Income is a powerful predictor of health among the elderly, but existing research has struggled to disentangle the direct causal effect of income on health. In this paper, I estimate the causal effect of Social Security income on health care utilization and health outcomes among elderly men. Using Medicare administrative records and a regression discontinuity design, I exploit several changes in the Social Security benefit formula that vary abruptly by date of birth – variation which has been overlooked by previous research. I find that increases in Social Security income reduces Medicare utilization across a variety of health care settings. I estimate a 1% increase in Social Security income causes a 0.9% decline in payments for Medicare covered services. I also find declines in diagnoses for chronic conditions and mortality. My results highlight the importance of examining health outcomes when evaluating the costs and benefits of social insurance programs.
The Effect of Dual Eligibility on Health Care Access and Health Outcomes (work in progress)
The Qualified Medicare Beneficiary (QMB) program accounts for 34% of Medicare spending and includes among the least healthy, most expensive patients in the United States. QMB beneficiaries are exempt from Medicare cost-sharing and premiums, but QMB providers face administrative burdens and lower reimbursement rates. Given these offsetting features, the effectiveness of the program is unclear. This paper provides the first quasi-experimental evaluation of the QMB program by studying an expansion which tripled program enrollment in Connecticut in 2009. Using a synthetic control design and detailed Medicare administrative data, I estimate the causal effect of QMB enrollment on health care access and health outcomes.
Measuring Fiscal Impetus: The Great Recession in Historical Context (with Leslie McGranahan), Economic Perspectives, 2014
Although there are vast literatures evaluating particular fiscal interventions, policymakers lack an indicator that describes the fiscal stance across all government sectors. In this paper, we create a comprehensive measure of fiscal policy called fiscal impetus. Our measure describes how purchases, taxes, and transfers across all levels of government affect growth. We use this measure of fiscal impetus to examine how fiscal policy has behaved during business cycles in the past, how it responded to the most recent recession, and how it is likely to evolve over the next several years. Our analysis reveals that policy was more expansionary than average during the 2007 recession and has been significantly more contractionary than average during the recovery. By the end of 2012, fiscal impetus was below its historical business cycle average and it is forecast to remain depressed well into the future.