Research In Progress
Unintended Consequences of Health Insurance: ACA’s Free Contraception Mandate and Risky Sex
Given current levels of health spending, distortions from insurance are vitally important. I examine insurance’s effect on risky sex, a behavior with quick, meaningful negative results. Leveraging mandated zero cost-sharing for contraception and pre-policy insured rates as a measure of treatment intensity, I find this policy reduced fertility but caused unintended consequences: decreased prevention and increased STIs. I discuss the imperfections of controlling for pre-trends using state-trends in difference-in-differences and suggest approaches to control for pre-trends directly. I use the 2010 dependent coverage mandate to examine the overall effect of insurance and find protective net effects of insurance on STIs.
The Impact of Information Disclosure on Consumer Behavior: Evidence from a Randomized Field Experiment of Calorie Labels on Restaurant Menus
The impact of information on consumer behavior is a classic topic in economics, and there has recently been particular interest in whether providing nutritional information leads consumers to choose healthier diets. For example, a nationwide requirement of calorie counts on the menus of chain restaurants took effect in the U.S. in May, 2018, and the results of such information disclosure are not well known. To estimate the impact of menu labeling, we conducted a randomized controlled field experiment in two full-service restaurants, in which the control group received the usual menus and the treatment group received the same menus but with calorie counts. We estimate that the labels resulted in a 3.0% reduction in calories ordered, with the reduction occurring in appetizers and entrees but not drinks or desserts. Exposure to the information also increases consumers’ support for requiring calorie labels by 9.6%. These results are informative about the impact of the new nationwide menu label requirement, and more generally contribute to the literature on the impact of information disclosure on consumer behavior. NBER Working Paper No. 24889 (with J. Cawley and A. Susskind)
The Long-Run Effects of Student Aid on Health: Leveraging Changes in Social Security Benefits
I investigate the effect of financial aid on health, specifically BMI and general self-report health. Aid lowers the cost of college, which increases college-going. However, there is little evidence on the long-run impact of aid on health. I exploit a 1981 shock in Social Security benefits to test the effect of aid on health. Minor children of retired or disabled Social Security beneficiaries and children with deceased parents are eligible for their own benefits, and before 1981 these children could receiving benefits conditional on college enrollment. Using difference-in-differences, I show benefits for college students reduced women’s BMI and improved general health, but had no effect on men. I also find that aid improved educational attainment for beneficiaries, which is a plausible mechanism between aid and health.
Rebates as Incentives: The Effects of a Gym Membership Reimbursement Program
Can financial incentives induce healthy behaviors? We examine this question by evaluating a large-scale wellness program at a major American university. The program offers gym membership reimbursements for students who attend the gym at least 50 times in a six-month period. Our analysis exploits individual-level administrative data on daily gym attendance for the universe of students over a five-year period: the three years that the policy was in place, one year before implementation, and one year after termination. This provides us with 100,000 student-year observations and 1.5 million gym visits. Using a combination of bunching methods and difference-in-difference strategies, we provide four empirical results. First, we document significant bunching at the 50-visit threshold in years when the policy is in place. Second, we show that this effect translates into a statistically significant and economically meaningful increase in gym attendance: the program increased average gym visits by almost five visits per semester, a 20% increase from the mean. Third, we show that the policy not only motivated students who were previously near the threshold, but that it increased attendance across the entire visit distribution. Finally, we show that approximately 50% of the program effect persists after program termination, providing evidence of habit formation. Taken together, these results suggest that rebate-framed incentives with a high attendance threshold can successfully induce healthy behaviors in the short-term, and also create new habits in the long-run.
(with Tatiana Homonoff and Alexander Willén)
Estimating the Health Impacts of WIC: A Regression Discontinuity Approach
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one of the most widely used food assistance programs in the U.S. We estimate regression discontinuity models that leverage sharp changes in program benefits and eligibility in order to examine effects of the program on a wide range of health and nutrition outcomes. We focus on the effects of WIC on infants and children; on spillover effects from targeted children to other family members; and on the effects of changes in the composition and delivery of program benefits.
(with M. Bitler, J. Currie, H. Hoynes, & L. Schulkind)
Non-Monetary Obstacles to Medical Care: Evidence from Postpartum Contraceptives
Since 2012, state Medicaid agencies have begun to offer increased reimbursement for inpatient postpartum long-acting reversible contraception (LARC). The reimbursement has come in the form of unbundling the device payment from the global hospital payment, i.e. reimbursing the hospital specifically for the insertion of LARC. We use variation across states and time to determine how the increased payments affect LARC use, fertility, and adverse birth outcomes. Preliminary event studies indicate a slight decrease in fertility, as well as a decrease in pre-term delivery among unmarried and teenage mothers. Consistent with our hypothesis, these effects are concentrated among women who have previously given birth.
(with M. Carlos)
The Effect of Weight on Mental Health: New Evidence Using Genetic IVs
The causal effect of obesity on mental health has been largely ignored by economists. Using genetic variation in obesity predisposition, I instrument for BMI to determine the impact on measures of suicidality and depression. I find an effect of BMI on suicidal ideation but not other measures of mental health. This effect on suicidal ideation is concentrated in white women. Social stigma is the mechanism through which weight affects mental health.
Pass-Through of a Tax on Sugar-Sweetened Beverages at the Philadelphia International Airport
Taxes on sugar-sweetened beverages have been proposed as a possible approach to prevent obesity and improve diets. A goal of the taxes is to increase prices and dissuade consumption, but the taxes are levied on beverage distributors, and it is unclear how much of the tax is passed through to consumers as higher retail prices vs being paid by distributors or manufacturers. We estimate the extent to which the tax of 1.5 cents/oz. on SSBs in Philadelphia (implemented on Jan. 1, 2017) raised retail prices.
(with J. Cawley and D. Frisvold)