Standardizing the fee-waiver application increased naturalization rates of low-income immigrants.

Citizenship can accelerate immigrant integration and result in benefits for both local communities and the foreign-born themselves. Yet the majority of naturalization-eligible immigrants in the United States do not apply for citizenship, and we lack systematic evidence on policies specifically designed to encourage take-up. In this study, we analyze the impact of the standardization of the fee-waiver process in 2010 by the US Citizenship and Immigration Service (USCIS). This reform allowed low-income immigrants eligible for citizenship to use a standardized form to have their application fee waived. We employ a difference-in-differences methodology, comparing naturalization behavior among eligible and ineligible immigrants before and after the policy change. We find that the fee-waiver reform increased the naturalization rate by 1.5 percentage points. This amounts to about 73,000 immigrants per year gaining citizenship who otherwise would not have applied. In contrast to previous research on the take-up of federal benefits programs, we find that the positive effect of the fee-waiver reform was concentrated among the subgroups of immigrants with lower incomes, language skills, and education levels, who typically face the steepest barriers to naturalization. Further evidence suggests that this pattern is driven by immigration service providers, who are well-positioned to help the most needy immigrants file their fee-waiver requests.

Determinants of refugee naturalization in the United States.

The United States operates the world's largest refugee resettlement program. However, there is almost no systematic evidence on whether refugees successfully integrate into American society over the long run. We address this gap by drawing on linked administrative data to directly measure a long-term integration outcome: naturalization rates. Assessing the full population of refugees resettled between 2000 and 2010, we find that refugees naturalize at high rates: 66% achieved citizenship by 2015. This rate is substantially higher than among other immigrants who became eligible for citizenship during the same period. We also find significant heterogeneity in naturalization rates. Consistent with the literature on immigration more generally, sociodemographic characteristics condition the likelihood of naturalization. Women, refugees with longer residency, and those with higher education levels are more likely to obtain citizenship. National origins also matter. While refugees from Iran, Iraq, and Somalia naturalize at higher rates, those from Burma, Ukraine, Vietnam, and Liberia naturalize at lower rates. We also find naturalization success is significantly shaped by the initial resettlement location. Placing refugees in areas that are urban, have lower rates of unemployment, and have a larger share of conationals increases the likelihood of acquiring citizenship. These findings suggest pathways to promote refugee integration by targeting interventions and by optimizing the geographic placement of refugees.

A randomized controlled design reveals barriers to citizenship for low-income immigrants.

Citizenship endows legal protections and is associated with economic and social gains for immigrants and their communities. In the United States, however, naturalization rates are relatively low. Yet we lack reliable knowledge as to what constrains immigrants from applying. Drawing on data from a public/private naturalization program in New York, this research provides a randomized controlled study of policy interventions that address these constraints. The study tested two programmatic interventions among low-income immigrants who are eligible for citizenship. The first randomly assigned a voucher that covers the naturalization application fee among immigrants who otherwise would have to pay the full cost of the fee. The second randomly assigned a set of behavioral nudges, similar to outreach efforts used by service providers, among immigrants whose incomes were low enough to qualify them for a federal waiver that eliminates the application fee. Offering the fee voucher increased naturalization application rates by about 41%, suggesting that application fees act as a barrier for low-income immigrants who want to become US citizens. The nudges to encourage the very poor to apply had no discernible effect, indicating the presence of nonfinancial barriers to naturalization.

Providing driver's licenses to unauthorized immigrants in California improves traffic safety.

The integration of immigrants presents a major challenge for policymakers in the United States. In an effort to improve integration, several US states recently have implemented laws that provide driver's licenses to unauthorized immigrants. These new laws have sparked widespread debate, but we lack evidence on the traffic safety impact of these policies. We examine the short-term effects of the largest-scale policy shift, California's Assembly Bill 60 (AB60), under which more than 600,000 licenses were issued in the first year of implementation in 2015 alone. We find that, contrary to concerns voiced by opponents of the law, AB60 has had no discernible short-term effect on the number of accidents. The law primarily allowed existing unlicensed drivers to legalize their driving. We also find that, although AB60 had no effect on the rate of fatal accidents, it did decrease the rate of hit and run accidents, suggesting that the policy reduced fears of deportation and vehicle impoundment. Hit and run behaviors often delay emergency assistance, increase insurance premiums, and leave victims with significant out of pocket expenses. Overall, the results suggest that AB60 provides an example of how states can facilitate the integration of immigrants while creating positive externalities for the communities in which they live.

