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Demography

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01.05.2011

Medicaid Expansions and Fertility in the United States

verfasst von: Thomas DeLeire, Leonard M. Lopoo, Kosali I. Simon

Erschienen in: Demography | Ausgabe 2/2011

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Abstract

Beginning in the mid-1980s and extending through the early to mid-1990s, a substantial number of women and children in the United States gained eligibility for Medicaid through a series of income-based expansions. Using natality data from the National Center for Health Statistics, we estimate fertility responses to these eligibility expansions. We follow Currie and Gruber (2001) and measure changes in state Medicaid-eligibility policy by simulating the fraction of a standard population that would qualify for benefits in different states and different time periods. From 1985 to 1996, the fraction of women aged 15–44 who were eligible for Medicaid coverage for a pregnancy increased more than 20 percentage points. When we use a state and year fixed-effects model with a limited set of covariates, our estimates indicate that fertility increases in response to Medicaid expansions. However, after we include fixed effects for demographic characteristics, the estimated relationship diminishes substantially in size and is no longer statistically significant. We conclude that there is no robust relationship between Medicaid expansions and fertility.

Vorheriger Artikel Health Measurement in Population Surveys: Combining Information from Self-reported and Observer-Measured Health Indicators

Nächster Artikel Microcredit, Family Planning Programs, and Contraceptive Behavior: Evidence From a Field Experiment in Ethiopia

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According to Espenshade (1977), the total cost of a child can be broken into two components: non-economic costs and economic costs. The non-economic costs are exceedingly difficult to measure. They include, among other things, the fatigue caused by abnormal sleeping patterns and the concern caused by having a sick child. The economic costs include both the direct financial costs as well as the opportunity costs. The estimates from Lino (2000) did not include the opportunity costs or the costs of prenatal care and delivery. Foster (2002) argued that the opportunity cost of a child is roughly the same as the direct financial economic cost.

In addition, 12 states made family planning services available to some women outside Medicaid eligibility (but typically just to former Medicaid moms in the postpartum period and/or women at less than 185% FPL) from 1994 to 2000 through Medicaid Section 1115 waivers. During 1994–1996, the years that overlap our study period, Delaware, Maryland, Rhode Island, and South Carolina implemented postpartum waivers, and Arizona implemented an income-based waiver (Kearney and Levine 2009; Lindrooth and McCullough 2007).

Even though the take-up rate among newly eligible children has been estimated to be rather low, we would expect nearly all pregnant women who are eligible for Medicaid (and not otherwise insured) to enroll in Medicaid at least to cover childbirth expenses. Nearly all births occur in hospitals, and hospitals have the ability and incentive to enroll eligible women in the program to be reimbursed for expenses. Despite this, Medicaid expansions likely will have a causal impact on fertility only to the extent that women know prior to conception that they will be covered by Medicaid; the percentage of women who end up having their child’s delivery expenses paid by Medicaid eligibility is likely an overestimate of the number of women who are aware, prior to pregnancy, that Medicaid will cover the costs of delivery, and only a subset of those will have altered their fertility behavior in response to their potential eligibility.

Currie and Gruber (2001) included an additional race category of “other,” thereby generating 66 cells. We chose not to report results using the “other” category because of the heterogeneity in the composition of this category across states. In preliminary results using this “other” category, however, the findings were identical to those we report for the white and African American populations.

Joyce et al. (1998) used a single dummy variable to record whether the state expanded eligibility to 100% of the poverty level by OBRA 1986 and a second dummy variable to record whether the state expanded eligibility under the 1987 and 1989 OBRAs from 100% of poverty to 185% of poverty.

Because we lagged several variables by three quarters, have birth data from 1985 to 1997, and have simulated Medicaid eligibility from 1985 to 1996, our actual time series runs from the last quarter of 1985 through the first three quarters of 1997.

For other examples, see Joyce et al. (1998), Kearney (2004), Levine et al. (1996), and Lopoo and DeLeire (2006).

Optimally, we would prefer to know the number of females that meet the definition for each cell: for example, females aged 25–29, married, with a college degree in a given state, in a given quarter of a given year. Data with this level of detail do not exist, to the best of our knowledge. One might have concerns because the weights are measured at a different level of aggregation than the fertility counts and Medicaid eligibility measures in our models. To determine whether this choice alters our findings, we construct a different weight using data from the 1990 5% PUMS and report results using this different weight in the Tests of Robustness section. Our results suggest that our choice of weight does not alter our findings.

Figure 2 (available in Online Resource 1) illustrates our measure of the proportion of the population of white women eligible for Medicaid by demographic cell, while Fig. 3 in Online Resource 1 illustrates the measure for African American women. The time series begins in the first quarter of 1985 (Time 0 in the graph) and terminates in the last quarter of 1996 (Time 48 in the graph). The graphs illustrate a couple of points. First, one can see the considerable heterogeneity in Medicaid eligibility across the cells. Secondly, as expected, the cells that have disproportionate shares of low-income women have greater increases in Medicaid expansions. For example, one sees considerable growth in eligibility among high school dropouts, particularly among white women. We investigate the relationship between Medicaid and fertility within some subsamples of the data, based in large measure on the evidence presented in these figures.

