Poverty, Health Coverage, and State Variation Under the Health-Inclusive Poverty Measure

• In Event: Medicaid Expansions and Contractions: the OBBBA, Poverty & Financial Insecurity

Abstract

This paper examines poverty among immigrant populations across states using the Health-Inclusive Poverty Measure (HIPM), an extension of the Supplemental Poverty Measure (SPM) that incorporates medical needs and evaluates access to adequate health coverage. It estimates poverty rates for individuals with imputed unauthorized status and for those in mixed-status families, assesses the poverty-reducing effects of key safety-net programs, and examines how these patterns vary across states.  

Using the CPS ASEC and the Census HIPM Public Use Extract, the analysis proceeds in three steps. First, we impute unauthorized immigration status using established methods from the literature and estimate poverty rates by race, ethnicity, and immigration status, including among individuals in mixed-status families. Second, we estimate the poverty-reducing effects of key safety-net programs, including Medicare and Medicaid, across these groups. Third, we extend the analysis to the state level by pooling CPS ASEC data from 2022 to 2024 to increase sample sizes for individual states and immigrant subpopulations, while accounting for overlapping samples across years resulting from the CPS rotating design. We then examine how poverty and program impacts vary across states, particularly where immigrant eligibility for public benefits differs across jurisdictions.

We find that HIPM poverty rates are especially high among Hispanic individuals, Black individuals, individuals with imputed unauthorized status, and those in mixed-status families. Individuals with imputed unauthorized status also experience more limited access to and smaller poverty-reducing effects from safety-net programs. At the same time, we highlight important limitations and note the need for caution when interpreting estimates that depend on imputed immigration status. At the state level, we find variation in both poverty rates and program impacts, reflecting differences in policy environments, immigrant eligibility rules, and access to health coverage. More broadly, our findings show that the choice of poverty measure affects which populations appear most vulnerable and which programs appear most effective.

Author

• Jose Enrique Caballero, Columbia University
  Presenting Author