My research interests include health economics, labor economics, public economics, and public policy.
"The Impact of Educational Rewards on the Diagnosis of Autism Spectrum Disorder" (with Scott McNamara ) Forthcoming at Economics and Human Biology
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that affects social interactions and communication. The prevalence of ASD has risen dramatically in recent years, but the underlying factors leading to this rise are not clear. In this paper, we test whether changes in state-level educational policy that impact school-level resources are associated with the rise in ASD diagnostic prevalence. Early identification of ASD can improve an array of outcomes for children, and school systems play an important role with identification of the condition. It is plausible that children attending schools with better resources from state governments are more likely to receive an ASD diagnosis and presumably appropriate services. We focus on one educational policy in particular, state-level rewards, which consist of a monetary transfer from state governments to school districts. To test the impact of educational rewards on ASD diagnosis, we rely on policy variation across states and time and estimate both two-way fixed effects (TWFE) models alongside recently advanced methods in the difference-in-differences (DiD) literature. Under a baseline TWFE specification we estimate that rewards policies are associated with a 18.46 percent increase in ASD diagnosis. Further, using DiD methods that account for bias in settings of differential policy timing, we find that the magnitude of the effect increases to 24.8 percent. We believe these findings to be suggestive evidence that educational rewards policies improved the likelihood of detection and diagnosis of ASD.
"Access to Health Care and Mental Health -- Evidence from the ACA Preexisting Conditions Provision" (with Otto Lenhart) Health Economics 2022 31(5), 760-783
This study evaluates the impact of the Affordable Care Act preexisting conditions provision on mental health. The 2014 policy ensured individuals with preexisting health conditions the right to obtain insurance coverage. Using longitudinal data from the Panel Study of Income Dynamics between 2009 and 2017 and estimating difference-in-differences models, our study provides evidence that the policy reduced severe mental distress by 1.38 percentage points among individuals with preexisting physical health conditions. Exploiting pre-ACA, state-level variation in policies providing insurance coverage options to people with preexisting conditions, we find that this improvement in mental well-being is highly associated with the presence of high-risk pools before 2014, which provided individuals with prior health conditions access to coverage. Specifically, we show that our main results are driven by individuals with preexisting health conditions living in the 16 states that did not have high-risk pools. Furthermore, gender-specific analysis shows that the reduction in mental distress is primarily observable among women. When examining a potential mechanism, our analysis provides evidence that reductions in financial strain related to health expenditures can explain the positive effects of the provisions on mental well-being.
"The Effect of the Affordable Care Act Medicaid Expansion on Marriage" (with Otto Lenhart )
Economic Inquiry 2022 60(2), 568-591
This paper investigates the impact of the Affordable Care Act Medicaid expansions on marital behavior. We use data from the American Community Survey from 2008 to 2019 and estimate difference-in-differences models to test for effects on marriage and divorce outcomes. We find that expansions led to a 0.95 percent reduction in marriage stock and a 2.22 percent increase in the stock of divorced individuals, with effects being larger among those with low education. We believe that two factors play a role as underlying mechanisms: 1) reduced reliance on spousal health insurance coverage, and 2) deciding to forego marriage or get divorced to meet post-policy eligibility restrictions.
"The Effect of the Affordable Care Act Preexisting Conditions Provision on Marriage" (with Otto Lenhart )
Health Economics 2019 28(11), 1345-1355
This paper investigates the effect of the Affordable Care Act preexisting conditions provision on marriage. The policy was implemented to prevent insurers from denying insurance coverage to individuals with preexisting health conditions. We test whether the implementation of the provision led to decreases in marriage among affected adults. We add to earlier work on how marital behavior is influenced by spousal health insurance and examine for the presence of "marriage lock," a situation in which individuals remain married primarily for insurance. Using data from the Panel Study of Income Dynamics from 2009 to 2017 and estimating difference-in-differences models, we find that male household heads with preexisting conditions are 7.12 percentage points (8.9 percent) less likely to be married after the policy. Using information on insurance status prior to the policy change, we find significant reductions in marriage among individuals with preexisting conditions who were previously insured by spousal health insurance plans. The findings suggest that the inability to attain individual coverage and reliance on spousal insurance provided incentives to remain married before 2014.
