Panel Paper:
Covering the Undocumented: The Effects of a Large-Scale Prenatal Care Intervention
Saturday, November 9, 2019
Plaza Building: Concourse Level, Plaza Court 8 (Sheraton Denver Downtown)
*Names in bold indicate Presenter
One out of every 13 births in the United States is to an undocumented immigrant. Despite this large share of births, undocumented immigrants are ineligible for public health insurance coverage of routine prenatal and postpartum care in the majority of states. In this paper, we examine the effect of a landmark policy in the state of California to expand eligibility for its Medicaid program to pregnant undocumented immigrants. Using state hospital discharge data, we estimate that nearly 20 percent of births to foreign-born women in the state gained Medicaid coverage under this policy change. We evaluate whether this large expansion in public coverage changed health care utilization during pregnancy for the women who benefited, and whether it improved birth outcomes. We use a novel dataset that links all births in the state to the decennial Census and American Community Survey. Using these data, we are able link siblings of foreign-born mothers born before and after the coverage expansions to compare changes in outcomes associated with exposure to the policy. By comparing outcomes for children born to the same mother, we are able to estimate changes in birth outcomes resulting from the policy change, rather than from large changes in immigration and the composition of immigrants occurring over the study period. Siblings of foreign-born mothers who are born entirely during the pre-period or during the post-period serve as comparison groups to net out differences in outcomes due to birth order, as well as children of native-born women to account for any secular changes in outcomes over time. Using this approach, we document improved prenatal care utilization and an increase in hospital delivery among pregnant immigrant women under the coverage expansion, as well as increased likelihood of delivery by a physician. We also find significant increases in gestation length and birth weight among the children who benefited from the policy change while in utero.
