Poster #5 - Public Insurance Expansions and Employer Reliance on Foreign-Born Medical Labor

• In Event: Friday Poster Reception

Abstract

Foreign-born physicians and other medical professionals play an important role in meeting healthcare needs in underserved U.S. communities, particularly where the domestic supply of healthcare workers is limited. At the same time, state Medicaid expansions under the Affordable Care Act generated large and uneven increases in healthcare demand across the federal system. Prior research shows that these expansions increased healthcare vacancies and hiring, raised earnings for some healthcare workers, and influenced where newly trained general internists chose to practice. Yet it remains unclear whether Medicaid expansion also increased employers’ reliance on foreign-born medical labor, through which visa channels, and in which local labor markets.

We address this question by examining whether Medicaid expansion increased employer demand for foreign-born workers in medical-related occupations and whether these responses varied by occupation, visa classification, education, renewal status, cap status, and country of origin. We also assess whether the effects were larger in rural communities and in areas with higher poverty rates or larger elderly populations, where staffing constraints are more likely to bind. To conduct this analysis, we use healthcare-related Form I-129 petitions filed between 2010 and 2020. We aggregate these petitions to the community-zone-by-year level and link them to American Community Survey measures of local demographic, economic, and workforce characteristics. We then exploit the staggered adoption of Medicaid expansion across states using a difference-in-differences and event-study framework.

This approach offers an important advantage. Because the data capture employer-filed petitions for nonimmigrant workers, they allow us to observe labor demand at the point of recruitment rather than the realized stock of workers after labor-market adjustment has occurred. This distinction matters because stock-based employment data cannot distinguish new recruitment from the continuation of existing workers, movement across visa channels, or changes in demand for workers with different credentials or countries of origin. Our analysis therefore speaks more directly to how healthcare providers respond when insurance expansions increase demand faster than the domestic labor supply can adjust.

The study contributes to three related literatures: Medicaid expansion and healthcare labor demand, physician distribution and foreign medical labor, and skilled immigration. More broadly, it addresses whether expansions in insurance coverage increase reliance on immigration-linked labor supply to convert newly expanded coverage into actual care capacity. This question is especially important in an era of growing cross-state policy variation and persistent shortages in medically underserved communities. The findings can inform complementary workforce and immigration policies designed to ensure that expanded insurance access translates into meaningful improvements in healthcare availability.

Author

• Catalina Amuedo-Dorantes, University of California, Merced
  Presenting Author