restricted access Chapter 7 Welfare-Leaving and Child Health and Behavior in Immigrant and Native Families
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Chapter 7 Welfare-Leaving and Child Health and Behavior in Immigrant and Native Families Ariel Kalil and Danielle A. Crosby CHILDREN OF immigrants are the fastest-growing segment of the child population. Although immigrants make up less than 13 percent of the total population, their children make up 22 percent of the total child population and 30 percent of the lowincome child population in the United States.1 Research indicating disparate access to resources and opportunities for immigrant families raises concerns about the health, economic well-being, and social and cognitive development of this significant segment of the child population. Children of immigrants are more likely than their native counterparts to be poor and to experience material hardships such as crowded housing conditions and difficulties affording food (Capps 2001). They are also much less likely to have health insurance, even after controlling for key demographic characteristics (Hernandez 2004), and the barriers immigrant families face in accessing health care often extend beyond those created by insurance coverage issues (Capps 2001). Moreover , the quality of care available to immigrants is likely to be less than that of their native counterparts (Ku and Matani 2001). That immigrant children are at increased risk for not having health insurance and a regular place for medical care partly explains why they are substantially more likely than their peers to be in 193 poor health (Reardon-Anderson, Capps, and Fix 2002), despite better health outcomes at birth and during infancy (Ventura et al. 2000). An important and unresolved issue concerns the extent to which changes in federal welfare policy have affected household economic security and the health and well-being of young children in immigrant families. Before the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), legal immigrants and their children were generally eligible for public benefits under the same terms as citizens. The main vehicle for welfare reform, PRWORA introduced broad restrictions on immigrants ’ eligibility for many health and social service programs, including cash welfare assistance (TANF), food stamps, and subsidized health insurance (Medicaid and the State Children’s Health Insurance Program, or SCHIP). For example, the law restricted TANF and Medicaid eligibility among legal immigrants to those who are citizens, refugees, those in the country for at least five years, and other small groups. Food stamp eligibility was restricted to legal immigrants with ten years of work history, though this requirement was later softened to a five-year residency requirement for adults and no restriction for legal immigrant children. Unauthorized immigrants were ineligible for these major public assistance programs both before and after PRWORA was enacted (Capps and Fortuny 2006). Caseloads for benefit programs fell dramatically in the wake of welfare reform (Blank 2002), but the declines were steeper for immigrants than for native-born citizens, even among immigrants who remained eligible for assistance because of their tenure and status in the United States or their child’s U.S. citizenship (Fix and Passel 1999; Haider et al. 2004; Ku and Blaney 2000; Van Hook and Balistreri 2006). Several hypotheses have been put forth to explain these patterns. First, there is some indication that immigrants had different (and more favorable) responses to the robust economy of the late 1990s (Capps et al. 2003; Haider et al. 2004; Kaestner and Kaushal 2005; Lofstrom and Bean 2002). It has also been suggested that the new restrictions on immigrants may have induced some families to seek citizenship (Fix and Haskins 2002; Van Hook 2003), making it appear as if the noncitizenship welfare rolls were declining at an accelerated rate. The hypothesis most relevant to this chapter, however, concerns the so-called 194 Immigrants and Welfare chilling effect, which maintains that immigrant families became reluctant to access public assistance after 1996 (even if eligible) because they were confused about the new policies and feared the potential consequences for family members (Shields and Behrman 2004). The new eligibility rules are complex, vary by state (depending on how states responded to the federal changes), and have continued to change over time. In addition, limited English proficiency may have contributed to immigrants’ confusion about the new laws. Noncitizen parents may have been unaware of their U.S.-born children’s eligibility for important benefits , or may have believed that seeking assistance for eligible children would hinder other family members’ efforts to obtain citizenship or legal status, or their ability to reenter and stay in the United States (Capps 2001; Fix and Passel 1999; Holcomb et al. 2003). LINKING PATTERNS OF...