State Variation in the Hospital Costs of Gun Violence, 2010 and 2014

This brief updates the armed assault hospital cost estimates with data from 2014, the first year of full implementation of the ACA's major coverage provisions. We provide data for Arizona, Florida, Kentucky, New Jersey, North Carolina, and Wisconsin; of these, Arizona, New Jersey, North Carolina, and Wisconsin were included in our previous brief. We selected these six states based on data availability, population size, geographic representation, and participation in the ACA Medicaid expansion (table 1). The states reflect a range of decisions on Medicaid coverage: Arizona, Kentucky, and New Jersey adopted the Medicaid expansion in 2014, but Florida, North Carolina, and Wisconsin did not. Arizona had a Section 1115 demonstration waiver in place in 2010 that provided coverage to childless adults with incomes up to 100 percent of the federal poverty level (FPL). Wisconsin also had a Section 1115 demonstration waiver to extend eligibility to 200 percent of FPL, but enrollment for the program was capped as of October 2009. In 2014, Wisconsin used state funds to provide eligibility to childless adults with incomes up to 100 percent of FPL and removed the enrollment cap. Most importantly, all six states have complete data for the analysis from the Healthcare Cost and Utilization Project, described later in this brief

Insuring the Learning Curve: Does Subsidized Public Health Insurance Improve Education Achievement?

The Medicaid public health insurance program provides children with healthcare access and financial protection from unanticipated adverse health events. Previous research demonstrates that Medicaid expansions are associated with increased healthcare utilization, decreased childhood mortality, and decreased personal bankruptcy rates. Less well studied are the secondary spillover benefits of the Medicaid program. This dissertation investigates whether Medicaid eligibility expansions can be linked to improvements in education achievement. This is a salient question for the Medicaid eligible population: children in low-income families have higher rates of chronic illness, are more likely to delay medical care due to cost, and score lower on math and reading assessments. To the extent the Medicaid program improves health and family income outcomes for children, two crucial inputs in the education production function, the Medicaid program may have the capacity to improve the children’s education achievement as well. The first study of the dissertation assesses whether Medicaid eligibility expansions affect out-of-pocket spending on healthcare and healthcare utilization using the restricted-use data from the Medical Expenditures Panel Survey. This highlights the potential mechanisms through which Medicaid expansions are likely to impact education. The second study of the dissertation combines Medicaid eligibility expansion data at the state, year, and age level with restricted-use individual data from the National Assessment of Education Progress. I test for whether Medicaid eligibility expansions at various ages of a child’s life impact test score and school attendance. The third study uses administrative data from the universe of North Carolina public schools from the North Carolina Education Research Data Center. I exploit a discontinuity in Medicaid eligibility exposure created by a Medicaid expansion mandate that only affected children in poverty born after a specific date. This work tests for whether early life Medicaid eligibility affects school grade advancement, test scores, and school absences

Does Subsidized Public Health Insurance for Parents Improve Children’s Human Capital and Close Achievement Gaps?

Presentation given at SEA Annual Conference

Comparing Standard Deviation Effects Across Contexts

Studies using tests scores as the dependent variable often report point estimates in student standard deviation units. We note that a standard deviation is not a standard unit of measurement since the distribution of test scores can vary across contexts. As such, researchers should be cautious when interpreting differences in the numerical size of point estimates when comparing across contexts. We empirically assess the importance of this issue both within the United States and internationally