IDEAS home Printed from https://ideas.repec.org/p/nbr/nberwo/12907.html
   My bibliography  Save this paper

Medicaid Expansions and Fertility in the United States

Author

Listed:
  • Thomas DeLeire
  • Leonard M. Lopoo
  • Kosali I. Simon

Abstract

Beginning in the mid 1980s and extending through the early to mid 1990s, a substantial number of women and children gained eligibility for Medicaid through a series of income-based expansions. Using natality data from the National Center for Health Statistics, we estimate fertility responses to these eligibility expansions. We measure changes in state Medicaid eligibility policy by simulating the fraction of a standard population that would qualify for benefits. From 1985 to 1996, the fraction of women aged 15 to 44 who were eligible for Medicaid coverage for a pregnancy increased on average by 24 percentage points. However, contrary to findings in the extant literature, our results do not indicate that this expansion in coverage had a statistically discernible effect on fertility.

Suggested Citation

  • Thomas DeLeire & Leonard M. Lopoo & Kosali I. Simon, 2007. "Medicaid Expansions and Fertility in the United States," NBER Working Papers 12907, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:12907
    Note: EH
    as

    Download full text from publisher

    File URL: http://www.nber.org/papers/w12907.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Lundberg, Shelly & Plotnick, Robert D, 1995. "Adolescent Premarital Childbearing: Do Economic Incentives Matter?," Journal of Labor Economics, University of Chicago Press, vol. 13(2), pages 177-200, April.
    2. Melissa Schettini Kearney, 2004. "Is There an Effect of Incremental Welfare Benefits on Fertility Behavior?: A Look at the Family Cap," Journal of Human Resources, University of Wisconsin Press, vol. 39(2).
    3. Robert A. Moffitt, 2003. "The Temporary Assistance for Needy Families Program," NBER Chapters, in: Means-Tested Transfer Programs in the United States, pages 291-364, National Bureau of Economic Research, Inc.
    4. Robert Kaestner & Sanders Korenman & June O'Neill, 2003. "Has welfare reform changed teenage behaviors?," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 22(2), pages 225-248.
    5. Saul D. Hoffman & E. Michael Foster, 2000. "AFDC Benefits and Nonmarital Births to Young Women," Journal of Human Resources, University of Wisconsin Press, vol. 35(2), pages 376-391.
    6. Aaron S. Yelowitz, 1998. "Will Extending Medicaid to Two-Parent Families Encourage Marriage?," Journal of Human Resources, University of Wisconsin Press, vol. 33(4), pages 833-865.
    7. Lo Sasso, Anthony T. & Buchmueller, Thomas C., 2004. "The effect of the state children's health insurance program on health insurance coverage," Journal of Health Economics, Elsevier, vol. 23(5), pages 1059-1082, September.
    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. Stacy Dickert-Conlin & Amitabh Chandra, 1999. "Taxes and the Timing of Birth," Journal of Political Economy, University of Chicago Press, vol. 107(1), pages 161-177, February.
    10. Robert A. Moffitt, 2003. "Means-Tested Transfer Programs in the United States," NBER Books, National Bureau of Economic Research, Inc, number moff03-1.
    11. Schmidt, Lucie, 2007. "Effects of infertility insurance mandates on fertility," Journal of Health Economics, Elsevier, vol. 26(3), pages 431-446, May.
    12. Marianne P. Bitler & Madeline Zavodny, 2000. "The effect of Medicaid eligibility expansions on births," FRB Atlanta Working Paper 2000-4, Federal Reserve Bank of Atlanta.
    13. Melissa S. Kearney & Phillip B. Levine, 2009. "Subsidized Contraception, Fertility, and Sexual Behavior," The Review of Economics and Statistics, MIT Press, vol. 91(1), pages 137-151, February.
    14. Whittington, Leslie A & Alm, James & Peters, H Elizabeth, 1990. "Fertility and the Personal Exemption: Implicit Pronatalist Policy in the United States," American Economic Review, American Economic Association, vol. 80(3), pages 545-556, June.
    15. David M. Cutler & Jonathan Gruber, 1996. "Does Public Insurance Crowd out Private Insurance?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 391-430.
