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Center for Immigration Studies

1629 K Street, NW, Suite 600, Washington, DC 20006 • Phone 202.466.8185 • Fax 202.466.8076 • www.cis.org

C I S

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October 2018

One of the most obvious and enduring impacts of immigration occurs through immigrants’ children. Long after immigrants pass on, their descendants will continue to shape the political, economic, and cultural life in the receiving society. Examining births to immigrants is thus a way of measuring the scale of im-

migration and its impact on the United States. Because the United States automatically awards citizenship to all persons born in the country, including those born to temporary visitors or illegal immigrants, the overwhelming majority of these children will stay in the United States.

This analysis looks at births to immigrants based on an analysis of the Census Bureau’s American Community Survey (ACS). It provides a good picture of births to immigrant mothers, including the mothers’ demographic characteristics.1 These characteristics allow us to estimate the likely number of births to illegal immigrants nation-ally, as well as births by state and by large metropolitan area.

An Excel file showing births by state and metro area is available here.

National Picture

• In2014,oneinfivebirths(791,000)intheUnitedStatewastoanimmigrantmother(legalorillegal).Our best estimate is that legal immigrants accounted for12.4percent(494,000)ofallbirths,andillegalimmigrantsaccountedfor7.5percent(297,000).

• The297,000birthsperyeartoillegalimmigrantsislargerthanthetotalnumberofbirthsinanystateother than California and Texas. It is also larger than the total number of births in 16 states plus the Dis-trict of Columbia, combined.

• Theestimated28,000birthstoillegalimmigrantsinjusttheLosAnglesmetroareaislargerthanthetotalnumberofbirthsin14statesandtheDistrictofColumbia.

• Amongthenative-born,alargeshareofnewmothers(42percent)areeitheruninsuredoronMedicaid.Therateisevenhigheramongnewmotherswhoarelegalimmigrants(47percent)andhigherstillfornewmotherswhoareintheUnitedStatesillegally(67percent).Almostallofthesebirthsarelikelypaidfor by taxpayers.

• Ofallbirthslikelypaidforbytaxpayers,aboutoneinfour(429,000)wastoanimmigrant(legaloril-legal).Illegalimmigrantsaccountfor11percent(198,000)ofallpubliclyfundedbirths,andlegalimmi-grantsareanother13percent(231,000).

• Weestimatethatthecosttotaxpayersforbirthstoimmigrants(legalandillegal)isroughly$5.3billion—$2.4billionofwhichisforillegalimmigrants.

Births to Legal and Illegal Immigrants in the U.S.A look at health insurance coverage among new mothers by legal status at the state and local level

By Steven A. Camarota, Karen Zeigler, and Jason Richwine

1629KStreet,NW,Suite600•Washington,DC20006•(202)466-8185•center@cis.org•www.cis.org

Steven A. Camarota is the director of research and Karen Zeigler is a demographer at the Center. Jason Richwine, PhD, is an independent public policy analyst based in Washington, D.C., and a contributing writer at National Review.

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Center for Immigration Studies

• Althoughimmigrationaddsenormouslytothenumberofbirths,itraisesthenation’soverallbirthratebyonly4percent, partly because immigrant fertility is not that much higher than that of natives.

States

• In California, New Jersey, and New York, immigrants (legal and illegal) account for about one-third of all births. InMassachusetts,Nevada,Florida,Texas,Hawaii,Maryland,andWashington,immigrantsaccountforoneinfourbirths. Immigrants account for one in five births in Virginia, Connecticut, Illinois, Arizona, Rhode Island, and Oregon.

• ThestateswiththelargestnumbersofbirthstoillegalimmigrantsareCaliforniawith65,000,Texaswith51,000, Floridawith16,000,Illinoiswith14,000,Georgiawith13,000,NewYorkwith12,000,andNewJerseyandNorthCarolinawith11,000each.

• The state with the highest share of births to illegal immigrants is Nevada, at nearly one in six. Births to illegal im-migrants account for one in seven births in California and Texas.