Oregon's Expansion of Prenatal Care Improved Utilization Among Immigrant Women.

Objectives To determine whether expanding Emergency Medicaid to cover prenatal care in Oregon affected maternal health outcomes for unauthorized immigrants. Methods This study takes place in Oregon from 2003 to 2015 and includes all Emergency Medicaid and Medicaid claims for women aged 12-51 with a pregnancy related claim. To isolate the effect of expanding access to prenatal care, we utilized a difference-in-differences approach that exploits the staggered rollout of the prenatal care program. The primary outcome was a composite measure of severe maternal morbidity and mortality. Additional outcomes include adequacy of prenatal care, detection of pregnancy complications and birth outcomes. Results A total of 213,746 pregnancies were included, with 35,182 covered by Emergency Medicaid, 12,510 covered by Emergency Medicaid Plus (with prenatal care), and 166,054 covered by standard Medicaid. Emergency Medicaid Plus coverage did not affect severe maternal morbidity (all pregnancies 0.05%, CI - 0.29; 0.39; high-risk pregnancies 2.20%, CI - 0.47; 4.88). The program did reduce inadequate care among all pregnancies (- 31.75%, 95% CI - 34.47; - 29.02) and among high risk pregnancies (- 38.60%, CI - 44.17; - 33.02) and increased diagnosis of gestational diabetes (6.24%, CI 4.36; 8.13; high risk pregnancies 10.48%, CI 5.87; 15.08), and poor fetal growth (7.37%, CI 5.69; 9.05; high risk pregnancies 5.34%, CI 1.00; 9.68). The program also increased diagnosis of pre-existing diabetes mellitus (all pregnancies 2.93%, CI 2.16; 3.69), hypertensive diseases of pregnancy (all pregnancies 1.28%, CI 0.52; 2.04) and a history of preterm birth (all pregnancies 0.87%, CI 0.27; 1.47). Conclusions for Practice Oregon's prenatal care expansion program produced positive effects for unauthorized immigrant women and their children.

More Trees, More Poverty? The Socioeconomic Effects of Tree Plantations in Chile, 2001-2011.

Tree plantations play a controversial role in many nations' efforts to balance goals for economic development, ecological conservation, and social justice. This paper seeks to contribute to this debate by analyzing the socioeconomic impact of such plantations. We focus our study on Chile, a country that has experienced extraordinary growth of industrial tree plantations. Our analysis draws on a unique dataset with longitudinal observations collected in 180 municipal territories during 2001-2011. Employing panel data regression techniques, we find that growth in plantation area is associated with higher than average rates of poverty during this period.

Public Health Insurance Expansion for Immigrant Children and Interstate Migration of Low-Income Immigrants.

Importance: Federal policy changes in 2002 and 2009 led some states to expand public health insurance coverage to non-US-born children and pregnant women who are lawful permanent residents during their first 5 years of residency in the United States. In other states, there were concerns that insurance expansion could attract immigrants to relocate to gain free health insurance coverage. Objective: To examine whether expansion of public health insurance to non-US-born, lawful permanent resident children and pregnant women during their first 5 years of residency is associated with increased interstate migration among these groups. Design, Setting, and Participants: This difference-in-differences analysis included data on 208 060 immigrants from the American Community Survey from 2000 through 2016, with analysis including all 50 states and the District of Columbia. The study sample included 2 treatment groups that became eligible under the expanded coverage: lawful permanent resident adults with at least 1 non-US-born child younger than 18 years (n = 36 438) and lawful permanent resident women of reproductive age (n = 87 418). Control groups that remained ineligible under the expanded coverage included lawful permanent resident adults without non-US-born children (n = 171 622), lawful permanent resident single men (n = 56 142), and lawful permanent resident postreproductive women (n = 15 129). A difference-in-differences design compared migration rates between eligible and ineligible immigrant groups before and after insurance coverage expansions. Data analysis was performed from November 3, 2018, to May 31, 2019. Exposures: Public health insurance coverage for immigrant women and children who were lawful permanent residents within 5 years of residency. Main Outcomes and Measures: Migration to a health expansion state from any other state and from a neighboring state. Results: Of 208 060 immigrants (47% women in the weighted sample; mean [SD] age, 32.97 [12.94] years; 63% Hispanic), the mean (SD) annual move rate across the entire sample was 3% (17%). Expansion of public health insurance to non-US-born children or pregnant women within their first 5 years of residency was not associated with interstate movement for health care benefits. Coverage expansion for non-US-born children of lawful permanent residents was not associated with a change in the rate of in-migration higher than 1.78 percentage points or lower than -1.28 percentage points. The corresponding estimate for coverage expansion of lawful permanent resident pregnant women was a change higher than 1.38 percentage points and lower than -1.20 percentage points. Conclusions and Relevance: The results suggest that states considering expanding health care benefits coverage to recently arrived immigrant children and pregnant women may be unlikely to experience in-migration of these persons from other states, which has important implications for understanding short- and long-term program costs.

