Testing the impact on children's health outcomes of states' policies on immigration enforcement and on provision of health insurance for immigrants

The Foundation's initiative, Evidence for Action: Investigator-Initiated Research to Build a Culture of Health, was designed to support investigator-initiated research projects that support the Robert Wood Johnson Foundation's work with a Culture of Health.This study examines the effect of state immigration enforcement and public health insurance policies on receipt of primary, preventive health care among children of unauthorized and legal immigrants. Beginning in the early 2000s, states diverged in their levels of cooperation with federal immigration enforcement and their approaches to expanding public benefits to immigrants, thus creating a natural experiment to assess the impact of these policies on immigrant well-being. Prior research indicates that strict immigration enforcement reduces immigrant parents' enrollment in public benefits and programs, regardless of their children's eligibility. Increased immigration enforcement may lead to parents' fear of interacting with institutions, including health care services. Restrictions on public health insurance for immigrants reduce access to health insurance and, thereby, may reduce access to health care among immigrants as well. Children of immigrants may be less likely to receive primary, preventive care as a result of these policies. Furthermore, if children of immigrants are less likely to receive vaccinations on schedule or more likely to utilize the emergency room for primary health care, this could have a negative impact on the broader population's health. To estimate how these policies affect health outcomes among children of immigrants, they will first link a database of state immigration policies with the restricted Medical Expenditure Panel Survey data, and then employ difference-in-difference analyses to measure the impact of these policies on this population's receipt of primary care. Given the ongoing national debate about the rights of immigrants and their children, this study will contribute to the field by being the first to examine the effects of immigration policies regarding enforcement, drivers' licenses, and access to public health insurance on health outcomes.