The Effects of DACA on Health Insurance, Access to Care, and Health Outcomes

In 2017, there were 11 million unauthorized immigrants in the United States, representing 3.4% of the country's population. These individuals constantly face the threat of deportation and the lack of work permits, access to credit, and access to government welfare programs. Given the sensitive nature of any immigrant regularization policy, its potential costs and benefits need to always be carefully evaluated. This paper studies the effects of the 2012 Deferred Action for Childhood Arrivals (DACA) initiative on health insurance coverage, access to care, health care use, and health outcomes of eligible undocumented immigrants in the United States. DACA is a temporary authorization program implemented by President Obama's administration in 2012, which provides certain undocumented immigrants who came to the country as minors with a two-year renewable deferral status. This status guarantees a reprieve from deportation, a work permit, and a social security number. Targeting up to 1.7 million individuals (15% of all unauthorized immigrants), DACA is the largest immigration reform in the United States since the 1986 Immigration Reform and Control Act (IRCA). To causally estimate the impact of DACA, we exploit a difference-in-differences setup that relies on the discontinuities in the program eligibility criteria and compares DACA-eligible with DACA-ineligible individuals, before and after the implementation of the program. Our estimated coefficients thus represent the intention-to-treat effect of DACA, understating the actual treatment effect of the policy. The analysis employs data from three large survey datasets: the American Community Survey (2005-2016), the National Health Interview Survey (2000-2016), and the confidential data of the California Health Interview Survey (2003-2015). We find that DACA increased health insurance coverage. In California and New York, the two states that granted access to the full-scope Medicaid, the increase was driven by an increase in public insurance take-up. In the rest of the United States, where public coverage was not available, DACA eligibility increased individually purchased insurance. Despite the increase in insurance coverage, there is no evidence of significant increases in health care use, although there is some evidence that DACA increased demand for mental health services in California. After 2012, DACA-eligible individuals were also more likely to report a usual place of care and less likely to delay care because of financial restrictions. Finally, we find some evidence that DACA improved self-reported health and reduced depression symptoms, indicators of stress and anxiety, and hypertension. These improvements are concentrated among individuals with income below the federal poverty level. The positive effects of DACA on health can be explained by the immediate reduction in chronic stressors (such as the fear of deportation) as well as the improvements in labor market outcomes.