"Labor Mobility and the Affordable Care Act: Heterogeneous Impacts of the Preexisting Conditions Provision" (with Laura Connolly and Otto Lenhart) Revise and Resubmit
The Patient Protection and Affordable Care Act (ACA) preexisting conditions provision ensures that insurance companies can no longer deny coverage or charge higher premiums to individuals due to a preexisting health condition. In this paper, we evaluate the impact of the ACA provision on labor mobility in the United States. We use data from the Panel Study of Income Dynamics for years 2009 through 2019 and estimate difference-in-differences models to determine whether the provision reduced job lock for individuals with chronic conditions. We find that the ACA provision significantly improved labor mobility among male household heads. Male household heads are 25 percent more likely to start a new job or become employed in a different industry in the post-policy period. In contrast, we do not observe significant changes in labor mobility among females. Labor mobility improvements are largest among families with children and those with a relatively low level of education. The results are consistent with the policy change improving access to healthcare, and both mental and physical wellbeing, which ultimately increased labor market flexibility among men with prior health conditions. Our results highlight the heterogeneous impacts of the ACA's preexisting conditions provision on different subgroups of the population.
"Minimum Wages, Retirement Timing, and Labor Supply" (with Evan Totty) Revise and Resubmit
Link to Census Bureau working paper
Media Coverage: Economic Policy Institute; Forbes; Market Watch
We find that minimum wage increases lead to increased employment, delayed permanent labor force exit, and delayed retirement benefit claiming for low-wage, retirement-age individuals. Own-wage elasticity estimates of the employment effect are larger than normal for the minimum wage literature but are consistent with recent evidence on labor supply effects of minimum wages and life-cycle models of labor supply. The delay in benefit claiming appears to be driven by an interaction between minimum wages and the Social Security earnings test. These results suggest that retirement-age individuals are very responsive to changes in labor market opportunities and that minimum wages may compliment Social Security incentives that encourage more work and delayed benefit claiming.
wage older workers.
"School Accountability and Hyperactivity" (with Susan E. Chen)
Revise and Resubmit
Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed mental health disorder among American children. In this paper, we examine whether continued school accountability policies in a post- No Child Left Behind period account for rises in ADHD prevalence. We estimate two-way fixed effects models that exploit variation across states and time in the introduction of school accountability laws to test for changes in mean ADHD diagnosis and prescription medication use. While we find no significant effects for consequential accountability laws, the results from our analysis suggest that the introduction of one specific policy instrument, state-level rewards given to high-performing schools, leads to a 1.9 percentage point increase in the probability of an ADHD diagnosis and a 1.0 percentage point increase in prescription medication use among children. We find that the effect is largest among children that are male, black, and covered by public insurance. Additionally, using a measure of state-level, per pupil spending on education, we find that the rewards policy is positive and significant for children in all quintiles of spending, except for those living in states among the bottom 20% of spenders. We believe that the rewards policy mechanism is a combination of both the presence of a financial incentive along with adequate resources devoted to schools by the state.
"Trends in Adolescent Suicide Behaviors in the State of Iowa" (with Lisa Hooper, Wei Schneider, and Sara Tomek) Under Review
Recent research has found that suicidality is increasing among Black American youths. In this paper, we test whether the reported increase in suicidality is evident in a sample of children living in the state of Iowa. Using data from the Youth Risk Behavior Surveillance System (YRBSS) over the period 1997-2019, we examine the trends in four measures of suicidal behavior among Iowa youth among sex and racial subsamples. We find that in general, suicidality among Iowa youth has been on the decline, except for one racial subcategory: Multiracial male adolescents. We find a concerning significant increase in suicidal ideation among this group, which suggests a new group of vulnerable youths. We conclude that some youth who identify as Multiracial males might suffer from feeling isolated due to sparse population and confusion in self-identification as adopting the dominant culture within society. Policymakers should take into consideration this particular subgroup within the state of Iowa when formulating strategies to combat mental illness and youth suicidality.
"Revisiting the Effect of the Affordable Care Act Medicaid Expansion on Migration" (with Laura Connolly and Otto Lenhart ) Under Review
We revisit the impact of the Affordable Care Act's Medicaid Expansion on interstate migration to determine the longer-run effects of the policy. Using American Community Survey data from 2010-2019 and a difference-in-differences (DiD) research design, we test for changes in migratory trends between expansion and non-expansion states. In contrast with prior findings examining short-run effects, we find evidence of increased post-policy migration from non-expansion-to-expansion states among those with Medicaid coverage. Staggered DiD methods indicate that increases in net migration to expansion states are driven by reduced out-migration from expansion states.
Work in Progress
"Childhood Disability and Parental Labor Outcomes"
"Understanding Trends in ADHD Prevalence: A Stochastic Dominance Approach" (with Susan E. Chen)
"Impacts of the Earned Income Tax Credit on Fertility" (with Otto Lenhart)
"The Impact of Caring for a Child with ADHD on Parental Outcomes"