Data are missing for many reasons, including that some states as a matter of policy did not collect education information on birth certificates for several of the years in our time series.

Yelowitz (1998) found that Medicaid expansions increase the likelihood of marriage. If true, then our decision to use marital status in our cell definitions may be problematic. The results in Table 6 suggest that even when we do not separate the cells by marital status, our findings are largely the same.

We find nearly identical results for African Americans. To conserve space, we will focus on the white subsample, but the same conclusions apply for African Americans.

An, C. B., Haveman, R., & Wolfe, B. (1993). Teen out-of-wedlock births and welfare receipt: The role of childhood events and economic circumstances. The Review of Economics and Statistics, 75, 195–208.CrossRef

Becker, G. S. (1960). An economic analysis of fertility. In Demographic and economic change in developed countries, a conference of the Universities – National Bureau Committee for Economic Research. Princeton University Press for the National Bureau of Economic Research. Reprinted 1976 in G. S. Becker. The economic approach to human behavior. Chicago, IL: The University of Chicago Press.

Becker, G. S. (1991). A treatise on the family (enlarged ed.). Cambridge, MA: Harvard University Press.

Becker, G. S., & Lewis, H. G. (1973). On the interaction between quality and quantity. Journal of Political Economy, 81(part 2), S279–S288.CrossRef

Bitler, M. P. (2006). Effects of increased access to infertility treatment on infant and child health: Evidence from health insurance mandates (Working Paper WR-330). Santa Monica, CA: RAND.

Bitler, M. P., & Schmidt, L. G. (2006). Health disparities and infertility: Impacts of state-level insurance mandates. Fertility and Sterility, 85, 858–865.CrossRef

Bitler, M. P., & Zavodny, M. (2010). The effect of Medicaid eligibility expansions on fertility. Social Science & Medicine, 71, 918–924.CrossRef

Blank, R., George, C., & London, R. (1996). State abortion rates: The impact of policies, providers, politics, demographics, and economic environment. Journal of Health Economics, 15, 513–553.CrossRef

Bundorf, K., Henne, M., & Baker, L. (2007). Mandated health insurance benefits and the utilization and outcomes of infertility treatments (NBER Working Paper No. 12820). Cambridge, MA: National Bureau of Economic Research.

Card, D., & Shore-Sheppard, L. D. (2004). Using discontinuous eligibility rules to identify the effects of the federal Medicaid expansions on low-income children. The Review of Economics and Statistics, 86, 752–766.CrossRef

Currie, J., & Gruber, J. (1996). Saving babies: The efficacy and cost of recent changes in the Medicaid eligibility of pregnant women. Journal of Political Economy, 104, 1263–1296.CrossRef

Currie, J., & Gruber, J. (2001). Public health insurance and medical treatment: The equalizing impact of the Medicaid expansions. Journal of Public Economics, 82, 63–89.CrossRef

Cutler, D. M., & Gruber, J. (1996). Does public insurance crowd out private insurance? Quarterly Journal of Economics, 111, 391–430.CrossRef

Dickert-Conlin, S., & Chandra, A. (1999). Taxes and the timing of births. Journal of Political Economy, 107, 161–177.CrossRef

Dubay, L. C., & Kenney, G. M. (1997). Did Medicaid expansions for pregnant women crowd-out private insurance? Health Affairs, 16, 185–193.CrossRef

Duncan, G. J., & Hoffman, S. D. (1990). Welfare benefits, economic opportunities, and out-of-wedlock births among black teenage girls. Demography, 27, 519–535.CrossRef

Espenshade, T. J. (1977). The value and cost of children. Population Bulletin, 32, 1–48.

Foster, E. M. (2002). How economists think about family resources and child development. Child Development, 73, 1904–1914.CrossRef

Gold, R. B., Richards, C. L., Ranji, U. R., & Salganicoff, A. (2007). Medicaid’s role in family planning (Women’s Issue Brief No. 7064–03). Menlo Park, CA, and New York: Henry J. Kaiser Foundation and Guttmacher Institute. Available online at http://www.kff.org/womenshealth/upload/7064_03.pdf

Gruber, J. (2003). Medicaid. In R. A. Moffitt (Ed.), Means-tested transfer programs in the United States (pp. 15–77). Chicago, IL: University of Chicago Press.

Gruber, J., & Simon, K. (2008). Crowd-out ten years later: Have recent public insurance expansions crowded out private health insurance? Journal of Health Economics, 27, 201–217.

Hamilton, B. H., & McManus, B. (2005). Infertility treatment markets: The effects of competition and policy (Working paper). St. Louis, MO: Olin School of Business, Washington University.

Hao, L., & Cherlin, A. J. (2004). Welfare reform and teenage pregnancy, childbirth, and school dropout. Journal of Marriage and Family, 66, 179–194.