    16. Marianne Bitler, 2005. "Effects of Increased Access to Infertility Treatment on Infant and Child Health Outcomes: Evidence from Health Insurance Mandates," PPIC Working Papers 2005.06, Public Policy Institute of California.
    17. 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.
    18. An, Chong-Bum & Haveman, Robert & Wolfe, Barbara, 1993. "Teen Out-of-Wedlock Births and Welfare Receipt: The Role of Childhood Events and Economic Circumstances," The Review of Economics and Statistics, MIT Press, vol. 75(2), pages 195-208, May.
    19. Currie, Janet & Gruber, Jonathan, 2001. "Public health insurance and medical treatment: the equalizing impact of the Medicaid expansions," Journal of Public Economics, Elsevier, vol. 82(1), pages 63-89, October.
    20. 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.
    21. H. W. Hoynes, "undated". "Does welfare play any role in female headship decisions?," Institute for Research on Poverty Discussion Papers 1078-95, University of Wisconsin Institute for Research on Poverty.
    22. Leonard M. Lopoo & Thomas DeLeire, 2006. "Did welfare reform influence the fertility of young teens?," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 25(2), pages 275-298.
    23. M. Kate Bundorf & Melinda Henne & Laurence Baker, 2007. "Mandated Health Insurance Benefits and the Utilization and Outcomes of Infertility Treatments," NBER Working Papers 12820, National Bureau of Economic Research, Inc.
    24. 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.
    25. Marianne Bitler, 2005. "Effects of Increased Access to Infertility Treatment on Infant and Child Health Outcomes: Evidence from Health Insurance Mandates," PPIC Working Papers 2005.06, Public Policy Institute of California.
    26. Jennifer M. Mellor, 1998. "The Effect of Family Planning Programs on the Fertility of Welfare Recipients: Evidence from Medicaid Claims," Journal of Human Resources, University of Wisconsin Press, vol. 33(4), pages 866-895.
    27. Greg Duncan & Saul Hoffman, 1990. "Welfare benefits, economic opportunities, and out-of-wedlock births among black teenage girls," Demography, Springer;Population Association of America (PAA), vol. 27(4), pages 519-535, November.
    28. Eugene M. Lewit & Alan C. Monheit, 1992. "Expenditures on Health Care for Children and Pregnant Women," NBER Working Papers 4221, National Bureau of Economic Research, Inc.
    29. Williamson Hoyne, Hilary, 1997. "Does welfare play any role in female headship decisions?," Journal of Public Economics, Elsevier, vol. 65(2), pages 89-117, August.
    30. 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.
    31. Marianne Bitler & Lucie Schmidt, 2006. "Health disparities and infertility: impacts of state-level insurance mandates," Department of Economics Working Papers 2006-04, Department of Economics, Williams College, revised Nov 2006.
    32. Gruber, Jonathan & Simon, Kosali, 2008. "Crowd-out 10 years later: Have recent public insurance expansions crowded out private health insurance?," Journal of Health Economics, Elsevier, vol. 27(2), pages 201-217, March.
    33. 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.
    34. Reagan Baughman & Stacy Dickert-Conlin, 2003. "Did Expanding the EITC Promote Motherhood?," American Economic Review, American Economic Association, vol. 93(2), pages 247-251, May.
    35. Thomas J. Kane & Douglas Staiger, 1996. "Teen Motherhood and Abortion Access," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 467-506.
    36. Jonathan Gruber & Kosali Simon, 2007. "Crowd-Out Ten Years Later: Have Recent Public Insurance Expansions Crowded Out Private Health Insurance?," NBER Working Papers 12858, National Bureau of Economic Research, Inc.
    37. Levine, Phillip B. & Trainor, Amy B. & Zimmerman, David J., 1996. "The effect of Medicaid abortion funding restrictions on abortions, pregnancies and births," Journal of Health Economics, Elsevier, vol. 15(5), pages 555-578, October.
