Utilization of Infertility Treatments: The Effects of Insurance Mandates

Over the last several decades, both delay of childbearing and fertility problems have become increasingly common among women in developed countries. At the same time, technological changes have made many more options available to individuals experiencing fertility problems. However, these technologies are expensive, and only 25% of health insurance plans in the United States cover infertility treatment. As a result of these high costs, legislation has been passed in 15 states that mandates insurance coverage of infertility treatment in private insurance plans. In this paper, we examine whether mandated insurance coverage for infertility treatment affects utilization. We allow utilization effects to differ by age and education, since previous research suggests that older, more educated women should be more likely to be directly affected by the mandates than younger women and less educated women, both because they are at higher risk of fertility problems and because they are more likely to have private health insurance which is subject to the mandate. We find robust evidence that the mandates do have a significant effect on utilization for older, more educated women that is larger than the effects found for other groups. These effects are largest for the use of ovulation-inducing drugs and artificial insemination.

The State of Social Safety Net in the Post-Welfare Reform Era

welfare, reform, health insurance, security

What Mean Impacts Miss:Distributional Effects of Welfare Reform Experiments

Labor supply theory predicts systematic heterogeneity in the impact of recent welfare reforms on earnings, transfers, and income. Yet most welfare reform research focuses on mean impacts. We investigate the importance of heterogeneity using random-assignment data from Connecticut's Jobs First waiver, which features key elements of post-1996 welfare programs. Estimated quantile treatment effects exhibit the substantial heterogeneity predicted by labor supply theory. Thus mean impacts miss a great deal. Looking separately at samples of dropouts and other women does not improve the performance of mean impacts. We conclude that welfare reform's effects are likely both more varied and more extensive than has been recognized.labor, welfare, reform

Utilization of Infertility Treatments: the Effects of Insurance Mandates

Over the last several decades, both delay of childbearing and fertility problems have become increasingly common among women in developed countries. At the same time, technological changes have made many more options available to individuals experiencing fertility problems. However, these technologies are expensive, and only 25% of health insurance plans in the United States cover infertility treatment. As a result of these high costs, legislation has been passed in 15 states that mandates insurance coverage of infertility treatment in private insurance plans. In this article, we examine whether mandated insurance coverage for infertility treatment affects utilization. We allow utilization effects to differ by age and education, since previous research suggests that older, more-educated women should be more likely to be directly affected by the mandates than younger women and less-educated women, both because they are at higher risk of fertility problems and because they are more likely to have private health insurance, which is subject to the mandate. We find robust evidence that the mandates do have a significant effect on utilization for older, more-educated women that is larger than the effects found for other groups. These effects are largest for the use of ovulation-inducing drugs and artificial insemination

Birth Rates and the Vietnam Draft

The Vietnam conflict was the defining event for a generation, with nearly 8 million Americans serving in the armed forces. A large literature in economics has focused on effects of Vietnam-Era service post-war, while little research looks at contemporaneous effects of the mobilization, despite the potential for this mobilization to change marriage markets for particular cohorts. We use exogenous variation across states and over time in the share of men 19-25 drafted to look at the effects of the wartime mobilization on birth rates. We find robust evidence that higher rates of inducted men led to significantly lower birth rates. ⊗ We are grateful to Walter Komorowski for assistance in obtaining data, and to Melanie Guldi and Hilary Hoyne

Financial services used by small businesses: evidence from the 1998 survey of small business finances

Using newly available data from the 1998 Survey of Small Business Finances, this article offers preliminary findings regarding the characteristics of small businesses in the United States and their use of credit and other financial services. The main goals of the survey are to provide information on credit accessibility for small businesses, their use of financial services, and the sources of those services. The survey also provides a general-purpose database that can be used to study small business financing. Preliminary findings suggest that although the financial landscape has changed markedly since the previous survey in 1993, financing patterns and the use of particular suppliers have not.Small business ; Financial services industry

Distributional Impacts of the Self-Sufficiency Project

A large literature has been concerned with the impacts of recent welfare reforms on income, earnings, transfers, and labor-force attachment. While one strand of this literature relies on observational studies conducted with large survey-sample data sets, a second makes use of data generated by experimental evaluations of changes to means-tested programs. Much of the overall literature has focused on mean impacts. In this paper, we use random-assignment experimental data from Canada’s Self-Sufficiency Project (SSP) to look at impacts of this unique reform on the distributions of income, earnings, and transfers. SSP offered members of the treatment group a generous subsidy for working full time. Quantile treatment effect (QTE) estimates show there was considerable heterogeneity in the impacts of SSP on the distributions of earnings, transfers, and total income; heterogeneity that would be missed by looking only at average treatment effects. Moreover, these heterogeneous impacts are consistent with the predictions of labor supply theory. During the period when the subsidy is available, the SSP impact on the earnings distribution is zero for the bottom half of the distribution. The SSP earnings distribution is higher for much of the upper third of the distribution except at the very top, where the earnings distribution is the same under either program or possibly lower under SSP. Further, during the period when SSP receipt was possible, the impacts on the distributions of transfer payments (IA plus the subsidy) and total income (earnings plus transfers) are also different at different points of the distribution. In particular, positive impacts on the transfer distribution are concentrated at the lower end of the transfer distribution while positive impacts on the income distribution are concentrated in the upper end of the income distribution. Impacts of SSP on these distributions were essentially zero after the subsidy was no longer availablewefare reforms, labor force

Insurance Mandates and Mammography

Recently adopted federal health reform requires insurers to cover mammograms without cost-sharing. We examine similar state insurance mandates that vary substantially in the timing of adoption and in specifying the ages of women eligible for different mammography benefits. In triple differences models we find that mandates requiring coverage of annual mammograms significantly increased past year mammography screenings by about 8 percent, representing over 800,000 additional women screened from 1987-2000. Mandates that explicitly prohibit deductibles are especially effective at increasing screenings among high school dropouts, suggesting that federal health reform is likely to further increase use of screening mammography.

Effects of Venue-Specific State Clean Indoor Air Laws on Smoking-Related Outcomes

A large literature has documented relationships between state clean indoor air laws (SCIALs) and smoking-related outcomes in the US. These laws vary within states over time and across venues such as schools, government buildings, and bars. Few studies, however, have evaluated whether the effects of SCIALs are plausibly concentrated among workers who should have been directly affected because they worked at locations covered by the venue-specific restrictions. We fill this gap in the literature using data on private sector workers, government employees, school employees, eating and drinking place workers, and bartenders from the 1992–2007 Tobacco Use Supplements to the Current Population Survey. Our quasi-experimental models indicate robust effects of SCIALs restricting smoking in bars: these laws significantly increased the presence of workplace smoking restrictions as reported by bartenders and reduced the fraction of bartenders who smoke. We do not, however, find that SCIALs in private workplaces, government workplaces, schools, or restaurants increased the presence of workplace smoking restrictions among groups of workers working in venues covered by these laws. This suggests that the smoking reductions associated with SCIALs in previous research are unlikely to have been directly caused by effects of workplace smoking restrictions on workers.