title: Welfare reform and health insurance of immigrants.
abstract: OBJECTIVE
  To investigate the effect of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) on the health insurance coverage of foreign- and U.S.-born families headed by low-educated women.
  
  
  METHODS
  Secondary data from the March series of the Current Population Surveys for 1994-2001.
  
  
  METHODS
  Multivariate regression methods and a pre- and post-test with comparison group research design (difference-in-differences) are used to estimate the effect of welfare reform on the health insurance coverage of low-educated, foreign- and U.S.-born unmarried women and their children. Heterogeneous responses by states to create substitute Temporary Aid to Needy Families or Medicaid programs for newly arrived immigrants are used to investigate whether the estimated effect of PRWORA on newly arrived immigrants is related to the actual provisions of the law, or the result of fears engendered by the law.
  
  
  RESULTS
  PRWORA increased the proportion of uninsured among low-educated, foreign-born, unmarried women by 9.9-10.7 percentage points. In contrast, the effect of PRWORA on the health insurance coverage of similar U.S.-born women is negligible. PRWORA also increased the proportion of uninsured among foreign-born children living with low-educated, single mothers by 13.5 percentage points. Again, the policy had little effect on the health insurance coverage of the children of U.S.-born, low-educated single mothers. There is some evidence that the fear and uncertainty engendered by the law had an effect on immigrant health insurance coverage.
  
  
  CONCLUSIONS
  This research demonstrates that PRWORA adversely affected the health insurance of low-educated, unmarried, immigrant women and their children. In the case of unmarried women, it may be partly because the jobs that they obtained in response to PRWORA were less likely to provide health insurance. The research also suggests that PRWORA may have engendered fear among immigrants and dampened their enrollment in safety net programs.
authors.affiliation: School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Kaushal
authors.forename: Robert
authors.initials: R
authors.lastname: Kaestner
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004522:Educational Status; D004641:Emigration and Immigration; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data* / Q000639:trends; D008430:Maternal-Child Health Centers / Q000191:economics*; D008484:Medicaid / Q000331:legislation & jurisprudence; D009035:Mothers; D011632:Public Assistance / Q000331:legislation & jurisprudence*; D011640:Public Policy; D012044:Regression Analysis; D020954:Single-Parent Family; D012946:Social Welfare / Q000191:economics / Q000331:legislation & jurisprudence*; D014481:United States