    38. Esel Y. Yazici & Robert Kaestner, 1998. "Medicaid Expansions and The Crowding Out of Private Health Insurance," NBER Working Papers 6527, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Lincoln H. Groves & Sarah Hamersma & Leonard M. Lopoo, 2018. "Pregnancy Medicaid Expansions and Fertility: Differentiating Between the Intensive and Extensive Margins," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 37(3), pages 461-484, June.
    2. 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.
    3. Leonard M. Lopoo & Kerri M. Raissian, 2014. "U.S. Social Policy and Family Complexity," The ANNALS of the American Academy of Political and Social Science, , vol. 654(1), pages 213-230, July.
    4. 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.
    5. Jonathan Gruber, 2003. "Medicaid," NBER Chapters, in: Means-Tested Transfer Programs in the United States, pages 15-78, National Bureau of Economic Research, Inc.
    6. Makayla Palmer, 2020. "Does publicly subsidized health insurance affect the birth rate?," Southern Economic Journal, John Wiley & Sons, vol. 87(1), pages 70-121, July.
    7. Marianne P. Bitler & Madeline Zavodny, 2014. "Medicaid: A Review of the Literature," NBER Working Papers 20169, National Bureau of Economic Research, Inc.
    8. 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.
    9. Hull, Marie C. & Yan, Ji, 2024. "The Impact of Children's Access to Public Health Insurance on Their Cognitive Development and Behavior," IZA Discussion Papers 17190, Institute of Labor Economics (IZA).
    10. Thompson, Owen, 2017. "The long-term health impacts of Medicaid and CHIP," Journal of Health Economics, Elsevier, vol. 51(C), pages 26-40.
    11. Maria Apostolova‐Mihaylova & Aaron Yelowitz, 2018. "Health Insurance, Fertility, And The Wantedness Of Pregnancies: Evidence From Massachusetts," Contemporary Economic Policy, Western Economic Association International, vol. 36(1), pages 59-72, January.
    12. Levine Phillip B & Schanzenbach Diane, 2009. "The Impact of Children's Public Health Insurance Expansions on Educational Outcomes," Forum for Health Economics & Policy, De Gruyter, vol. 12(1), pages 1-28, May.
    13. R. A. Moffitt, "undated". "The Effect of Welfare on Marriage and Fertility: What Do We Know and What Do We Need to Know?," Institute for Research on Poverty Discussion Papers 1153-97, University of Wisconsin Institute for Research on Poverty.
    14. Melissa S. Kearney & Phillip B. Levine, 2007. "Socioeconomic Disadvantage and Early Childbearing," NBER Chapters, in: The Problems of Disadvantaged Youth: An Economic Perspective, pages 181-209, National Bureau of Economic Research, Inc.
    15. Lincoln H. Groves & Leonard M. Lopoo, 2018. "Federal Financial Aid and Family Formation: Examining the Social Security Student Benefit Program," Journal of Family and Economic Issues, Springer, vol. 39(3), pages 436-444, September.
    16. Koch, Thomas G., 2013. "Using RD design to understand heterogeneity in health insurance crowd-out," Journal of Health Economics, Elsevier, vol. 32(3), pages 599-611.
    17. Hamersma, Sarah & Maclean, Johanna Catherine, 2021. "Do expansions in adolescent access to public insurance affect the decisions of substance use disorder treatment providers?," Journal of Health Economics, Elsevier, vol. 76(C).
    18. Wolfe, Barbara & Wilson, Kathryn & Haveman, Robert, 2001. "The role of economic incentives in teenage nonmarital childbearing choices," Journal of Public Economics, Elsevier, vol. 81(3), pages 473-511, September.
    19. Phillip B. Levine & Robin McKnight & Samantha Heep, 2009. "Public Policy, Health Insurance and the Transition to Adulthood," NBER Working Papers 15114, National Bureau of Economic Research, Inc.
    20. Libertad González Luna, 2005. "The determinants of the prevalence of single mothers: A cross-country analysis," Economics Working Papers 876, Department of Economics and Business, Universitat Pompeu Fabra.

    More about this item

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I28 - Health, Education, and Welfare - - Education - - - Government Policy

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nbr:nberwo:12907. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/nberrus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.