Association for Public Policy Analysis & Management

After the reauthorization of the Children's Health Insurance Program (CHIP) in 2009, 21 states and DC raised their CHIP income eligibility thresholds to further reduce the number of uninsured immigrant children. This study utilizes the 2008 panel of the Survey of Income and Program Participation to examine the impact of expansions on public health insurance enrollment and self-rated health among foreign-born children who became newly eligible for CHIP.

Using a difference-in-differences (DD) approach, I find that the expansion increased public health insurance enrollment rate among the main beneficiary group of the foreign-born children who arrived in the U.S. less than five years ago by 13.8 percentage points when compared to the same group of children in non-expansion states. However, the sensitivity analysis on the children of immigrants shows that CHIPRA had no statistically significant effect in increasing public health insurance enrollment for this group. Moreover, the difference-in difference-in-differences (DDD) model suggests that there is no evidence of a statistically significant relationship between the public health insurance enrollment or self-rated health for both foreign-born children and children of immigrants when they are compared to the U.S.-born native children in the expansion states.

This suggests that CHIPRA improved coverage for both foreign-born children but the policy effects of CHIPRA on coverage may not be different from those experienced by the U.S.-born children with U.S.-born parents. Using nationally representative panel data with immigrants’ duration in the U.S. information strengthens the generalizability of this study’s findings. This study demonstrates that due to CHIPRA’s possible impacts on U.S. born native children, the DD model comparing the immigrant children in expansion states vs. non-expansion states gives better estimates for policy effects.