• InNorthCarolina,Texas,andGeorgia,three-fourthsofbirthstoillegalimmigrantswerelikelypaidforbytaxpay-ers.InCalifornia,Florida,andNewYork,two-thirdsofthesebirthswerelikelytaxpayerfunded.InIllinoisandNewJersey, more than half were likely funded by the public.

Metropolitan Areas

• Among the nation’s largest metro areas, immigrants (legal and illegal) account for half or nearly half of births in Miami,SanFrancisco,andSanJose,Calif.TheyaretwooutoffivebirthsinLosAngelesandtheNewYorkCityarea.TheyarealsooneoutofthreebirthsinthemetroareasofWashington,D.C.,Houston,SanDiego,Seattle,Boston,and Las Vegas.

• Illegal immigrants account for more than one in seven births in the Los Angeles, Las Vegas, San Jose, Dallas, and Houstonmetroareas.Typicallybetweentwo-thirdsandthree-fourthsofthesebirthsarelikelypaidforbytaxpayers.

Data and MethodsThis analysis relies on the Census Bureau’s five-year, public-use file from the American Community Survey (ACS), collected between2012and2016.Withroughly15.7millionrespondents,including1.8millionimmigrants,thefive-yearACSisbyfar the largest survey conducted by the Census Bureau. It is weighted to reflect the size and characteristics of the U.S. popula-tion over the full five-year period.

Definitions. In this analysis we use the terms “foreign-born” and “immigrant” synonymously. Immigrants are persons living in the United States who were not U.S. citizens at birth. Census Bureau data such as the ACS includes naturalized American citizens, legal permanent residents (green card holders), illegal aliens, and people on long-term temporary visas, such as foreign students or guest workers.

FollowingtheU.S.government’sdefinition,illegal(orunauthorized)immigrantsaredefinedasallforeign-bornnon-citizenswhoarenotlegalresidents.MostillegalimmigrantscametotheUnitedStateseitherbysneakingacrosstheborderoronatemporary visa that has since expired.2

Possible Undercount of New Mothers.TheNationalCenterforHealthStatistics(NCHS)recordsvirtuallyallbirthsintheUnitedStates.IntheACS,birthdatacomesfromself-reportedresponsesfromwomenages15to50whoindicatewhethertheygavebirthinthelastyear. Overall,theNCHSandACSnumberslineupwell.TheACSshows3.971millionnewmothersin2014,whiletheNCHSdatashows3.988million birthstoU.S.residents—a0.4percentdifference.3

However,theACSandNCHSdonotagreeascloselywhenitcomestothenumberofbirthstoimmigrantsspecifically.Look-ingonlyatU.S.residents,the2014NCHSdatashows872,256birthstoimmigrants,whiletheACSshows790,582births. The81,674difference ispartlyduetodifferingdefinitions.TheACSdoesnotcountthosebornaboardtoAmericanparentsas

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Center for Immigration Studies

immigrants.Bycontrast,theNCHSdatarecordsinformationaboutthemother’scountryofbirthonly,nothercitizenship.Therefore,theNCHSforeign-bornnumberincludesthosebornaboardtoAmericanparents. ItispossibletocalculatethenumberofbirthsintheACSdatausingtheNCHSdefinitionoftheforeign-born.ButtheACSstillshowsabout5percentfewerimmigrantbirths.ThismaymeanthattheundercountofimmigrantbirthsintheACSisabout5percentbecauseim-migrantmothersmisreportthattheyarenative-born.Forthepurposesofthisanalysis,weacceptthefiguresintheACSandreport them without adjusting for undercount.4

Estimating the Illegal Population. Illegal immigrants are present in Census data, but they are never explicitly identified by the Bureau. To determine which respondents are most likely to be illegal aliens, CIS follows a methodology similar to those usedbythePewResearchCenterandtheCenterforMigrationStudies.5 Westartbyeliminatingimmigrantrespondentswhoare almost certainly not illegal aliens — for example, spouses of natural-born citizens; veterans; people who receive direct welfarepayments(exceptMedicaidforwomenwhogavebirthwithinthepastyearandforresidentsofcertainstates);peoplewhohavegovernmentjobs;Cubans(becauseofspecialrulesforthatcountry);immigrantswhoarrivedbefore1980(be-causethe1986amnestyshouldhavealreadycoveredthem);peopleincertainoccupationsrequiringlicensing,screening,ora government background check (e.g., doctors, pharmacists, and law enforcement); and people likely to be on student visas.

