Medicaid Expansion Through the Affordable Care Act and Interstate Mobility of Low-Income Immigrants: Welfare Magnet or Myth?

Immigrants’ access to public benefits, including healthcare coverage, has remained at the front and center of the debate on immigration and welfare policy in many host countries. As policymakers in the USA engage in ongoing discussions about expanding Medicaid, including extending access to immigrants, some concerns have been raised regarding the potential for insurance expansion to attract more immigrants who may relocate in search of free health insurance coverage. Using the Affordable Care Act (ACA) Medicaid expansions as a natural experiment setup, I examined the impact of the ACA Medicaid expansion on the interstate migration of low-income immigrants. Unlike previous papers that examined the effect of public insurance expansion on interstate movement of the low-income population in general, I specifically focus on the immigrant population. Using individual-level data from the American Community Surveys over 2009–2018, results from difference-in-difference analyses indicate that the expansion of the ACA in some states has no statistically significant effect on in-migration and a decrease in out-migration among the low-income immigrant population. This finding suggests that expanding Medicaid through ACA does not incur the large-scale added cost associated with increased in-migration of low-income immigrants. The results are robust to various sensitivity tests, including alternate policy variables of overall states’ Medicaid generosity index.