Effect of public health insurance programs on immigrant children's cognitive skills in the Los Angeles area

1. Effect of Public Health Insurance Programs
on Immigrant Children’s Cognitive Skills
in the Los Angeles Area
Soomi Lee
University of La Verne
Southern Political Science Association Annual Meeting
January 4, 2013
Orlando, FL

2. “It is easier to build strong children
than to repair broken men.”
Frederick Douglass
***
“If those most at risk happen to be children and youth,
the urgency of reform is so much greater
because it is today’s children
that will be tomorrow’s productive base
—or, in case of failure to reform,
tomorrow’s expensive social problems.”
Esping-Anderson

3. Research Question
Public health
insurance access
in early childhood
cognitive skills
in early school
age years
Among Children of Immigrants

4. • Children of immigrants make up 25% of the
child population (2010 Census).
• In the near future, they will be a significant
portion of the entire labor force paying into
Social Security and Medicare.
• Their labor productivity is important due to
the rising dependency ratio.
Motivation: Why Children of Immigrants?

5. Dependency Ratios
# Dependents per 100 Persons of Working Age, US: 1950-2080
(source: Congressional Research Service, 2006)

6. • Human capital investment (Becker 1964)
• Child health  Positive effect on school
performance, earning capacity, and cognitive ability
as an adult (Case and Paxon 2010, 2009, 2006, 2005;
Currie et al. 2002)
Early Childhood Investment on Health

7.  In low-income families
 Lack health insurance
 Lack usual source of care
 Utilize less health care service.
 Sicker
 Perform worse in school.
 More likely to drop out school.
 Earn less than children of natives.
Underinvestment on Children of Immigrants

8. • Children’s health care access improves child health
(Gruber 1997; Aizer 2007).
• The effect differs among subpopulation (Currie and
Thomas 1995; de la Mata 2011).
• Little known is the effect among children of
immigrants and whether the effect differs from
children of natives (Borjas 2011).
Health Care Access and Health

9. • State policy variation
• Causality
• Detailed health insurance and cognitive skills
• Sizable immigrant population
Empirical Challenges

10. • Data source: Los Angeles Family and Neighborhood
Survey conducted by UCLA and RAND
• Two-wave longitudinal study in the Los Angeles County
(88 cities) in 2001 and 2007
• Uses census tract, randomly selects households, adult
respondents, and child respondents.
• A primary caregiver was interviewed.
• Sample size: 501 children (age 0-5 at wave 1).
Los Angeles County Data

11. • Dependent variables: cognitive skills (scale 1-100)
– Letter-Word Identification
– Mathematical problem solving skills
– Paragraph comprehension
• Independent variables:
– Health insurance type at wave 1 and 2
• Control variables:
– Child characteristics (age, infant dummy, Latino, black,
gender, chronic condition, health status w1 and w2, birth
weight, on-and-off health insurance)
– Family characteristics (income(log), parents immigrant
status, caregiver’s educational attainment, single parent
household)
Variables

12. Summary Statistics
Immigrant Family (52%) Native Family (48%)
Variable n Mean SD n Mean SD
LWI 220 61.11 30.26 198 70.10 27.13
MATH 214 61.66 32.63 200 73.79 27.22
COMP 220 54.33 30.78 198 63.41 27.81
Public insurance w1 201 0.67 0.47 193 0.28 0.45
Public insurance w2 233 0.67 0.47 218 0.23 0.42
Birth weight 232 7.52 1.25 216 7.28 1.42
Health status w1 232 4.00 1.10 218 4.37 0.91
Health status w2 233 3.95 1.05 218 4.36 0.87

13. Cognitive skilli(t+1) = a
+ b1×(public Insurance)it
+ b2×(immigrant familyi)
+ b3×((public Insurance)it× immigrant familyi)
+ b4×(public Insurance)i(t+1)
+ b5×((public Insurance)i(t+1)× immigrant familyi)
+ X’λ + ei,
Empirical Framework

14. Letter-Word
Identification
Math
Paragraph
Comprehension
Public Insurance (t)
0.019 -0.136 0.017
(0.128) (0.166) (0.129)
Public Insurance (t+1)
-0.446* -0.521* -0.568*
(0.137) (0.175) (0.148)
Public Insurance (t)
× Immigrant Family
-0.004 0.148 0.031
(0.161) (0.225) (0.157)
Public Insurance (t+1)
× Immigrant Family
0.186 0.088 0.25
(0.176) (0.249) (0.189)
Immigrant Family
-0.03 -0.13 -0.014
(0.089) (0.109) (0.103)
N 353 349 354
Adj.R2 0.236 0.201 0.275
F 7.371 4.409 9.369
Control variables are included in all models. * p<0.05.
Results: Full Sample

15. Children of Immigrant Only Children of Natives Only
LWI MATH COMP LWI MATH COMP
Public Insurance (t)
.146 0.169 0.181 -0.116 -0.302 -0.087*
(.121) (0.175) (0.116) (0.145) (0.175) (0.154)
Public Insurance (t+1)
-0.133 -0.408* -0.169 -0.438* -0.437* -0.58*
(0.146) (0.187) (0.159) (0.144) (0.173) (0.166)
N 180 176 181 173 173 173
Adj.R2 0.218 0.181 0.265 0.33 0.258 0.325
F 6.786 5.35 7.117 4.877 2.037 5.952
Control variables are included in all models. *p<0.05.
Results: Sub-samples

16. • Access does not mean utilization.
• Health is not the only factor in developing
children’s cognitive ability.
• Sample size is small to compare children with
public insurance and children with no
insurance among low-income children of
immigrants.
Discussion

17. • First attempt to establish a causal link between early
childhood health investment and cognitive skills in
early school age among children of immigrants.
• Public health insurance access in early childhood
generally has no effect on elementary school age
children’s cognitive skills for both children of
immigrants and children of natives.
• Current insurance is more important than earlier
insurance.
• Findings suggest that there may be a different effect of
early childhood public insurance access on cognitive
skills for immigrants and natives.
Conclusion