My research interests include health economics, labor economics, and applied microeconomics.
(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.
"School Accountability and Hyperactivity" (with Susan E. Chen)
Revise and Resubmit at American Journal of Health Economics
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.
"Access to Health Care and Mental Health -- Evidence from the ACA Preexisting Conditions Provision" (with Otto Lenhart) Revise and Resubmit at Health Economics
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 Behavior" (with Otto Lenhart )
Revise and Resubmit at Economic Inquiry
This paper investigates the impact of the 2014 Medicaid expansions on marital behavior. The Patient Protection and Affordable Care Act (ACA) encouraged states to expand Medicaid and thereby increase insurance options for low-income individuals. Contributing to earlier work showing evidence of a link between insurance coverage and incentives to marry, we test whether the Medicaid expansions affected marriage and divorce decisions. Using data from the American Community Survey from 2008 to 2018 and estimating difference-in-differences models, we test the impact of Medicaid expansion on both stock and flow marital outcomes. As a first-stage effect, we show that the expansions increased Medicaid coverage by 31.15 percent in first-time expansion states. When evaluating the effects of the policy on marriage behavior, we find that Medicaid expansions led to a 0.75 percent reduction in the stock of married people, a 4.15 percent reduction in the likelihood of having married in the past year, and a 3.61 percent increase in the probability of having had a recent divorce. We believe the underlying mechanism to be twofold. First, Medicaid expansion led to increased insurance options, which decreased reliance on spousal health insurance coverage. Second, by changing eligibility thresholds, Medicaid led to people choosing to forego marriage or get divorced to meet post-policy program eligibility restrictions.
"Minimum Wages, Retirement Timing, and Labor Supply" (with Evan Totty) Under Review
Link to Census Bureau working paper
We use linked survey-administrative data to study the impact of minimum wage increases on Social Security retirement benefit claiming behavior and labor supply for low-wage, older workers. The share of the labor force working for a rate of pay near the minimum wage increases for older ages near retirement, yet this population is typically ignored in the minimum wage literature. We first verify that we find the expected short-run effects of minimum wage increases on wages, earnings, and employment in the survey data. We then use linked administrative data to estimate hazard models of retirement benefit claiming and panel models of employment over ages 62-70. Individuals exposed to minimum wage increases during these ages delay their claiming of retirement benefits and do so by six months, on average. The delay appears to be driven by an interaction between the minimum wage and the Social Security earnings test. We also find that exposure to minimum wage increases leads to increased full-time and part-time employment during ages 62-70. We combine the claiming and employment outcomes to define partial and full retirement and find that minimum wage increases are associated with less full retirement and more partial retirement. These results suggest that increases in the minimum wage can enhance the financial well-being of low-wage older workers.
"The Impact of Educational Rewards on the Diagnosis of Autism Spectrum Disorder" (with Scott McNamara ) Under Review
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that affects social interactions and communication. ASD diagnostic prevalence has risen dramatically in recent years; however, the underlying factors leading to this rise are not clear. In this paper, we test whether changes in state-level educational policy that impacts school-level resources is associated with the rise in ASD. 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 and support from state governments are more likely to receive 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. Exploiting state-year variation in the policy, we find that children living in states implementing rewards policies between 2003 and 2011 are 8.9 percent more likely to receive an ASD diagnosis. In an analysis of policy heterogeneity, we find the children most impacted by the policy are those not in extreme poverty, with private insurance, and living in two-parent households. We estimate an additional model that allows the effect to vary across age and find that the policy has the largest impact among white children ages 6-17.
"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.
Work in Progress
"Childhood Disability and Parental Labor Outcomes" (with Susan E. Chen)
"Understanding Trends in ADHD Prevalence: A Stochastic Dominance Approach" (with Susan E. Chen)
"The Impact of Caring for a Child with ADHD on Parental Outcomes"