Association for Public Policy Analysis & Management

Only 67 percent of first generation immigrants under the age of 65 have health insurance, while 87 percent of natives do. One potential reason for these health insurance disparities is that many immigrants lack English language skills. English skills could allow immigrants to have better jobs or to more easily navigate public health insurance requirements.

The endogeneity of English language skills poses a challenge to estimating the effect of language skills on health insurance coverage. English language skills are likely correlated with many other unobserved variables that are also related to health insurance coverage, which means estimates from ordinary least squares regressions will likely produce biased estimates of effect of language skills on health insurance coverage. In this paper, I use 2008-2013 American Community Survey data to estimate the causal effect of English language skills on health insurance coverage of adults who immigrated to the United States as children and on the health insurance coverage of their children by exploiting the fact that young children can learn a new language much more easily than older children.

Immediately prior to puberty, changes in the brain reduce a child's ability to acquire language skills, meaning the first several years of life are a critical period of language acquisition. If exposure to a language begins during this time period, language learners can catch up to native speakers. If exposure to the language begins afterwards, language learners lag behind native speakers. The ease with which young children can learn a new language means that immigrants who arrive to the United States while young can learn English much more easily than immigrants who arrive to the United States slightly older.

In this paper, I first demonstrate that English skills are strongly associated with immigrants' age at arrival for people coming from countries where English is not the official language. For immigrants from English speaking countries, English ability has no relationship to age at arrival. I next consider how health insurance coverage varies with age at arrival for immigrants from countries that do not speak English and find evidence of a strong relationship between age at arrival and health insurance coverage for adults who immigrated to the United States as children. Parents’ age at arrival does not influence whether or not a child has health insurance but instead is related to whether the child has Medicaid or employer sponsored coverage.

Based on the similarities in the age at arrival profiles for language skills and health insurance, I implement an instrumental variables strategy in to estimate the causal impact of English language ability on health insurance coverage. To account for the fact that age at arrival could potentially affect health insurance coverage through mechanisms other than English skills, the instrument is the interaction between immigrants' age at arrival and having been born in a non-English speaking country. The results suggest language skills have a large impact on whether or not adult immigrants have any health insurance and whether their children have Medicaid or employer sponsored coverage.