Hoffman, S. D., & Foster, E. M. (2000). AFDC benefits and nonmarital births to young women. The Journal of Human Resources, 35, 376–391.CrossRef

Horvath-Rose, A. E., & Peters, H. E. (2001). Welfare waivers and non-marital childbearing. In G. J. Duncan & P. L. Chase-Lansdale (Eds.), For better and for worse: Welfare reform and the well-being of children and families (pp. 222–244). New York: Russell Sage Foundation.

Hoynes, H. (1997). Does Welfare play any role in female headship decisions? Journal of Public Economics, 65, 89–117.CrossRef

Joyce, T., Kaestner, R., & Kwan, F. (1998). Is Medicaid pronatalist? The effect of eligibility expansions on abortions and births. Family Planning Perspectives, 30, 108–113. 127.CrossRef

Kaestner, R., Korenman, S., & O’Neill, J. (2003). Has welfare reform changed teenage behavior? Journal of Policy Analysis and Management, 22, 225–248.CrossRef

Kane, T., & Staiger, D. (1996). Teen motherhood and abortion access. Quarterly Journal of Economics, 111, 467–506.CrossRef

Kearney, M. S. (2004). Is there an effect of incremental welfare benefits on fertility behavior? A look at the family cap. The Journal of Human Resources, 39, 295–325.CrossRef

Kearney, M., & Levine, P. (2009). Subsidized contraception, fertility, and sexual behavior. The Review of Economics and Statistics, 91, 137–151.CrossRef

Leibowitz, A. (1990). The response of births to changes in health care costs. The Journal of Human Resources, 25, 697–711.CrossRef

Levine, P. B. (2004). Sex and consequences: Abortion, public policy, and the economics of fertility. Princeton, NJ: Princeton University Press.

Levine, P. B., Trainor, A. B., & Zimmerman, D. J. (1996). The effect of Medicaid abortion funding restrictions on abortions, pregnancies, and births. Journal of Health Economics, 15, 555–578.CrossRef

Lewit, E. M., & Monheit, A. C. (1992). Expenditures on health care for children and pregnant women. The Future of Children, 2, 95–114.CrossRef

Lindrooth, R. C., & McCullough, J. S. (2007). The effect of Medicaid family planning expansions on unplanned births. Women’s Health, Issues, 17(2), 66–74.CrossRef

Lino, M. (2000). Expenditures by families on children, 2000 annual report (Miscellaneous Publication No. 1528–2000). Washington, DC: U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. Available online at http://www.cnpp.usda.gov

Lo Sasso, A. T., & Buchmueller, T. C. (2004). The effect of the State Children’s Health Insurance Program on health insurance coverage. Journal of Health Economics, 23, 1059–1082.CrossRef

Lopoo, L. M., & DeLeire, T. (2006). Did welfare reform influence the fertility of young teens? Journal of Policy Analysis and Management, 25, 275–298.CrossRef

Lundberg, S., & Plotnick, R. D. (1995). Adolescent premarital childbearing: Do economic incentives matter? Journal of Labor Economics, 13, 177–200.CrossRef

Mayer, S. E. (1997). What money can’t buy: Family income and children’s life chances. Cambridge, MA: Harvard University Press.

Mellor, J. (1998). The effect of family planning programs on the fertility of welfare recipients: Evidence from Medicaid claims. The Journal of Human Resources, 33, 866–895.CrossRef

Moffitt, R. A. (2003). The temporary assistance for needy families program. In R. A. Moffitt (Ed.), Means-tested transfer programs in the United States (pp. 291–363). Chicago, IL: University of Chicago Press.

Schmidt, L. (2007). Effects of infertility insurance mandates on fertility. Journal of Health Economics, 26, 431–446.CrossRef

Tritz, K., Tilson, S., Stone, J., Peterson, C., O’Sullivan, J., Morgan, P. C., et al. (2006). Side-by-side comparison of Medicare, Medicaid, and SCHIP provisions in the Deficit Reduction Act of 2005 (CRS Report for Congress, Order Code RL33251). Washington, DC: Congressional Research Service, Library of Congress.

Whittington, L. A., Alm, J., & Peters, H. E. (1990). Fertility and the personal exemption: Implicit pronatalist policy in the United States. The American Economic Review, 80, 545–556.

Yazici, E., & Kaestner, R. (2000). Medicaid expansions and the crowding out of private health insurance among children. Inquiry, 37, 23–32.

Yelowitz, A. S. (1998). Will extending Medicaid to two-parent families encourage marriage? The Journal of Human Resources, 33, 833–865.CrossRef

Titel: Medicaid Expansions and Fertility in the United States
verfasst von: Thomas DeLeire
Leonard M. Lopoo
Kosali I. Simon
Publikationsdatum: 01.05.2011
Verlag: Springer US
Erschienen in: Demography / Ausgabe 2/2011
Print ISSN: 0070-3370
Elektronische ISSN: 1533-7790
DOI: https://doi.org/10.1007/s13524-011-0031-6

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