with Amy Finkelstein and Katherine Baicker, NBER Working Paper
Abstract Those involved with the criminal justice system have disproportionately high rates of mental illness and substance-use disorders, prompting speculation that health insurance, by improving treatment of these conditions, could reduce crime. Using the 2008 Oregon Health Insurance Experiment, which randomly made some low-income adults eligible to apply for Medicaid, we find no statistically significant impact of Medicaid coverage on criminal charges or convictions. These null effects persist for high-risk subgroups, such as those with prior criminal cases and convictions or mental health conditions. In the full sample, our confidence intervals can rule out most quasi-experimental estimates of Medicaid's crime-reducing impact.
with Elizabeth Rhodes, Alex Bartik, David Broockman, Karina Dotson, Patrick Krause and Eva Vivalt, NBER Working Paper
Abstract We study the causal effects of income on political attitudes and behavior with a field experiment. In the experiment, a non-profit gifted 1,000 low-income Americans $1,000 per month for three years tax-free, and 2,000 control participants $50 monthly. Contrary to resource models of participation, we find no effects on political participation or engagement, and rule out effects equivalent to the observational association between turnout and income. Political preferences largely do not change, with the estimates again distinguishable from the observational relationship that economic conservatism increases with income. Dispositions such as trust in government, polarization, and support for democracy also do not change. We do find effects consistent with mood misattribution: affect towards one's own racial group, other racial groups, and some politicians slightly improves. There is also some evidence that treated participants saw work as more important for individuals, society, or even as a requirement for accessing government programs; qualitative evidence illuminates potential mechanisms. Our findings contrast with findings from other economic shocks such as government-sponsored or taxable transfers—thereby helping clarify the mechanisms likely responsible for their effects—and underscore the durability of political predispositions.
with Elizabeth Rhodes, Alex Bartik, David Broockman, Patrick Krause and Eva Vivalt, NBER Working Paper
Abstract We provide new evidence on the causal effect of unearned income on consumption, balance sheets, and financial outcomes by exploiting an experiment that randomly assigned 1000 individuals to receive $1000 per month and 2000 individuals to receive $50 per month for three years. The transfer increased measured household expenditures by at least $300 per month. The spending impact is positive in most categories, and is largest for housing, food, and car expenses. The treatment increases housing unit and neighborhood mobility. We find noisily estimated modest positive effects on asset values, driven by financial assets, but these gains are offset by higher debt, resulting in a near-zero effect on net worth. The transfer increased self-reported financial health and credit scores but did not affect credit limits, delinquencies, utilization, bankruptcies, or foreclosures. Adjusting for underreporting, we estimate marginal propensities to consume non-durables between 0.44 and 0.55, durables and semi-durables between 0.21 and 0.26, and marginal propensities to de-lever of near zero. These results suggest that large temporary transfers increase short-term consumption and improve financial health but may not cause persistent improvements in the financial position of young, low-income households.
with Elizabeth Rhodes, Alex Bartik, David Broockman, Patrick Krause and Eva Vivalt, revise and resubmit, American Economic Review
Abstract This paper provides new evidence on the causal relationship between income and health by studying a randomized experiment in which 1,000 low-income adults in the United States received $1,000 per month for three years, with 2,000 control participants receiving $50 over that same period. The cash transfer resulted in large but short-lived improvements in stress and food security, greater use of hospital and emergency department care, and increased medical spending of about $20 per month in the treatment relative to the control group. Our results also suggest that the use of other office-based care---particularly dental care---may have increased as a result of the transfer. However, we find no effect of the transfer across several measures of physical health as captured by multiple well-validated survey measures and biomarkers derived from blood draws. We can rule out even very small improvements in physical health and the effect that would be implied by the cross-sectional correlation between income and health lies well outside our confidence intervals. We also find that the transfer did not improve mental health after the first year and by year 2 we can again reject very small improvements. We also find precise null effects on self-reported access to health care, physical activity, sleep, and several other measures related to preventive care and health behaviors. Our results imply that more targeted interventions may be more effective at reducing health inequality between high- and low-income individuals, at least for the population and time frame that we study.
