Policy Context

Policy Context
In 1996, Congress passed welfare reform legislation that restrictedb legal noncitizens’ access to public benefits; undocumented immigrants were already ineligible for most benefits. Immediately after enactment of the law, use of public benefits fell, not just
among legal noncitizen children with noncitizen parents, but also among citizen children in mixed-status families (Zimmermann and Fix 1998). About the same time, Congress expanded health care coverage of low-income children by enacting SCHIP, and many
states extended their state-funded health insurance programs to legal noncitizens (Zimmermann and Tumlin 1999). Between 1999 and 2002, the federal government
made it clear that receipt of health benefits would not jeopardize the naturalization of immigrant family members or their adjustment to legal permanent resident status (Schlosberg and Wong 2002), and several states with large immigrant populations made extensive outreach efforts to these families (Holcomb et al. 2003).
The share of all children under age 18 without health insurance coverage fell
from 12.4 percent to 9.4 percent between 1999 and 2002 (data not shown). This gain was driven by a decline in the uninsurance rate for low-income children, which fell by 5.9 percentage points. The uninsurance rate for children in higherincome families did not change significantly during this period (Kenney, Haley, and Tebay 2003).
Uninsurance fell for both groups of low-income citizen children between 1999 and 2002: the rate dropped 6.0 percentage points for children with citizen parents and 7.1 percentage points for children in mixed-status families (figure 1). Nonetheless, 12.4 percent of children with citizen parents and 21.6 percent of children in mixed-status
families were uninsured in 2002. These coverage gaps are consistent with gaps reported in a recent study based on Current Population Survey data (Ku and Waidman 2003).
Improvements in coverage among low-income citizen children are attributable to expanded public—not employer—coverage. These children gained Medicaid/SCHIP coverage at high rates between 1999 and 2002: public coverage increased by 13.0
percentage points for children with citizen parents and 11.6 percentage points for children in mixed-status families (figure 2).