Recent Immigrants and Public Charge: Access to Coverage and New Legal Arrivals’ Employment, Self-Employment, and Health Insurance After Medicaid Expansions and the Marketplace

Abstract

This article uses data from the American Community Survey from 2009 to 2016 to identify the effect of Medicaid expansions and the creation of the ACA Insurance Market Exchange (Marketplace) on low-income recent immigrants’ employment, self-employment, and health coverage. There is increasing interest in the connection between public coverage and employment outcomes among low-income documented immigrants after the current administration proposed to include the use of Medicaid as a potential reason for denying green card and citizenship applications based on the public charge criteria. The article finds little evidence on reduction of employment among those who are eligible in nongenerous states. We find evidence of an increase in the likelihood of being self-employed in generous states that expanded Medicaid before the implementation of the Marketplace. The findings suggests that low-income immigrants are likely to be employed regardless of their years in the country and that access to public coverage only affects the likelihood of having public versus private coverage.