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LETTER |
Ted Joyce is with Baruch College, City University of New York, and the National Bureau of Economic Research, New York, NY. Tamar Bauer is with the New York Academy of Medicine, New York, NY. Howard Minkoff is with Maimonides Medical Center, Brooklyn, NY, and the State University of New York Health Science Center at Brooklyn. Robert Kaestner is with the Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, and the National Bureau of Economic Research, New York.
Correspondence: Requests for reprints should be sent to Ted Joyce, PhD, National Bureau of Economic Research, 365 Fifth Ave, 5th Floor, New York, NY 10016-4309 (e-mail: ted_joyce{at}baruch.cuny.edu).
We appreciate the comments by Seils et al. As we stated in our article, we agree that relatively few foreign-born Latinas lost eligibility for publicly financed prenatal care under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). However, there was substantial fear and confusion in immigrant communities as to the ramifications of PRWORA. Governor Wilson of California was explicit about his desire to cut off public funding of prenatal care for the undocumented. A study by Urban Institute researchers of applications for Medi-Cal and welfare benefits in California after PRWORA concluded, "Since immigrant eligibility for these benefits has not changed in California since January 1996, this decline appears to reflect fewer immigrants applying for assistance for which they remain eligible."1
In California, where data on Medicaidfinanced births by immigration status exist, in 1995 more than 74 000 births, or 55% of births to foreign-born Latinas, were to undocumented women. Our best estimate of births to undocumented Latinas in Texas was also substantial and was noted in our article. In short, the size of the affected population was potentially large, since many documented and undocumented immigrants believed themselves vulnerable to the implications of PRWORA.
We limited the analysis to Latinas because the large number of US-born Latinas provided a natural comparison group. We believed it unlikely that the addition of more states with many fewer foreign-born women or "controls" would have increased power to detect an effect with vital data.
It may be true that Latino men with coronary disease were adversely affected by PRWORA. We obviously never addressed that question, and we cannot be responsible for those who would generalize our results to other populations. We felt our question was explicit and, given the tenor of the times, appropriate. The percentage of births to US-born and foreign-born Latinas who initiate prenatal care early has risen without interruption since 1990. Our finding that PRWORA had no impact on this trend suggests that improved access to prenatal care among foreign-born Latinas remains an impressive achievement of the Medicaid eligibility expansions.
Reference
1. Zimmerman W, Fix M. Declining Immigrant Applications for Medi-Cal and Welfare Benefits in Los Angeles County. Washington, DC: Urban Institute; July 1998:1–2. Also available at: http://www.urban.org/immig/lacounty.html. Accessed February 27, 2002.
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