Public Health Insurance, Program Take-Up, and Child Health

Of the ten million uninsured children in 1996, nearly half were eligible for Medicaid, the public health insurance program for poor families, but not enrolled. In response, policy efforts to improve coverage have shifted to increasing Medicaid take-up among those already eligible rather than expanding eligibility. However, little is known about the reasons poor families fail to use public programs or the consequences of failing to enroll. The latter is of particular relevance to Medicaid given that children are typically enrolled when they become sufficiently sick as to require hospitalization. Using new data on Medicaid outreach, enrollment and child hospitalizations in California, I find that information and administrative costs are important barriers to program enrollment, with the latter particularly true for Hispanic and Asian families. In addition, enrolling children in Medicaid before they get sick promotes the use of preventative care, reduces the need for hospitalization and improves health.

Wages, Violence and Health in the Household

Three quarters of all violence against women is perpetrated by domestic partners. I study both the economic causes and consequences of domestic violence. I find that decreases in the male-female wage gap reduce violence against women, consistent with a household bargaining model. The relationship between the wage gap and violence suggests that reductions in violence may provide an alternative explanation for the well-established finding that child health improves when mothers control a greater share of the household resources. Using instrumental variable and propsensity score techniques to control for selection into violent relationships, I find that violence against pregnant women negatively affects the health of their children at birth. This work sheds new light on the health production process as well as observed income gradients in health and suggests that in addition to addressing concerns of equity, pay parity can also improve the health of American women and children via reductions in violence.

Networks or Neighborhoods? Correlations in the Use of Publicly-Funded Maternity Care in California

This study focuses on network effects' in the utilization of publicly funded prenatal care using Vital Statistics data from California for 1989 to 2000. Networks are defined using 5-digit zipcodes and a woman's racial or ethnic group. Like others, we find evidence that the use of public programs is highly correlated within groups defined using race/ethnicity and neighborhoods. These correlations persist even when we control for many unobserved characteristics by including zipcode-year fixed effects, and when we focus on the interaction between own group behavior and measures of the potential for contacts with other members of the group ( contact availability'). However, the richness of our data allows us to go further and to conduct several tests of one hypothesis about networks: That the estimated effects represent information sharing within groups. The results cast doubt on the idea that the observed correlations can be interpreted as evidence of information sharing, and point instead to differences in the behavior of the institutions serving different groups of low-income women as the primary explanation for group-level differences in the take-up of this important public program.

Parental Medicaid Expansions and Health Insurance Coverage

During the 1990s many states extended Medicaid eligibility to low-income parents who were not receiving welfare. We evaluate the effects of those expansions on health insurance coverage. To account for unobservable differences between expansion states and non-expansion states that may be correlated with both policy decisions and insurance coverage, we employ a within-state difference-in-difference technique that makes use of data only from expansion states. We find that the parental eligibility expansions increased Medicaid coverage of mothers with only small effects on private coverage. The expansions also increased the coverage of children, presumably by raising the benefit to the family of applying for coverage. We find substantial racial and ethnic differences in the effects of the expansions. As a result, the expansions help reduce racial and ethnic gaps in insurance coverage, particularly for adults.

The Impact of Child Support Enforcement on Fertility, Parental Investment and Child Well-Being

Increasing the probability of paying child support, in addition to increasing resources available for investment in children, may also alter the incentives faced by men to have children out of wedlock. We find that strengthening child support enforcement leads men to have fewer out-of-wedlock births and among those who do become fathers, to do so with more educated women and those with a higher propensity to invest in children. Thus, policies that compel men to pay child support may affect child outcomes through two pathways: an increase in financial resources and a birth selection process.

Love, Hate and Murder: Commitment Devices in Violent Relationships

Many violent relationships are characterized by a high degree of cyclicality: women who are the victims of domestic violence often leave and return multiple times. To explain this we develop a model of time inconsistent preferences in the context of domestic violence. This time inconsistency generates a demand for commitment. We present supporting evidence that women in violent relationships display time inconsistent preferences by examining their demand for commitment devices. We find that "no-drop" policies -- which compel the prosecutor to continue with prosecution even if the victim expresses a desire to drop the charges -- result in an increase in reporting. No-drop policies also result in a decrease in the number of men murdered by intimates suggesting that some women in violent relationships move away from an extreme type of commitment device when a less costly one is offered.

Peer Effects and Human Capital Accumulation: the Externalities of ADD

Recent work shows that peers affect student achievement, but the mechanisms are not well understood. I show that peer behavior is an important mechanism, perhaps more so than ability, by exploiting exogenous timing in diagnosis/treatment of ADD among peers that improves peer behavior while holding peer achievement constant. Improvements in peer behavior increase student achievement. Moreover, resources mitigate the negative effects of peer behavior. These findings imply that the optimal response in the presence of peer effects is not necessarily to reorganize classrooms. Rather, existing institutions can modify peer effects by improving behavior and/or mitigating the impact of poor behavior.

Competition in Imperfect Markets: Does it Help California's Medicaid Mothers?

Poor and uneducated patients may not know what health care is desirable and, if fully insured, have little incentive to minimize the costs of their care. Partly in response to these concerns, most states have moved a substantial portion of their Medicaid caseloads out of traditional competitive fee-for-service (FFS) care, and into mandatory managed care (MMC) plans that severely restrict the choice of provider. We use a unique longitudinal data base of California births in order to examine the impact of this policy on pregnant women and infants. California phased in MMC creating variation in the timing of MMC. We identify the effects of MMC using changes in the regime faced by individual mothers between births. Some counties adopted single-carrier plans, while others adopted regimes with at least two carriers. Hence, we also ask whether competition between at least two carriers improved MMC outcomes. We find that MMC reduced the quality of prenatal care and increased low birth weight, prematurity, and neonatal death. Our results suggest that the competitive FFS system provided better care than the new MMC system, and that requiring the participation of at least two plans did not improve matters.