The remaining candidates are weighted to replicate known characteristics of the illegal population (size, age, gender, region or country of origin, state of residence, and length of residence in the United States) as determined by the Department of HomelandSecurity(DHS).6 The resulting illegal population, which consists of a weighted set of ACS respondents, can then beusedtoinfercharacteristicsnotpublishedbyDHS,suchasbirthsandMedicaidusebyillegalaliens.

Of course, all profiles of the illegal immigrant population carry significant uncertainty, and the share of births to illegal im-migrant mothers across the United States are no exception. Since our estimates become less precise in smaller geographic areas,welimitthedataforspecificmetroareastothe50largestbytotalpopulation.

Births Paid for by Taxpayers. Thepubliccostofdeliveryorpost-partumcareispaidforbyMedicaidunderthe“pregnancycare” provision administered by the states. Medicaidwillpayforadeliveryinalmostallcasesifthemotherisuninsuredorhas a low income, though some mothers without insurance may not even realize the program has paid health care provid-ers.IllegalimmigrantsandmostnewlegalimmigrantsareineligibleforMedicaid,buttheprogramwillstillcoverthecostofdeliveryandpost-partumcareforthesemothersforatleastafewmonths.FundingforMedicaidcomesfromboththefederal government and the states.

The ACS is not a perfect measure of insurance coverage for mothers at the time of birth because it asks about current health insurancecoverage,notcoverageatthetimeofdelivery.However,itislikelythatmotherswhohavegivenbirthwithinthelastyearhadthesameinsurancestatusatthetimeofthesurveyastheydidwhenthechildwasborn.IntheACS,99percentofthechildrenunderoneyearofagewhosemothersareonMedicaidarealsoinsuredbytheprogram.7 Of new immigrant motherswhoreporttheyareuninsuredatthetimeofthesurvey,84percentoftheirnewbornsarecoveredbyMedicaid.

ByexaminingnewmothersintheACSwhoareuninsuredoronMedicaid,wearelookingatwomenwhosedeliverywas,inalmost all cases, paid for by taxpayers. Infact,theshareofallnewmothers(immigrantandnative)whoareonMedicaidoruninsured(44percent)intheACSisclosetothe43percentofallbirthspaidforbyMedicaidreportedbytheNCHS.8

Estimatingthecostsofpubliclyfinancedbirthsisdifficult.TheamountthatMedicaidspendsperbirthonmotherandchildisnotsomethingthefederalgovernmentandstatesreport.For2010,theGuttmacherInstituteestimated$12,777forpre-natal,delivery,post-partum,andinfantcareinthefirst12months.Adjustingto2014dollars,themiddleyearoftheACSdatainthisreport,wouldincreasetheamountto$13,596.WeassignthiscosttonewmothersonMedicaid.Asdiscussedabove,84percentofuninsurednewmothershaveachildlessthanoneyearofagewhoiscoveredbyMedicaid.Wethereforeassumethat84percentofbirthstouninsuredmotherswerecoveredbyMedicaid.Weimplementthisbyassigningonly84percentofthe cost of publicly funded births to new mothers who report they are uninsured at the time of the survey. This is a conser-vative estimate as it is likely that a larger share of these births were in fact publicly funded since only a small share of births are actually “self-pay”.9Usingthisapproachproducesanestimateof$5.3billionintaxpayermoney going to fund births to immigrantsin2014,$2.35billionofwhichisforillegalimmigrantbirths.Whilethisestimateprovidesinsightintothelikelycosts of births to illegal immigrants each year, it is only a rough estimate given the data limitations.

