Abstract
The rapid growth of the immigrant population in the United States, along with changes in the demographics and the political landscape, has often raised questions for understanding trends of inequality. Important issues that have received little scholarly attention thus far are excluding immigrants’ social rights through decisive policy choices and the distributive consequences of such exclusive policies. In this article, we examine how immigration and state policies on immigrants’ access to safety net programs together influence social inequality in the context of health care. We analyze the combined effect of immigration population density and state immigrant Medicaid eligibility rules on the gap of Medicaid coverage rates between native‐ and foreign‐born populations. When tracking inequality in Medicaid coverage and critical policy changes in the post‐PRWORA era, we find that exclusive state policies widen the native‐foreign Medicaid coverage gap. Moreover, the effect of state policies is conditional on the size of the immigrant population in that state. Our findings suggest immigrants’ formal integration into the welfare system is crucial for understanding social inequality in the U.S. states.
Highlights
The United States stands alone from other industrialized democracies because of its longstanding political struggle over universal health care reforms (Starr, 2011)
We contend that the Medicaid coverage gap between immigrants and their native-born counterparts is larger in states with more exclusive policies, and this positive relationship between state policy exclusiveness and social inequality is strengthened in states with lower levels of immigrant population density
We find support for the hypotheses that immigrant population density and states’ immigrant Medicaid eligibility rules interactively shape the native-foreign Medicaid coverage gap. 12
Summary
The United States stands alone from other industrialized democracies because of its longstanding political struggle over universal health care reforms (Starr, 2011). We analyze the combined effect of immigration population density and state immigrant Medicaid eligibility rules on the gap of Medicaid coverage rates between native- and foreign-born populations. We contend that the Medicaid coverage gap between immigrants and their native-born counterparts is larger in states with more exclusive policies, and this positive relationship between state policy exclusiveness and social inequality is strengthened in states with lower levels of immigrant population density.
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