1996. "The effect of expansions in medicaid income eligibility on abortion," Demography, Springer;Population Association of America (PAA), vol. 33(2), pages 181-192, May.
    3. Currie, Janet & Grogger, Jeffrey, 2002. "Medicaid expansions and welfare contractions: offsetting effects on prenatal care and infant health?," Journal of Health Economics, Elsevier, vol. 21(2), pages 313-335, March.
    4. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 431-466.
    5. Arleen Leibowitz, 1990. "The Response of Births to Changes in Health Care Costs," Journal of Human Resources, University of Wisconsin Press, vol. 25(4), pages 697-711.
    6. repec:aph:ajpbhl:1999:89:2:199-203_4 is not listed on IDEAS
    7. Aaron S. Yelowitz, 1995. "The Medicaid Notch, Labor Supply, and Welfare Participation: Evidence from Eligibility Expansions," The Quarterly Journal of Economics, Oxford University Press, vol. 110(4), pages 909-939.
    8. David Card & Lara D. Shore-Sheppard, 2004. "Using Discontinuous Eligibility Rules to Identify the Effects of the Federal Medicaid Expansions on Low-Income Children," The Review of Economics and Statistics, MIT Press, vol. 86(3), pages 752-766, August.
    9. Jacob Alex Klerman, 1999. "U.S. Abortion Policy and Fertility," American Economic Review, American Economic Association, vol. 89(2), pages 261-264, May.
    10. David M. Cutler & Jonathan Gruber, 1996. "Does Public Insurance Crowd out Private Insurance?," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 391-430.
    11. Deborah Haas-Wilson, 1993. "The economic impact of state restrictions on abortion: Parental consent and notification laws and medicaid funding restrictions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 12(3), pages 498-511.
    12. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-1296, December.
    13. Blank, Rebecca M. & George, Christine C. & London, Rebecca A., 1996. "State abortion rates the impact of policies, providers, politics, demographics, and economic environment," Journal of Health Economics, Elsevier, vol. 15(5), pages 513-553, October.
    14. Thomas J. Kane & Douglas Staiger, 1996. "Teen Motherhood and Abortion Access," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 467-506.
    15. Gary S. Becker, 1960. "An Economic Analysis of Fertility," NBER Chapters,in: Demographic and Economic Change in Developed Countries, pages 209-240 National Bureau of Economic Research, Inc.
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    Cited by:

    1. Thomas DeLeire & Leonard Lopoo & Kosali Simon, 2011. "Medicaid Expansions and Fertility in the United States," Demography, Springer;Population Association of America (PAA), vol. 48(2), pages 725-747, May.
    2. Marianne Bitler & Lucie Schmidt, 2012. "Utilization of Infertility Treatments: The Effects of Insurance Mandates," Demography, Springer;Population Association of America (PAA), vol. 49(1), pages 125-149, February.
    3. repec:bla:coecpo:v:36:y:2018:i:1:p:59-72 is not listed on IDEAS
    4. Thompson, Owen, 2017. "The long-term health impacts of Medicaid and CHIP," Journal of Health Economics, Elsevier, vol. 51(C), pages 26-40.
    5. Joanna N. Lahey, 2012. "The efficiency of a groupā€specific mandated benefit revisited: The effect of infertility mandates," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 31(1), pages 63-92, December.
    6. Andrea Menclova, 2013. "The Effects of Unemployment on Prenatal Care Use and Infant Health," Journal of Family and Economic Issues, Springer, vol. 34(4), pages 400-420, December.
    7. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters,in: Economics of Means-Tested Transfer Programs in the United States, volume 1, pages 21-136 National Bureau of Economic Research, Inc.


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