Are Public Housing Projects Good For Kids?

One goal of federal housing policy is to improve the prospects of children in poor families. But little research has been conducted into the effects on children of participation in housing programs, perhaps because it is difficult to find data sets with information about both participation and interesting outcome measures. This paper combines data from several sources to provide a first look at the effects of participation in public housing projects on housing quality and on the educational attainment of children. We first use administrative data from the Department of Housing and Urban Development to impute the probability that a Census household lives in a public housing project. We find that a higher probability of living in a project is associated with poorer outcomes. We then use a two-sample instrumental variables (TSIV) technique to combine information on the probability of living in a project, obtained from the 1990 to 1995 Current Population Surveys, with information on outcomes obtained from the 1990 Census. The instrument common to both samples is an indicator equal to one if the household is entitled to a larger housing project unit because of the sex composition of the children in the household. Families entitled to a larger unit because of sex composition are 24 percent more likely to live in projects. When we control for omitted variables bias using TSIV, we find that project households are less likely to suffer from overcrowding and less likely to live in high-density complexes. Project children are also 12 to 17 percentage points less likely to have been held back in school one or more grades, although this effect is confined to boys. Thus, most families do not face a tradeoff between housing quality and child outcomes—the average project improves both.

Did recent medicaid reforms cause the caseload explosion in the food stamp program?

I examine whether changes in Medicaid eligibility for young children can help explain the caseload growth in the Food Stamp program between 1987 and 1995. Medicaid may increase food stamp participation through increased awareness about other welfare benefits. It could also reduce earnings through perverse labor supply incentives, thereby increasing food stamp participation. The Medicaid expansions enacted during the 1980s offer a unique opportunity to examine empirically Medicaid's interaction with the Food Stamp program because they conditioned eligibility on the age of the child. Households with ineligible children (based on the child's age) serve as a control group to isolate Medicaid's effect. They help to eliminate many other plausible explanations for the rise in food stamp participation, including economic fluctuations at the state and national levels. I use the Survey of Income and Program Participation (SIPP) to tackle this question. It shows evidence that expanding Medicaid eligibility increased food stamp participation. The effect is quite modest, however. The expansions explain less than 10 percent of the growth in food stamps, substantially smaller than previous estimates. Moreover, its effect on food stamp participation comes entirely through increased program awareness, rather than from any change in labor supply.

Public Health Insurance and Private Savings

Recent theoretical work suggests that means and asset-tested social insurance programs can explain the low savings of lower income households in the United States. We assess the validity of this hypothesis by investigating the effect of Medicaid, the health insurance program for low-income women and children, on savings behavior. We do so using data on asset holdings from the Survey of Income and Program Participation, and on consumption from the Consumer Expenditure Survey, matched to information on the eligibility of each household for Medicaid. Exogenous variation in Medicaid eligibility is provided by the dramatic expansion of this program over the 1984–1993 period. We document that Medicaid eligibility has a sizeable and significant negative effect on wealth holdings; we estimate that in 1993 the Medicaid program lowered wealth holdings by 17.7 percent among the eligible population. We confirm this finding by showing a strong positive association between Medicaid eligibility and consumption expenditures; in 1993, the program raised consumption expenditures among eligibles by 5.2 percent. We also exploit the fact that asset testing was phased out by the Medicaid program over this period to document that these Medicaid effects are stronger in the presence of an asset test, confirming the importance of asset testing for household savings decisions.

Health Insurance and Less Skilled Workers

We begin this research with the belief that low and declining levels of private-employer sponsored health insurance were a continuing problem, especially among less skilled workers. Our analysis, however, paints a more complex picture. Using data from the March CPS, the SIP, and CPS benefits surveys, we find that while many less skilled workers remain uncovered, the decline in private employer-sponsored health insurance coverage has slowed recently and may even have reversed. Neither crowdout nor a deterioration in the quality of jobs available to the less skilled seems likely to fully explain these time-series trends in health insurance coverage. A simple explanation that has been largely overlooked is that rising health care costs have driven much of the reduction in private insurance coverage, but it is more difficult to test this hypothesis given the available data.

Public Health Insurance and Private Savings

Recent theoretical work suggests that means and asset-tested social insurance programs can explain the low savings of lower income households in the U.S. We assess the validity of this hypothesis by investigating the effect of Medicaid, the health insurance program for low income women and children, on savings behavior. We do so using data on asset holdings from the Survey of Income and Program Participation, and on consumption from the Consumer Expenditure Survey, matched to information on the eligibility of each household for Medicaid. Exogenous variation in Medicaid eligibility is provided by the dramatic expansion of this program over the 1984-1993 period. We document that Medicaid eligibility has a sizeable and significant negative effect on wealth holdings; we estimate that in 1993 the Medicaid program lowered wealth holdings by 17.7% among the eligible population. We confirm this finding by showing a strong positive association between Medicaid eligibility and consumption expenditures; in 1993, the program raised consumption expenditures among eligibles by 5.2%. We also exploit the fact that asset testing was phased out by the Medicaid program over this period to document that these Medicaid effects are much stronger in the presence of an asset test, confirming the importance of asset testing for household savings decisions.

How Did the ACA Affect Health Insurance Coverage in Kentucky?