In search of opportunity and community: Internal migration of refugees in the United States.

At a time of heightened anxiety surrounding immigration, state governments have increasingly sought to manage immigrant and refugee flows. Yet the factors that influence where immigrants choose to settle after arrival remain unclear. We bring evidence to this question by analyzing population-level data for refugees resettled within the United States. Unlike other immigrants, refugees are assigned to initial locations across the country but are free to relocate and select another residence after arrival. Drawing on individual-level administrative data for adult refugees resettled between 2000 and 2014 (N = 447,747), we examine the relative desirability of locations by examining how retention rates and patterns of secondary migration differ across states. We find no discernible evidence that refugees' locational choices are strongly influenced by state partisanship or the generosity of welfare benefits. Instead, we find that refugees prioritize locations with employment opportunities and existing co-national networks.

Extending Delivery Coverage to Include Prenatal Care for Low-Income, Immigrant Women Is a Cost-Effective Strategy.

OBJECTIVE: To compare the outcomes and cost effectiveness of two alternate policy strategies for prenatal care among low-income, immigrant women: coverage for delivery only (the federal standard) and prenatal care with delivery coverage (state option under the Children's Health Insurance Program). METHODS: A decision-analytic model was developed to determine the cost effectiveness of two alternate policies for pregnancy coverage. All states currently provide coverage for delivery, and 19 states also provide coverage for prenatal care. An estimated 84,000 unauthorized immigrant women have pregnancies where no prenatal care is covered. Our outcomes were costs, quality-adjusted life-years, and cases of cerebral palsy and infant death before age 1. Model inputs were obtained from a database of Oregon Medicaid claims and the literature. Univariate and bivariate sensitivity analyses, as well as a Monte Carlo simulation, were performed. RESULTS: Extending prenatal coverage is a cost-effective strategy. Providing prenatal care for the 84,000 women annually who are currently uninsured could prevent 117 infant deaths and 34 cases of cerebral palsy. Prenatal care coverage costs $380 more per woman than covering the delivery only. For every 865 additional women receiving prenatal care, one infant death would be averted, at an average cost of $328,700. Cost-effectiveness acceptability curve analyses suggest a 99% probability that providing prenatal care is more cost effective at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year. CONCLUSIONS: Extending prenatal care to low-income, immigrant women, regardless of citizenship status, is a cost-effective strategy.

A low-cost information nudge increases citizenship application rates among low-income immigrants.

We show that an information nudge increased the rate of American citizenship applications among low-income immigrants eligible for a federal fee waiver. Approximately half of the 9 million naturalization-eligible immigrants qualify for a federal programme that waives the cost of the citizenship application for low-income individuals. However, take-up of this fee waiver programme remains low1-3. Here we use a randomized field experiment to test the effectiveness of a low-cost intervention (a 'nudge') that informed low-income immigrants about their eligibility for the fee waiver. We find that the information nudge increased the rate of citizenship applications by about 8.6 percentage points from 24.5% in the control group to 33.1% in the treatment group (ordinary least squares regression with robust standard errors (d.f. = 933); P = 0.015; 95% confidence interval ranged from 1.7 to 15.4 percentage points). We found no evidence that the nudge was less effective for poorer or less educated immigrants. These findings contribute to the literature that addresses the incomplete take-up of public benefits by low-income populations4-10 and suggest that lack of information is an important obstacle to citizenship among low-income immigrants who demonstrate an interest in naturalization.