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Center for Immigration Studies

Number of BirthsShare of All Births

NumberonMedicaidNumber Uninsured

ShareonMedicaidShare UninsuredShareUninsuredoronMedicaidShareofAllBirthsonMedicaidorUninsured

NumberofMothers<HSEducationShareofMothers<HSEducationShareofAllBirthstoMotherswith<HSEducation

NumberofMothersinPovertyShareofMothersinPovertyShare of All Births in Poverty

Table 1. Births to Natives and Immigrants by Legal Status

Source:2012-2016public-usefilesoftheAmericanCommunitySurvey.

AllImmigrants

790,58219.9%

184,840244,374

23.4%30.9%54.3%24.4%

201,80525.5%36.9%

240,08830.4%23.1%

IllegalImmigrants

297,0737.5%

42,053155,841

14.2%52.5%66.6%11.2%

120,93440.7%22.1%

118,69540.0%11.4%

LegalImmigrants

493,50912.4%

142,78788,533

28.9%17.9%46.9%13.1%

80,87116.4%14.8%

121,39324.6%11.7%

Natives

3,180,56480.1%

960,106370,398

30.2%11.6%41.8%75.6%

345,12810.9%63.1%

799,95025.2%76.9%

AllWomenAllImmigrantWomenIllegalImmigrantWomenLegalImmigrantWomenNativeWomenNativeandLegalImmigrantWomen

Table 2. Births for Natives and Immigrants by Legal Status (per 1,000)

Source:2012-2016public-usefilesoftheAmericanCommunitySurvey.

Women Ages 15-50

526271575051

In PovertyAges 15-50

7887109727575

< H.S. Edu.Ages 15-50

416069503537

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Center for Immigration Studies

Figure 1. Share of births to immigrants varies significantly across states.

Source:2012-2016public-usefilesoftheAmericanCommunitySurvey.

Calif.N.J.N.Y.

Mass.Nev.Fla.

TexasHawaii

Md.Wash.

Va.Conn.

Ill.Ariz.U.S.R.I.

Ore.Del.D.C.

Minn.Colo.N.C.Ga.

N.M.Neb.Kan.N.H.Pa.

Mich.Tenn.IowaUtahOkla.

Ind.Idaho

Ark.Wisc.

AlaskaVt.

S.C.OhioAla.La.Ky.

Mo.Miss.N.D.

MaineWyo.S.D.

W.Va.Mont.

0 5% 10% 15% 20% 25% 30% 35%

Immigrant Share of All Births

Illegal Immigrant Share of All Births

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Center for Immigration Studies

Figure 2. Share of births to immigrants varies significantly across the largest 50 metro areas.

Source:2012-2016public-usefilesoftheAmericanCommunitySurvey.

San Jose, Calif.Miami, Fla.

San Francisco, Calif.Los Angeles, Calif.

New York, N.Y.-N.J.-Pa.Washington D.C.-Va.-Md.-W.Va.

Houston, TexasSan Diego, Calif.

Seattle, Wash.Boston, Mass.-N.H.

Las Vegas, Nev.Sacramento, Calif.

Dallas, TexasRiverside-San Bernardino, Calif.

Orlando, Fla.Chicago, Ill.-Ind.-Wisc.

Austin, TexasRaleigh, N.C.

Portland, Ore.-Wash.Phoenix, Ariz.

Atlanta, Ga.Minneapolis, Minn.-Wisc.

Denver, Colo.United States

Charlotte, N.C.-S.C.Tampa, Fla.

Philadelphia, Pa.-N.J.-Del.-Md.Columbus, OhioHartford, Conn.Baltimore, Md.

Providence, R.I.-Mass.San Antonio, TexasSalt Lake City, Utah

Nashville, Tenn.Indianapolis, Ind.

Detroit, Mich.Milwaukee, Wisc.

Oklahoma City, Okla.Buffalo, N.Y.

Jacksonville, Fla.New Orleans, La.

Richmond, Va.Memphis, Tenn.-Miss.-Ark.

Virginia Beach, Va.-N.C.Kansas City, Mo.-Kan.

Cleveland, OhioLouisville, Ky.-Ind.

