Health Insurance and Ex Ante Moral Hazard: Evidence from Medicare

Basic economic theory suggests that health insurance coverage may cause a reduction in prevention activities, but empirical studies have yet to provide much evidence to support this prediction. However, in other insurance contexts that involve adverse health events, evidence of ex ante moral hazard is more consistent. In this paper, we extend the analysis of the effect of health insurance on health behaviors by allowing for the possibility that health insurance has a direct (ex ante moral hazard) and indirect effect on health behaviors. The indirect effect works through changes in health promotion information and the probability of illness that may be a byproduct of insurance-induced greater contact with medical professionals. We identify these two effects and in doing so identify the pure ex ante moral hazard effect. This study exploits the plausibly exogenous variation in health insurance as a result of obtaining Medicare coverage at age 65. We find evidence that obtaining health insurance reduces prevention and increases unhealthy behaviors among elderly men. We also find evidence that physician counseling is successful in changing health behaviors.

Changes in the Welfare Caseload and the Health of Low-educated Mothers

Declines in the welfare caseload in the late 1990s brought significant change to the lives of many low-educated, single mothers. Many single mothers left welfare and entered the labor market and others re-arranged their lives in order to avoid going on public assistance. These changes may have affected the health and health behaviors of these women. To date, there has been no study of this issue. In this paper, we obtained estimates of the association between the welfare caseload and welfare policies, and three health behaviors --smoking, drinking, and exercise and two self-reported measures of health --days in poor mental health, and overall health status. The results of our study reveal that changes in the caseload had little effect on measures of health status, but were significantly associated with two health behaviors: binge drinking and regular exercise. The fall in the welfare caseload was associated with a decrease in binge drinking and an increase in regular and sustained physical activity.

Alcohol Taxes and Labor Market Outcomes

In this paper, we present estimates of the effect of alcohol taxes on employment, hours of work per week, and wages. These are reduced form estimates derived from a structural model linking alcohol use to labor market outcomes. The reduced form estimates are meaningful in two ways: first, they provide estimates of the effect of an important public policy tool, alcohol taxes, on labor market outcomes, and second, they can be used to evaluate hypotheses about the structural effects of alcohol use on labor market outcomes. The results of the analysis suggest that alcohol taxes are unrelated to employment, hours of work, and wages. Estimates of the effect of alcohol taxes on labor market outcomes were large and imprecise, and characterized by significant variation in sign and magnitude across samples and types of alcohol taxes. This suggests that there is a weak and indeterminate relationship between alcohol taxes and labor market outcomes. This finding implies that alcohol use does not adversely affect labor market outcomes and is inconsistent with findings from previous studies.

Effects of Title IX and Sports Participation on Girls' Physical Ability and Weight

Summarizes findings from "Effects of Title IX and Sports Participation on Girls' Physical Ability and Weight," a study of how legislation to increase girls' participation in sports affected physical activity levels, body mass index, and body composition

Do Minimum Wages Affect Non-wage Job Attributes? Evidence on Fringe Benefits and Working Conditions

Neoclassical labor market theories imply that employers will react to binding minimum wages by changing the level of employment. A multitude of studies consider this aspect of minimum wages, yet fail to reach a consensus as to its employment effects. While the employment effects of the minimum wage are certainly important, the empirical literature has not adequately explored the possibility that employers may also adjust non-wage components of the job such as fringe benefits, job safety, and access to training opportunities. We study the effect of minimum wage legislation on fringe benefits (employer provision of health insurance, pension coverage, dental insurance, vacation pay, and training/educational benefits) and working conditions (shift work, irregular shifts, and workplace safety) during the period 1979 to 2000 using the National Longitudinal Survey of Youth and the Current Population Survey. We examine effects of state and federal variation in the minimum wages on groups likely to be affected by the minimum wage. These effects are compared to estimates found for groups unlikely to be affected by minimum wages. Our results indicate no discernible effect of the minimum wage on fringe benefit generosity for low-skilled workers. This conclusion is unchanged whether we use only state level variation or federal and state variation in minimum wages.

Medicaid Expansions and The Crowding Out of Private Health Insurance

In this paper, we re-examine the question of crowd out among children. Our primary contribution is the use of longitudinal data. These data allow us to identify several groups of children depending on whether their eligibility for Medicaid was affected by the eligibility expansions, and to investigate whether changes in insurance coverage of children affected by the expansions differed from changes in insurance coverage of children unaffected by the expansions. For example, we directly measure whether children who became eligible for Medicaid due to the expansions decreased their enrollment in private insurance plans faster than children whose eligibility for Medicaid was unaffected by the expansions. Our results suggest that there was relatively little crowd out among children. We estimate that 14.5 percent of the recent increase in Medicaid enrollment came from private insurance.

An Investigation of the Effects of Alcohol Policies on Youth STDs

The purpose of this paper is to examine the role of alcohol policies in reducing the incidence of sexually transmitted diseases among youth. Previous research has shown that risky sexual practices (e.g., unprotected sex and multiple partners) that increase the risk of contracting a STD are highly correlated with alcohol use. If alcohol is a cause of risky sexual behavior, then policies that reduce the consumption of alcohol may also reduce the incidence of STDs. In this paper, we examine the relationship between alcohol policies (e.g., beer taxes and statutes pertaining to alcohol sales and drunk driving) and rates of gonorrhea and AIDS among teenagers and young adults. Results indicate that higher beer taxes are associated with lower rates of gonorrhea for males and are suggestive of lower AIDS rates. Strict drunk driving policies in the form of zero tolerance laws may also lower the gonorrhea rate among males under the legal drinking age.