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Hamersma and Lopoo paper on pregnancy Medicaid expansions and fertility published in PR&PR

May 31, 2018

Pregnancy Medicaid Expansions and Fertility: Differentiating Between the Intensive and Extensive Margins

Lincoln H. Groves, Sarah Hamersma, Leonard M. Lopoo & Sarah Hamersma

Population Research and Policy Review, May 2018

Sarah Hamersma

Sarah Hamersma


Leonard M. Lopoo

Leonard M. Lopoo


The theoretical and empirical links between public health insurance access and fertility in the United States remain unclear. Utilizing a demographic cell-based estimation approach with panel data (1987–1997), the authors revisit the large-scale Medicaid expansions to pregnant women during the 1980s to estimate the heterogeneous impacts of public health insurance access on childbirth.

While the decision to become a parent (i.e., the extensive margin) appears to be unaffected by increased access to Medicaid, we find that increased access to public health insurance positively influenced the number of high parity births (i.e., the intensive margin) for select groups of women. In particular, the authors find a robust, positive birth effect for unmarried women with a high school education, a result which is consistent across the two racial groups examined in our analysis: African American and white women. This result suggests that investigating effects along both the intensive and extensive margin is important for scholars who study the natalist effects of social welfare policies, and the authors' evidence provides a more nuanced understanding of the influence of public health insurance on fertility.