Cincinnati, Ohio-Ky.-Ind.St. Louis, Mo.-Ill.Birmingham, Ala.

Pittsburgh, Pa.

0 10% 20% 30% 40% 50% 60%

Immigrant Share of All Births

Illegal Immigrant Share of All Births

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Center for Immigration Studies

End Notes1Inseveralpriorreports,weexaminedbirthcertificaterecordsfromtheNationalCenterforHealthStatistics(NCHS).Thatdata shows a higher number of births to immigrant mothers than the ACS does, partly because of the way the foreign-born aredefinedbytheNCHS.Moreover,thereislikelysomeundercountofimmigrantbirthsintheACScomparedtowhatisshowninbirthcertificaterecords.Wediscussthesetwoissuesingreaterdetailinthemethodssectionofthisreport.

2TheOfficeofImmigrationStatisticsinitsestimateoftheillegalpopulationfor2014states,“Personswhoarebeneficiariesof Temporary Protected Status (TPS), Deferred Action for Childhood Arrivals (DACA), or other forms of prosecutorial discretion, or who are residing in the United States while awaiting removal proceedings in immigration court, are included among the unauthorized population estimates.” Further discussion can be found in Bryan Baker, “Estimates of the UnauthorizedImmigrantPopulationResidingintheUnitedStates:January2014”,DepartmentofHomelandSecurity,OfficeofImmigrationStatistics,January2017.

3Weshouldnotexpectthetwonumbertolineupexactly.TheACSusedhereisafive-yearaverage,with2014asthemiddleyear,anditisbasedonasurvey.Bycontrast,theNCHSnumbersaredrawnfromadministrativedata.Furthermore,theACSisweightedtoreflectthemiddleoftheyear,whiletheNCHSdataappliesonlytocalendaryear2014.TheNCHSfinaldatafor2014canbefoundin“Births:FinalDatafor2016”, National Vital Statistics Reports,Vol.67,No.1,U.S.DepartmentofHealthandHumanServices,January31,2018.

4 Therewere9,644birthsinwhichthenativityofthemotherwasnotreportedinthepublic-useNCHSdata.UsingtheNCHSdefinitionoftheforeign-bornshows829,293birthstoimmigrantwomenintheACS. ThenumberofbirthstoimmigrantsintheACSdefinedinthiswayisstill42,963lowerthaninNCHSdata,butitisabouthalfthe81,674whenusingtheCensusBureau definition of the foreign-born.Thismeansthatthebirthrecordsshow4.9percentmorebirthstoimmigrantsthandoestheACS,whichmaybeduetosomeforeign-bornmothersreportingthattheyareU.S.-born. The4.9percentcouldbeameasure of the undercount in ACS data among immigrants, at least those who give birth, but more analysis would be needed to confirm that.

5 SeeJeffreyS.PasselandD’VeraCohn, “OverallNumberofU.S.UnauthorizedImmigrantsHoldsSteadySince2009”, Pew ResearchCenter,September20,2016;andRobertWarren, “Democratizing Data about Unauthorized Residents in the United States:EstimatesandPublic-UseData,2010to2013”, Journal on Migration and Human Security,Vol.2,No.4,2014.

6Wechosethe2014DHSestimatestorepresentthemiddleofthe2012-2016periodcoveredbythefive-yearACSdatausedinthisreport.About90percentofillegalimmigrantsarethoughttorespondtotheACS.SeeBryanBaker,“Estimates of the UnauthorizedImmigrantPopulationResidingintheUnitedStates:January2014”,DepartmentofHomelandSecurity,OfficeofImmigrationStatistics,July2017.

7 This is based on linking new mothers to their children less than one year of age in the ACS data. The public-use data shows thatformotherscurrentlyonMedicaid,99percentoftheirchildrenundertheageofonearealsoonMedicaid.

8SeeTable19in“Births:FinalDatafor2016”, National Vital Statistics Reports,Vol.67,No.1,U.S.DepartmentofHealthandHumanServices,January31,2018.

9 Ibid.NCHSreportsthat4.1percentofbirthswere“selfpay”in2016.