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In the first chapter of this dissertation, I study the effect of child support health insurance mandates on children's health insurance coverage. Children are more likely to lose health insurance when their parents divorce or separate, which is problematic because lack of health insurance is associated with reduced preventive care, diagnosis of diseases at later stages, and higher mortality. In order to increase coverage for children and reduce costs associated with public health insurance, many states have passed child support laws which mandate that a parent provide health insurance for the children if it is available at a reasonable cost. This paper is the first to evaluate the impact of these statutes on the number of children who lose health insurance due to parental divorce or separation. I codify the relevant laws by state and year from 1990 through 2007 in terms of the presence of mandates and the number and type of enforcement mechanisms. These variables are then linked to panels of the Survey of Income and Program Participation (SIPP), which provide the remainder of the necessary variables. Three main regressions are estimated. The first measures the overall effect of child support health insurance mandates on children's insurance coverage. The second equation measures the first intermediate step, whether child support health insurance mandates result in an order in the child support agreement to provide health insurance. The third equation measures the second intermediate step, whether an order for the parents to provide health insurance results in insurance coverage for children. I find that child support laws requiring parents to provide health insurance do not significantly impact the presence or type of health insurance coverage for children of divorced or separated parents. Additionally, these laws do not increase the probability that the child support agreement contains an order to provide health insurance, and an order to provide health insurance does not increase the probability of either any coverage or private coverage. In the second paper, we study the relationship between divorce and health insurance. Changing marital status is an important source of health insurance change. However, neither the health nor family economics literatures have examined this phenomenon. Using the SIPP, we document how health insurance status changes over time for men, women, and children as divorce and separation occur, as well as the likely causes of these changes. We find modest changes in overall coverage, but these changes mask large changes in type of coverage as people divorce or separate. In the third paper, we look at the effects of government aid expansions on labor market outcomes. While many studies investigate the magnitude by which public insurance expansions 'crowdout' private coverage, we ask a question new question: are such families able to recoup the benefits of no longer relying on employer provided coverage for children when they move to public coverage? Our findings from the SIPP do not show noticeable improvements, though our findings from the Current Population Survey (CPS) show a positive and significant effect on income and hourly wages.
Chapter 1 studies the role of Unemployment Insurance (UI) in preventing the children of benefit recipients from dropping out of school. Parental job loss has been associated with a number of negative educational outcomes for the children of job losers. In this paper, I investigate whether Unemployment Insurance (UI) can mitigate some of these deleterious effects. I find evidence that more generous UI benefits available to parents are associated with a lower probability of their children dropping out of high school. Chapter 2 considers the relationship between local economic conditions and health. Using data from all California hospitalizations from 1990 to 2011, I investigate how hospitalization rates are affected by the business cycle. I find that health, as proxied by hospitalizations, is counter-cyclical. Most of the estimated effects, however, are driven by groups not strongly attached to the labor force, such as the elderly and those covered by Medicare. Chapter 3 examines the interaction between special education programs and child Social Security Income caseloads. Between 1990 and 2007, child SSI caseloads grew by 263%. Much of this increase is unexplained. In this paper, we explore the role played by fiscal incentives for classifying children as special education embedded in state school finance formulas. We exploit variation in fiscal incentives across school districts in Texas, and find evidence that larger fiscal incentives are associated with higher rates of SSI participation among children. Our results emphasize that heterogeneity in child outcomes across localities depend on complicated interactions between schools and social safety net programs within our federalist system.
"Empirical work shows that health insurance coverage improves children's health and that healthier children have better educational and labor market outcomes. This suggests that the benefits of higher insurance rates among children go beyond improvements in health. However, there are no investigations in the United States that track the long-term socioeconomic benefits of health insurance coverage during childhood. Using data from the Children of the National Longitudinal Survey of Youth to estimate family fixed effects models, I find evidence that health insurance coverage at ages 0-4 has a positive effect on test scores in mathematics, reading recognition, reading comprehension, and vocabulary at ages 5-14. The second essay in this dissertation, co-authored with Charles Courtemanche, investigates the effect of the Massachusetts health care reform on self-reported health. The main objective of this reform was to achieve universal health insurance coverage through a combination of insurance market reforms, mandates, and subsidies. This reform was later used as a model for the Patient Protection and Affordable Care Act (ACA). Using individual-level data from the Behavioral Risk Factor Surveillance System and a difference in differences estimation strategy, this essay provides evidence that this reform led to better overall self-assessed health. Several determinants of overall health, including physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity also improved. Public food assistance programs share the fundamental goal of helping needy and vulnerable people in the U.S. obtain access to nutritious foods that they might not otherwise be able to afford. These programs also have other objectives, such as improving recipients' health, furthering children's development and school performance. To investigate these broader impacts, the third chapter of this dissertation, co-authored with David Ribar, examines the relationship between participation in food assistance programs, family routines and time use. Results from fixed effects models estimated using longitudinal data from the Three-City Study indicate that SNAP participation is negatively associated with homework routines. WIC participation on the other hand, is positively associated with family routines in general and with dinner routines, homework routines, and family-time routines in particular."--Abstract from author supplied metadata.
