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Inside the Refrigerator: Immigration Enforcement and Chilling Effects in Medicaid Participation

Economists have puzzled over why eligible individuals fail to enroll in social safety net programs. "Chilling effects" arising from an icy policy climate are a popular explanation for low program take-up rates among immigrants, but such effects are inherently hard to measure. This paper investigates a concrete determinant of chilling, Federal immigration enforcement, and finds robust evidence that heightened enforcement reduces Medicaid participation among children of non-citizens. This is the case even when children are themselves citizens and face no eligibility barriers to Medicaid enrollment. Immigrants from countries with more undocumented U.S. residents, those living in cities with a high fraction of other immigrants, and those with healthy children are most sensitive to enforcement efforts. Up to seventy-five percent of the relative decline in non-citizen Medicaid participation around the time of welfare reform, which has been attributed to the chilling effects of the reform itself, is explained by a contemporaneous spike in immigration enforcement activity. The results imply that safety net participation is influenced not only by program design, but also by a broader set of seemingly unrelated policy choices.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 16278.

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Date of creation: Aug 2010
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Publication status: published as Watson, Tara, Forthcoming. "Inside the Refrigerator: Immigration Enforcement and Chilling in Immigrant Medicaid Participation.” American Economic Journal: Economic Policy. (Earlier draft: National Bureau of Economic Research Working Paper 16278.)
Handle: RePEc:nbr:nberwo:16278
Note: CH HE LS
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  1. Anna Aizer, 2003. "Low Take-Up in Medicaid: Does Outreach Matter and for Whom?," American Economic Review, American Economic Association, vol. 93(2), pages 238-241, May.
  2. Borjas, George J., 2003. "Welfare reform, labor supply, and health insurance in the immigrant population," Journal of Health Economics, Elsevier, vol. 22(6), pages 933-958, November.
  3. Gee Emily R. & Giuntella G. Osea, 2011. "Medicaid and Ethnic Networks," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(1), pages 1-31, December.
  4. Marianne Bitler & Jonah Gelbach & Hilary Hoynes, 2004. "Welfare Reform and Health," NBER Working Papers 10549, National Bureau of Economic Research, Inc.
  5. Aizer, Anna & Currie, Janet, 2004. "Networks or neighborhoods? Correlations in the use of publicly-funded maternity care in California," Journal of Public Economics, Elsevier, vol. 88(12), pages 2573-2585, December.
  6. Tara Watson, 2010. "Inside the Refrigerator: Immigration Enforcement and Chilling Effects in Medicaid Participation," NBER Working Papers 16278, National Bureau of Economic Research, Inc.
  7. Davila, Alberto & Pagan, Jose A, 1997. "The Effect of Selective INS Monitoring Strategies on the Industrial Employment Choice and Earnings of Recent Immigrants," Economic Inquiry, Western Economic Association International, vol. 35(1), pages 138-50, January.
  8. Robert Kaestner & Neeraj Kaushal, 2001. "Immigrant and Native Responses to Welfare Reform," NBER Working Papers 8541, National Bureau of Economic Research, Inc.
  9. Thomas Buchmueller & Sean Orzol & Lara Shore-Sheppard, 2014. "Stability of children’s insurance coverage and implications for access to care: evidence from the Survey of Income and Program Participation," International Journal of Health Care Finance and Economics, Springer, vol. 14(2), pages 109-126, June.
  10. Davila, Alberto & Pagan, Jose A & Grau, Montserrat Viladrich, 1999. " Immigration Reform, the INS, and the Distribution of Interior and Border Enforcement Resources," Public Choice, Springer, vol. 99(3-4), pages 327-45, June.
  11. Thomas Buchmueller & Anthony Lo Sasso & Kathleen Wong, 2007. "How Did SCHIP Affect the Insurance Coverage of Immigrant Children?," NBER Working Papers 13261, National Bureau of Economic Research, Inc.
  12. Bruce D. Meyer & Wallace K. C. Mok & James X. Sullivan, 2009. "The Under-Reporting of Transfers in Household Surveys: Its Nature and Consequences," Working Papers 0903, Harris School of Public Policy Studies, University of Chicago.
  13. Thomas DeLeire & Judith A. Levine & Helen Levy, 2006. "Is Welfare Reform Responsible for Low-Skilled Women’s Declining Health Insurance Coverage in the 1990s?," Journal of Human Resources, University of Wisconsin Press, vol. 41(3).
  14. Lara D. Shore-Sheppard, 2005. "Stemming the Tide? The Effect of Expanding Medicaid Eligibility on Health Insurance," NBER Working Papers 11091, National Bureau of Economic Research, Inc.
  15. Cynthia Bansak, 2005. "The Differential Wage Impact of the Immigration Reform and Control Act on Latino Ethnic Subgroups," Social Science Quarterly, Southwestern Social Science Association, vol. 86(s1), pages 1279-1298.
  16. Borjas, George J & Hilton, Lynette, 1996. "Immigration and the Welfare State: Immigrant Participation in Means-Tested Entitlement Programs," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 575-604, May.
  17. Pia M. Orrenius & Madeline Zavodny, 2009. "The effects of tougher enforcement on the job prospects of recent Latin American immigrants," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 28(2), pages 239-257.
  18. Hungerman, Daniel M., 2005. "Are church and state substitutes? Evidence from the 1996 welfare reform," Journal of Public Economics, Elsevier, vol. 89(11-12), pages 2245-2267, December.
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