A Reevaluation of the Effects of State and ACA Dependent Coverage Mandates on Health Insurance Coverage

We study state and federal health insurance coverage mandates for young adults. Despite consistent findings that the Affordable Care Act's (ACA) federal mandate was effective, research has disagreed on whether preexisting, state-level mandates were successful in increasing coverage. We reconsider the issue with a new analytical perspective and newly available accurate data on state mandates. We show that the impact of the state mandates was substantive and concentrated among young adults between ages 19 and 23. Our estimates indicate that dependent coverage rose by 3.9 percentage points and overall coverage rose by 3.3 percentage points. Crowd-out of coverage through young adults’ own jobs was negligible. For those above 23, we find little evidence of changes in coverage. We incorporate these insights into analysis of the ACA's mandate, showing its effects were focused among those who were not eligible for state mandates, or were eligible but older than 23. Our results suggest that eligibility restrictions played important roles in limiting the scope of the state mandates, but they can be practical and effective tools for policymakers looking to ensure or expand coverage for young adults in the face of uncertainty about the ACA.     

The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions

The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors. One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance. This paper estimates how the ACA‐facilitated state‐level expansions of Medicaid in 2014 affected these outcomes. Using data from the Behavioral Risk Factor Surveillance System, and a difference‐in‐differences model that compares states that did and did not expand Medicaid, we examine the impact of the expansions on preventive care (e.g., dental visits, immunizations, mammograms, cancer screenings), risky health behaviors (e.g., smoking, heavy drinking, lack of exercise, obesity), and self‐assessed health. We find that the expansions increased insurance coverage and access to care among the targeted population of low‐income childless adults. The expansions also increased use of certain forms of preventive care, but there is no evidence that they increased ex ante moral hazard (i.e., there is no evidence that risky health behaviors increased in response to health insurance coverage). The Medicaid expansions also modestly improved self‐assessed health.     

Public Health Insurance and Medical Spending: The Incidence of the ACA Medicaid Expansion

This paper examines the incidence of the cost burden associated with expanding public health insurance to low-income adults in the context of the Affordable Care Act. Using data from the Medical Expenditures Panel Survey (MEPS), I exploit exogenous variation in Medicaid eligibility rules across states, income groups and time. I find that public insurance eligibility reduced mean out-of-pocket spending by 19.6 percent among targeted households, but it did not causally increase total expenditures among beneficiaries. Rather, Medicaid expansion shifted the burden of payment from eligible households and private insurance (21.5 percent reduction) to taxpayers in the form of public insurance (46.6 percent increase). The efficiency of these public funds can be summarized by a mean Marginal Value of Public Funds of 0.70 in the full sample, 0.99 among households with at least one pre-existing condition, and 1.26 in states with an above-median number of public hospitals.     

The Effect of Medical Marijuana Laws on the Health and Labor Supply of Older Adults: Evidence from the Health and Retirement Study

Older adults are at elevated risk of reducing labor supply due to poor health, partly because of high rates of symptoms that may be alleviated by medical marijuana. Yet, surprisingly little is known about how this group responds to medical marijuana laws (MMLs). We quantify the effects of state medical marijuana laws on the health and labor supply of adults age 51 and older, focusing on the 55 percent with one or more medical conditions with symptoms that may respond to medical marijuana. We use longitudinal data from the Health and Retirement Study to estimate event study and differences‐in‐differences regression models. Three principle findings emerge from our analysis. First, active state medical marijuana laws lead to lower pain and better self‐assessed health among older adults. Second, state medical marijuana laws lead to increases in older adult labor supply, with effects concentrated on the intensive margin. Third, the effects of MMLs are largest among older adults with a health condition that would qualify for legal medical marijuana use under current state laws. Findings highlight the role of health policy in supporting work among older adults and the importance of including older adults in assessments of state medical marijuana laws.     

Access to Healthcare and Criminal Behavior: Evidence from the ACA Medicaid Expansions

I investigate the causal relationship between access to healthcare and crime following state decisions to expand Medicaid coverage after the Affordable Care Act. I combine state-level crime data from the Federal Bureau of Investigation Uniform Crime Reports for the years 2009 through 2018 with variation in insurance eligibility generated by the Medicaid expansion. Using a difference-in-differences design, my findings indicate that states that expanded Medicaid have experienced a 5.3 percent reduction in annual reported violent crime rates relative to nonexpansion states. This effect is explained by decreases in aggravated assaults and corresponds to 17 fewer incidents per 100,000 people. The estimated decrease in reported crime amounts to an annual cost savings of approximately $4 billion.     

Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non‐Expansion States

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference‐in‐difference‐in‐differences models that exploit cross‐sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre‐ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non‐expansion states. Our preferred specification suggests that, at the average pre‐treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer‐provided and non‐group coverage. The coverage gains from the full ACA were largest for those without a college degree, non‐whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.     

How Local Economic Conditions Affect School Finances,Teacher Quality,and Student Achievement: Evidence from the Texas Shale Boom

Whether improved local economic conditions lead to better student outcomes is theoretically ambiguous and will depend on how schools use additional revenues and how students and teachers respond to rising private sector wages. The Texas boom in shale oil and gas drilling, with its large and localized effects on wages and the tax base, provides a unique opportunity to address this question that spans the areas of education, labor markets, and public finance. An empirical approach using variation in shale geology across school districts shows that the boom reduced test scores and student attendance, despite tripling the local tax base and creating a revenue windfall. Schools spent additional revenue on capital projects and debt service, but not on teachers. As the gap between teacher wages and private sector wages grew, so did teacher turnover and the percentage of inexperienced teachers, which helps explain the decline in student achievement. Changes in student composition did not account for the achievement decline but instead helped to moderate it. The findings illustrate the potential value of using revenue growth to retain teachers in times of rising private sector wages.     

Patrolling Public Schools: The Impact of Funding for School Police on Student Discipline and Long‐term Education Outcomes

As police officers have become increasingly common in U.S. public schools, their role in school discipline has often expanded. While there is growing public debate about the consequences of police presence in schools, there is scant evidence of the impact of police on student discipline and academic outcomes. This paper provides the first quasi‐experimental estimate of funding for school police on student outcomes, leveraging variation in federal Community Oriented Policing Services (COPS) grants. Exploiting detailed data on over 2.5 million students in Texas, I find that federal grants for police in schools increase middle school discipline rates by 6 percent. The rise in discipline is driven by sanctions for low‐level offenses or school code of conduct violations. Further, I find that Black students experience the largest increases in discipline. I also find that exposure to a three‐year federal grant for school police is associated with a 2.5 percent decrease in high school graduation rates and a 4 percent decrease in college enrollment rates.     

Homeowner Behavior,Health Status,and Medicaid Payment Eligibility: Evidence from the Deficit Reduction Act of 2005

This paper analyzes the effect of a change in the status of housing equity as a protected asset for Medicaid long‐term care payment eligibility. A difference‐in‐difference‐in‐differences strategy is employed to estimate the effect of the policy on the housing equity holdings of potentially treated individuals. Using a panel of unmarried homeowners, the policy induced treated individuals who were likely to require long‐term care to hold less housing equity by values of $82,000 to $193,000 relative to control individuals. This equates to relative reductions of 12 to 29 percent for treated individuals after the policy change. Similar effects are not observed when considering health measures less predictive of long‐term care services and for a sample of married households who were unlikely affected by the policy. These estimates confirm the importance of the housing asset as a shelter for Medicaid eligibility.     

Local Labor Demand and Program Participation Dynamics: Evidence from New York SNAP Administrative Records

This study estimates the effect of local labor demand on the likelihood that Supplemental Nutrition Assistance Program (SNAP) beneficiaries are able to transition out of the program. Our data include SNAP administrative records from New York (2007 to 2012), linked at the person‐level to the 2010 Census, and linked at the county‐month‐level to industry‐specific labor market conditions. We find that local labor markets matter for the length of time spent on SNAP, but there is substantial heterogeneity in estimated effects across local industries. Using Bartik‐style instruments to isolate the effect of labor demand and controlling for the changing composition of entrants and program rules brought on by the Great Recession, we find that fluctuations in labor demand in industries with high shares of SNAP participants—especially food service and retail—change the likelihood of exiting the program. Notably, estimated industry effects vary across race and parental status, with black participants being most sensitive to changes in local labor market conditions and mothers benefiting less from growth in local labor demand than fathers and non‐parents. We confirm that our results are not driven by endogenous inter‐county mobility or New York City labor markets and are robust to multiple specifications.     

Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid

For many low‐income Medicare beneficiaries, Medicaid provides important supplemental insurance that covers out‐of‐pocket costs and additional benefits. We examine whether Medicaid participation by low‐income adults age 65 and up increased as a result of Medicaid expansions to working‐age adults under the Affordable Care Act (ACA). Previous literature documents so‐called “welcome mat” effects in other populations but has not explicitly studied older persons dually eligible for Medicare and Medicaid. We extend this literature by estimating models of Medicaid participation among persons age 65 and up using American Community Survey data from 2010 to 2017 and state variation in ACA Medicaid expansions. We find that Medicaid expansions to working‐age adults increased Medicaid participation among low‐income older adults by 1.8 percentage points (4.4 percent). We also find evidence of an “on‐ramp” effect; that is, low‐income Medicare beneficiaries residing in expansion states who were young enough to gain coverage under the 2014 ACA Medicaid expansions before aging into Medicare were 4 percentage points (9.5 percent) more likely to have dual Medicaid coverage relative to similar individuals who either turned 65 before the 2014 expansions or resided in non‐expansion states. This on‐ramp effect is an important mechanism behind welcome mat effects among some older adults.     

Housing Voucher Take‐Up and Labor Market Impacts

Low participation rates in government assistance programs are a major policy concern in the United States. This paper studies take‐up of Section 8 housing vouchers, a program in which take‐up rates are quite low among interested and eligible households. We link 18,109 households in Chicago that were offered vouchers through a lottery to administrative data and study how baseline employment, earnings, public assistance, arrests, residential location, and children's academic performance predict take‐up. Our analysis finds mixed evidence of whether the most disadvantaged or distressed households face the largest barriers to program participation. We also study the causal impact of peer behavior on take‐up by exploiting idiosyncratic variation in the timing of voucher offers. We find that the probability of lease‐up increases with the number of neighbors who recently received voucher offers. Finally, we explore the policy implications of increasing housing voucher take‐up by applying reweighting methods to existing causal impact estimates of voucher receipt. This analysis suggests that greater utilization of vouchers may lead to larger reductions in labor market activity. Differences in take‐up rates across settings may be important to consider when assessing the external validity of studies identifying the effects of public assistance programs.     

我国城镇最低生活保障制度改革的微观模拟——基于劳动供给反应的政策效应研究

最低生活保障制度改革一直是我国社会与学界关注的重点，而由于微观数据和建模技术的匮乏．对于该问题的研究往往限于定性理解和总量分析。本文以计算机微观模拟技术为突破口，将微观主体的异质特征和行为决策机制纳入模拟的实验范畴，建立相应的模拟模型，对我国城镇居民最低生活保障制度改革进行深入的量化研究。结合区域经济现实，分别从历史特定的制度改革和政策参数的灵敏度实验两方面进行了微观模拟，实验结果量化了制度改革所引发的劳动供给与收入分配效应。同时揭示了制度潜在的低效率及其本质原因，并提出应对策略；为最低生活保障制度改革的评价与设计提供了建设性依据。     

Newspapers and Budgeting: The Effects of Media Coverage on Local Expenditure Decisions

The media play an important role for the political agenda. It is less clear, however, how strong the media impact is on political decisions. This article pursues a different approach from the one commonly used in the media–policy research tradition. Instead of focusing on the relationship between the content of the media agenda and the political agenda, it is argued here that from a broader policy perspective, media pressure on the incumbents is a more relevant variable. Media pressure is measured as media competition and media coverage. Furthermore, the article investigates the effect of media variables on budgetary decisions in different spending areas, and compares the relationships between media pressure and policy under various economic, political and institutional conditions. This allows the authors to investigate which factors hinder and promote media influence on policy. The units of analysis are the Danish municipalities, which are similar political units with different newspaper coverage. Coverage by local newspapers is intense in some municipalities, but absent in others. As expected, the authors find that in municipalities with intensive coverage from local newspapers, local politicians do feel a stronger media pressure. However, when it comes to budgetary decisions, almost no observable effects of media pressure are found, either generally or in favourable political, economic or institutional settings.     