This book provides a comprehensive examination of the legal regulation of the provision of healthcare to young children in England and Wales. A critical analysis is given on the law governing the provision of healthcare to young and dependent children identifying an understanding of the child as vulnerable and in need of protection, including from his or her own parents. The argument is made for a conceptual framework of relational responsibilities which would ensure that consideration is given to the needs of the child as an individual, to the experiences of parents gained as they care for their child and that the wider context, such as attitudes towards disability, public health issues or the support and resources available, is examined. This book makes an important contribution to understanding the law regulating the provision of healthcare to young and dependent children and to the development of a discourse of responsibility.
This dissertation is comprised of two essays examining expansions in eligibility for public health insurance in the U.S. In the first essay, I focus on expanded eligibility for family planning services under Medicaid and the impact on fertility and the utilization of women's preventive care. In the second essay, which is joint work with Bruce D. Meyer, we examine the immediate and longer-term mortality effects of Medicaid eligibility expansions for children. Both of these papers use variation in public health insurance eligibility created by changes in federal or state eligibility rules to identify a causal relationship between public coverage and health-related outcomes.
Children's health has clearly improved over the past several decades. Significant and positive gains have been made in lowering rates of infant mortality and morbidity from infectious diseases and accidental causes, improved access to health care, and reduction in the effects of environmental contaminants such as lead. Yet major questions still remain about how to assess the status of children's health, what factors should be monitored, and the appropriate measurement tools that should be used. Children's Health, the Nation's Wealth: Assessing and Improving Child Health provides a detailed examination of the information about children's health that is needed to help policy makers and program providers at the federal, state, and local levels. In order to improve children's health-and, thus, the health of future generations-it is critical to have data that can be used to assess both current conditions and possible future threats to children's health. This compelling book describes what is known about the health of children and what is needed to expand the knowledge. By strategically improving the health of children, we ensure healthier future generations to come.
America's Children is a comprehensive, easy-to-read analysis of the relationship between health insurance and access to care. The book addresses three broad questions: How is children's health care currently financed? Does insurance equal access to care? How should the nation address the health needs of this vulnerable population? America's Children explores the changing role of Medicaid under managed care; state-initiated and private sector children's insurance programs; specific effects of insurance status on the care children receive; and the impact of chronic medical conditions and special health care needs. It also examines the status of "safety net" health providers, including community health centers, children's hospitals, school-based health centers, and others and reviews the changing patterns of coverage and tax policy options to increase coverage of private-sector, employer-based health insurance. In response to growing public concerns about uninsured children, last year Congress voted to provide $24 billion over five years for new state insurance initiatives. This volume will serve as a primer for concerned federal policymakers and regulators, state agency officials, health plan decisionmakers, health care providers, children's health advocates, and researchers.
The strengths and abilities children develop from infancy through adolescence are crucial for their physical, emotional, and cognitive growth, which in turn help them to achieve success in school and to become responsible, economically self-sufficient, and healthy adults. Capable, responsible, and healthy adults are clearly the foundation of a well-functioning and prosperous society, yet America's future is not as secure as it could be because millions of American children live in families with incomes below the poverty line. A wealth of evidence suggests that a lack of adequate economic resources for families with children compromises these children's ability to grow and achieve adult success, hurting them and the broader society. A Roadmap to Reducing Child Poverty reviews the research on linkages between child poverty and child well-being, and analyzes the poverty-reducing effects of major assistance programs directed at children and families. This report also provides policy and program recommendations for reducing the number of children living in poverty in the United States by half within 10 years.