The impact of access to prenatal health insurance for noncitizen women on child health

Objective: To estimate the effects of prenatal public health insurance targeting noncitizens on the health of U.S.-born children of noncitizen mothers beyond birth outcomes. Data Sources and Study Setting: This paper uses the restricted version of the 1998-2014 National Health Interview Survey with state-level geographic identifiers. Study Design: The empirical strategy compares outcomes in states that adopted the Children's Health Insurance Plan (CHIP) Unborn Child Option with states that never adopted or adopted it at different times, controlling for differences in the pretreatment period. I use a flexible event-study analysis to quantify the effects of the Unborn Child Option on noncitizen women's health insurance coverage, health care utilization, and their children's health. Data Collection/Extraction Methods: All data are derived from pre-existing sources. Principal Findings: The study finds that the impact of the Unborn Child Option is a 4.7%-point increase in public health insurance coverage (p < 0.01) and 0.48 more doctor's office visits (p < 0.1) annually among noncitizens of childbearing ages. Subsequently, the reform leads to a 7%-point rise in the rate of parents reporting their 4-6-year-old children are in 'excellent' or 'very good' health (p < 0.01). While no improvements are evident at birth and at younger ages, observed health improvements begin to appear by preschool age. Conclusions: The study contributes to the literature by providing evidence that certain benefits of in-utero public health insurance targeting noncitizens may appear several years after birth, specifically around preschool age. KEYWORDS access/demand/utilization of services, child and adolescent health, health economics, health policy/politics/law/regulation, maternal and perinatal care and outcomes What is known on this topic * Prior studies on the Children's Health Insurance Plan (CHIP) Unborn Child Option (UCO), a prenatal public health insurance option for noncitizens, find moderate increases in prenatal care utilization but no improvement in birth outcomes. * Literature on the impact of prenatal public health insurance eligibility has focused on US citizens. * Recent studies have shown significant effects of prenatal public health insurance eligibility on health and economic achievement in adulthood, but have not investigate intermediate outcomes in childhood. What this study adds * This study focuses on the UCO's impact beyond the neonatal period. * The findings show that observed health improvements begin to appear by preschool age, while no improvements are evident at birth and at younger ages. * This research demonstrates the impact of in-utero public health insurance eligibility for non-citizens on their US-born children's health, which has been understudied.
1 | INTRODUCTION Previous literature has shown that the prenatal environment is critical to the subsequent health trajectory experienced throughout life. (1-4) In an effort to improve the prenatal environment, [...]