The deadly effects of losing health insurance

The number of undocumented migrants in developed countries has increased in recent years, which has generated discussions about the extent to which access to public programs should be restricted for this population. This is the first paper that estimates the effects of restricting access to one of these public programs, health care, on mortality rates of undocumented immigrants. We exploit the natural experiment that arises from a reform implemented in Spain in September 2012 that introduced this restriction. We show that, during the first three years of implementation, the restriction increased the monthly mortality rate of undocumented immigrants by 0.31 deaths per 100,000 individuals (which corresponds to 82 additional deaths each year). We also document small changes in the composition of the treated population with 5% of middle educated individuals being substituted by lower educated ones. However, this selective migration can only account for 3.45% of our mortality effects. Our results show the large effects of health insurance coverage on the health status of vulnerable populations and have important policy implications for developed countries currently receiving sizeable migration flows.