with Eva Vivalt, Elizabeth Rhodes, Alex Bartik, David Broockman, and Patrick Krause, NBER Working Paper
Abstract We study the causal impacts of income on a rich array of employment outcomes, leveraging an experiment in which 1,000 low-income individuals were randomized into receiving $1,000 per month unconditionally for three years, with a control group of 2,000 participants receiving $50/month. We gather detailed survey data, administrative records, and data from a custom mobile phone app. The transfer caused total individual income to fall by about \$1,500/year relative to the control group, excluding the transfers. The program resulted in a 2.0 percentage point decrease in labor market participation for participants and a 1.3-1.4 hour per week reduction in labor hours, with participants' partners reducing their hours worked by a comparable amount. The transfer generated the largest increases in time spent on leisure, as well as smaller increases in time spent in other activities such as transportation and finances. Despite asking detailed questions about amenities, we find no impact on quality of employment, and our confidence intervals can rule out even small improvements. We observe no significant effects on investments in human capital, though younger participants may pursue more formal education. Overall, our results suggest a moderate labor supply effect that does not appear offset by other productive activities.
with Amelia Hawkins, Christopher Hollrah, Laura R.Wherry, Mitchell Wong and Gloria Aldana, conditionally accepted, American Economic Review, NBER Working Paper
Abstract This paper examines whether a generous cash intervention early in life can ``undo'' some of the long-term disadvantage associated with poor health at birth. We use new linkages between several large-scale administrative datasets to examine the short-, medium-, and long-term effects of providing low-income families with low birthweight infants support through the Supplemental Security Income (SSI) program. This program uses a birthweight cutoff at 1200 grams to determine eligibility. We find that families of infants born just below this cutoff experience a large increase in cash benefits totaling about 27% of family income in the first three years of the infant's life. These cash benefits persist at lower amounts through age 10. Eligible infants also experience a small but statistically significant increase in Medicaid enrollment during childhood. %and are eligible for referrals to other supportive programs. We examine whether this support affects health care use and mortality in infancy, educational performance in high school, post-secondary school attendance and college degree attainment, and earnings, public assistance use, and mortality in young adulthood for all infants born in California to low-income families whose birthweight puts them near the cutoff. We also examine whether these payments had spillover effects onto the older siblings of these infants who may have also benefited from the increase in family resources. Despite the comprehensive nature of this early life intervention, we detect no improvements in any of the study outcomes, nor do we find improvements among the older siblings of these infants. These null effects persist across several subgroups and alternative model specifications, and, for some outcomes, our estimates are precise enough to rule out published estimates of the effect of early life cash transfers in other settings.
with Kate Kennedy-Moulton, Petra Persson, Maya Rossin-Slater, Laura R. Wherry and Gloria Aldana, revise and resubmit, Review of Economics and Statistics
Abstract We use linked administrative data that combines the universe of California birth records, hospitalizations, and death records with parental income from Internal Revenue Service tax records to provide novel evidence on economic inequality in infant and maternal health. We find that birth outcomes vary non-monotonically with parental income, and that children of parents in the top ventile of the income distribution have higher rates of low birth weight and preterm birth than those in the bottom ventile. However, unlike birth outcomes, infant mortality varies monotonically with income, and infants of parents in the top ventile of the income distribution---who have the worst birth outcomes---have a death rate that is half that of infants of parents in the bottom ventile. When studying maternal health, we find that although mothers in the top and bottom income ventiles have similar rates of severe maternal morbidity, the former group are three times less likely to die than the latter. At the same time, these disparities by parental income are small when compared to racial disparities, and we observe virtually no convergence in health outcomes across racial and ethnic groups as income rises. Indeed, infant and maternal health in Black families at the top of the income distribution is markedly worse than that of white families at the bottom of the income distribution. Lastly, we benchmark the health gradients in California to those in Sweden, finding that infant and maternal health is worse in California than in Sweden for most outcomes throughout the entire income distribution.
with Laura R. Wherry, revise and resubmit, AEJ: Economic Policy
Abstract Undocumented immigrants are ineligible for public insurance coverage for prenatal care in most states, despite their children representing a large fraction of births and having U.S. citizenship. In this paper, we examine a policy that expanded Medicaid pregnancy coverage to undocumented immigrants. Using a novel dataset that links California birth records to Census surveys, we identify siblings born to immigrant mothers before and after the policy. Implementing a mothers' fixed effects design, we find that the policy increased coverage for and use of prenatal care among pregnant immigrant women, and increased average gestation length and birth weight among their children.