Improving refugee integration through data-driven algorithmic assignment.

Developed democracies are settling an increased number of refugees, many of whom face challenges integrating into host societies. We developed a flexible data-driven algorithm that assigns refugees across resettlement locations to improve integration outcomes. The algorithm uses a combination of supervised machine learning and optimal matching to discover and leverage synergies between refugee characteristics and resettlement sites. The algorithm was tested on historical registry data from two countries with different assignment regimes and refugee populations, the United States and Switzerland. Our approach led to gains of roughly 40 to 70%, on average, in refugees' employment outcomes relative to current assignment practices. This approach can provide governments with a practical and cost-efficient policy tool that can be immediately implemented within existing institutional structures.

Expanding Prenatal Care to Unauthorized Immigrant Women and the Effects on Infant Health.

OBJECTIVE: To measure the effect of access to prenatal care on unauthorized and low-income, new legal permanent resident immigrant women and their offspring. METHODS: We used a difference-in-differences design that leverages the staggered rollout of Emergency Medicaid Plus by county from 2008 to 2013 as a natural experiment to estimate the effect on health service utilization for women and health outcomes for their infants. Regular Medicaid pregnancies were used as an additional control in a triple difference design. RESULTS: Our sample included pregnancies covered by Emergency Medicaid (35,182), Emergency Medicaid Plus (12,510), and Medicaid (166,054). After expansion of access to prenatal care, there was an increase in prenatal visits (7.2 more visits, 95% CI 6.45-7.96), receipt of adequate prenatal care (28% increased rate, CI 26-31), rates of diabetes screening (61% increased rate, CI 56-66), and fetal ultrasonograms (74% increased rate, CI 72-76). Maternal access to prenatal care was also associated with an increased number of well child visits (0.24 more visits, CI 0.07-0.41), increased rates of recommended screenings and vaccines (0.04 increased probability, CI 0.002-0.074), and reduced infant mortality (-1.01/1,000, CI -1.42 to -0.60) and rates of extremely low birth weight (less than 1,000 g) (-1.33/1,000, CI -2.44 to -0.21). CONCLUSION: Our results provide evidence of increased utilization and improved health outcomes for unauthorized immigrants and their children who are U.S. citizens after introduction of prenatal care expansion in Oregon. This study contributes to the debate around reauthorization of the Children's Health Insurance Program in 2017.

Protecting unauthorized immigrant mothers improves their children's mental health.

The United States is embroiled in a debate about whether to protect or deport its estimated 11 million unauthorized immigrants, but the fact that these immigrants are also parents to more than 4 million U.S.-born children is often overlooked. We provide causal evidence of the impact of parents' unauthorized immigration status on the health of their U.S. citizen children. The Deferred Action for Childhood Arrivals (DACA) program granted temporary protection from deportation to more than 780,000 unauthorized immigrants. We used Medicaid claims data from Oregon and exploited the quasi-random assignment of DACA eligibility among mothers with birthdates close to the DACA age qualification cutoff. Mothers' DACA eligibility significantly decreased adjustment and anxiety disorder diagnoses among their children. Parents' unauthorized status is thus a substantial barrier to normal child development and perpetuates health inequalities through the intergenerational transmission of disadvantage.

When lives are put on hold: Lengthy asylum processes decrease employment among refugees.

European governments are struggling with the biggest refugee crisis since World War II, but there exists little evidence regarding how the management of the asylum process affects the subsequent integration of refugees in the host country. We provide new causal evidence about how one central policy parameter, the length of time that refugees wait in limbo for a decision on their asylum claim, affects their subsequent economic integration. Exploiting exogenous variation in wait times and registry panel data covering refugees who applied in Switzerland between 1994 and 2004, we find that one additional year of waiting reduces the subsequent employment rate by 4 to 5 percentage points, a 16 to 23% drop compared to the average rate. This deleterious effect is remarkably stable across different subgroups of refugees stratified by gender, origin, age at arrival, and assigned language region, a pattern consistent with the idea that waiting in limbo dampens refugee employment through psychological discouragement, rather than a skill atrophy mechanism. Overall, our results suggest that marginally reducing the asylum waiting period can help reduce public expenditures and unlock the economic potential of refugees by increasing employment among this vulnerable population.