The major components of the Affordable Care Act (ACA) were implemented in 2014, including the rollout of the Health Insurance Marketplace, Medicaid expansions, and the individual mandate. Kentucky stands out as one of the few southern states to expand Medicaid, and earlier work has demonstrated that Kentucky experienced some of the largest gains in health insurance coverage. The goal of the current study is to further explore the sources that individuals used to gain coverage in Kentucky using a large, publicly available dataset, the American Community Survey (ACS). Several findings emerge. First, overall health insurance coverage increased by 5.7 percentage points, from 85.1 percent to 90.8 percent, from 2013 to 2014. Roughly 269,000 individuals in Kentucky gained coverage, the overwhelming majority (85%) of whom were adults aged 19–64 (229,000 individuals). Gains were extremely modest for both children and the elderly. Among adults, roughly 80 percent of the gains were from Medicaid coverage, with most of the rest coming from individual coverage. Using income reported by the ACS respondents, approximately 38 percent of new adult Medicaid recipients had incomes exceeding the Medicaid eligibility threshold (roughly $33,000 for a family of four). This translates into 73,000 ineligible, new Medicaid participants. Almost all ineligible, new participants would appear to qualify for private, nongroup coverage with subsidies through the premium tax credit. A variety of sensitivity checks suggest at least 36,000 ineligible, new participants on Medicaid due to the expansions, including more than 13,000 with incomes exceeding 250 percent of the FPL. Possible explanations are explored and ineligible participants are characterized

Competition and market structure in local real estate markets

The persistence of the standard six percent real estate sales commission across markets and over time calls into question the competitiveness of the residential real estate brokerage industry. While there is anecdotal evidence that some local real estate markets are fairly concentrated, no systematic study of market structures has been conducted. We have collected primary data on the number and market shares of real estate brokers in a variety of small, medium, and large real estate markets across the U.S. for 2007 and 2009. In addition to these cross sectional data, we have also collected longitudinal data on the size distribution of firms for Louisville, KY for a nine-year period. In our cross-sectional analysis of medium and large markets, we find no evidence that market concentration might create problems for competition. We do find that small markets on average have higher HHI’s than medium and large markets. The longitudinal analysis reveals that many small brokers are in and out of the market, selling a house or two one year and selling zero houses the next year.HHI; real estate brokerage competition; Herfindahl-Hirschman Index

Public Policy and Health Care Choices of the Elderly: Evidence from the Medicare Buy-In Program

This study provides evidence on the economic decisions of senior citizens with respect to the largest means-tested program in the United States: the Medicaid program. Virtually all senior citizens have health insurance coverage through Medicare, but poor seniors may also be eligible for Medicaid, which fills in many of the gaps in Medicare coverage. Since 1987, the Medicaid program has undergone a series of changes relating to eligibility. In particular, two new categories of elderly Medicaid recipients, known as Qualified Medicare Beneficiaries (QMBs) and Specified Low-Income Medicare Beneficiaries (SLMBs), were created. This study uses the Survey of Income and Program Participation to explore three issues relating to the expansions. First, how much did the QMB expansions increase Medicaid eligibility? Second, how did increases in Medicaid eligibility affect supplemental insurance coverage? Finally, does increased Medicaid coverage translate into increased health care utilization? There are five principal findings. First, actual Medicaid eligibility increased dramatically, from 8 percent in 1987 to 12.5 percent in 1995. Second, the expansions for the elderly resulted in dramatically higher Medicaid take-up rates than similar expansions for children. For every 100 elderly who became eligible, 49 took it up. Nearly 30 out of 100 elderly dropped private coverage, however, resulting in crowd out of 60 percent. Third, crowd out was concentrated among the youngest of senior citizens. Fourth, crowd out came from individuals dropping privately purchased health insurance rather than dropping employer-provided retiree health insurance. Finally, Medicaid coverage increased the number of hospitalizations, though the findings on health care utilization are generally inconclusive.

How Does Occupational Licensing Affect Entry into the Medical Field? An Examination of EMTs

The COVID-19 pandemic has led to temporary suspensions of many occupational licensing laws, especially for health care professionals, in an effort to manage surges in health care demand. The crisis highlights more general concerns about occupational licensing laws, yet convincing empirical evidence on the degree to which such laws have inhibited entry into health care professions is scarce because most studies must rely on cross-sectional variation to identify such effects. In this study, we indirectly examine how occupational licensing affects the choice to become an Emergency Medical Technician (EMT) by exploiting the demand-side shock from the Affordable Care Act (ACA). Although demand-side shocks should increase the likelihood of becoming an EMT relative to other similar non-medical professions, this effect should be moderated in states with higher barriers to entry. Using a large number of individuals from the American Community Survey (ACS) who work as either EMTs or in a similar non-medical field (protective services), we find suggestive evidence that while the demand-side shock from the ACA increased the likelihood of being an EMT, this effect was substantially moderated by more stringent occupational licensing laws. Although the effect for the full sample is marginally significant, the estimated effects are substantially larger for individuals under age 40, who are presumably more flexible in choosing a career path. Evaluated at the average number of days to complete EMT training and the pre-treatment uninsured rate, the implied effects for young individuals in the most careful specification suggests virtually complete offset; the ACA demand-side shock would increase entry by 18 percentage points, while occupational licensing restrictions reduce entry by a similar magnitude