The Effects of Mandated Health Insurance Benefits for Autism on Out‐of‐Pocket Costs and Access to Treatment

As of 2014, 37 states have passed mandates requiring many private health insurance policies to cover diagnostic and treatment services for autism spectrum disorders (ASDs). We explore whether ASD mandates are associated with out‐of‐pocket costs, financial burden, and cost or insurance‐related problems with access to treatment among privately insured children with special health care needs (CSHCNs). We use difference‐in‐difference and difference‐in‐difference‐in‐difference approaches, comparing pre–post mandate changes in outcomes among CSHCN who have ASD versus CSHCN other than ASD. Data come from the 2005 to 2006 and the 2009 to 2010 waves of the National Survey of CSHCN. Based on the model used, our findings show no statistically significant association between state ASD mandates and caregivers’ reports about financial burden, access to care, and unmet need for services. However, we do find some evidence that ASD mandates may have beneficial effects in states in which greater percentages of privately insured individuals are subject to the mandates. We caution that we do not study the characteristics of ASD mandates in detail, and most ASD mandates have gone into effect very recently during our study period.     

The Unexpected Effects of No Pass,No Drive Policies on High School Education

Since 1988, 27 states have introduced No Pass, No Drive laws, which tie a teenager's ability to receive and maintain a driver's license to various school-related outcomes—most commonly, enrollment and attendance. Enrollment-Based No Pass, No Drive policies, in 21 states, target both enrollment and attendance, and have negligible effects on dropout rates. However, these policies decrease the Averaged Freshman Graduation Rate (AFGR) by between 1 and 1.7 percentage points. This lower graduation rate stems from students delaying their dropout decision by up to two years. As a result, these students are retained in the ninth and tenth grades, increasing 9th-grade enrollment by 3.6 percent relative to 8th-grade enrollment the year prior; this causes an artificial reduction in the graduation rate, rather than a reduction in the true likelihood that a student will graduate. Truancy-Based No Pass, No Drive policies, in five states, target only attendance—teens that fail to meet a minimum attendance requirement lose their driver's license. However, these policies allow students to drop out of school without facing this penalty. These policies increase the annual dropout rate by between 23 and 34 percent (1 to 1.6 percentage points).     

就业风险对农村剩余劳动力转移的影响——模型与实证

农村剩余劳动力转移既是我国实现经济持续增长必须面对的重大课题,也是解决我国“三农”问题的重要途径。本文的理论模型表明,就业风险是影响我国农村剩余劳动力转移的重要因素,且创新性地发现就业风险对农村剩余劳动力转移影响的传导机制是间接的;基于调查问卷的实证分析表明,自身能力、就业环境和就业条件对农村剩余劳动力转移有显著影响。总体来看,目前我国农村剩余劳动力的就业风险较大,形势不客乐观。我国需要尽快建立农村剩余劳动力转移的长效机制,改善城镇就业环境、提高农村劳动力的自身素质、降低农村剩余劳动力就业风险,以保证农村劳动力转移的有序性、平稳性和持续性。     

The Impact of Rehabilitation and Counseling Services on the Labor Market Activity of Social Security Disability Insurance (SSDI) Beneficiaries

We use data from a social experiment to estimate the impact of a rehabilitation and counseling program on the labor market activity of newly entitled Social Security Disability Insurance (SSDI) beneficiaries. Our results indicate that the program led to a 4.6 percentage point increase in the receipt of employment services within the first year following random assignment and a 5.1 percentage point increase in participation in the Social Security Administration's Ticket to Work program within the first three years following random assignment. The program led to a 5.3 percentage point increase, or almost 50 percent increase, in employment, and an $831 increase in annual earnings in the second calendar year after the calendar year of random assignment. The employment and earnings impacts are smaller and not statistically significant in the third calendar year following random assignment, and we describe SSDI rules that are consistent with this finding. Our findings indicate that disability reform proposals focusing on restoring the work capacity of people with disabilities can increase the disability employment rate.     

收入、健康与医疗保险对老年人幸福感的影响

本文使用中国9个省、2200名55岁以上老年人的微观调查数据,主要检验了收入水平、健康状况与医疗保险对主观幸福感的影响。Ordered Logit回归分析结果表明：收入增加能够显著提高城镇老年人的主观幸福感,收入差距的影响不显著;对农村老年人而言,收入的作用不明显,而收入差距则有显著的负向影响。心理健康和城乡老年人幸福感呈高度的正相关,记忆力、日常生活自理能力等身体健康因素也具有显著的正向影响。公费医疗显著提高农村老年人的幸福感,城镇职工医疗保险和合作医疗分别对城镇和农村老年人幸福感具有积极的作用。总体上,城镇老年人的主观幸福感高于农村,东部老年人幸福感高于中部,中部高于西部。因此,增加老年人的收入水平,完善老年人医疗保险制度,并逐步协调城乡和地区经济发展,有助于从整体上提高老年人的幸福感。