Chapter 1: Intertemporal Substitution in Response to Non-Linear Health Insurance ContractsHealth insurance contracts with high annual deductibles have become increasingly popular in the U.S. This feature of insurance contracts allows consumers to substitute healthcare in one period for healthcare in another period by, for example, increasing consumption in the year the annual deductible was met and decreasing future consumption. I obtain an estimate of the causal effect of meeting the deductible on healthcare consumption in the following year. I exploit variation in the timing of an injury that generates significant healthcare expenses and a regression discontinuity design to identify the effect of meeting the deductible. Data for the analysis are from the Marketscan database of medical claims on privately insured individuals at large firms. Estimates indicate that there is intertemporal substitution in healthcare consumption. Reaching the coinsurance arm in one year leads to $13,263 less healthcare consumed, $788 less paid out of pocket, and 7.4 fewer care dates in the following year. For those induced to consume more healthcare by reaching the coinsurance arm of their plan, I find that for every dollar of discretionary healthcare consumed in the year the coinsurance arm is reached, roughly $0.56 less is consumed in the following year. Chapter 2: Postpartum Medicaid Eligibility Expansions and Postpartum Health Measures (with Claire Margerison) Maternal mortality and morbidity in the US are high compared to similar countries, and racial/ethnic disparities exist, with many of these events occurring in the later postpartum period. Proposed federal and recently enacted state policy interventions extend pregnancy Medicaid from covering 60 days to a full year postpartum. This work estimates the association between maintaining Medicaid eligibility in the later postpartum period (relative to only having pregnancy Medicaid eligibility) with postpartum checkup attendance and depressive symptoms using regression analysis, overall and stratified by race/ethnicity. People with postpartum Medicaid eligibility were 1.0-1.4% more likely to attend a postpartum checkup relative to those with only pregnancy Medicaid eligibility overall, primarily driven by a 3.8-4.0% higher likelihood among Hispanic postpartum people. Conversely, postpartum Medicaid is associated with a 2.2-2.3% lower likelihood of postpartum checkup attendance for Black postpartum people. Postpartum eligibility is also associated with a 9.7-11.6% lower likelihood of self-reported depressive symptoms compared to only pregnancy Medicaid eligibility for white postpartum people only. Postpartum Medicaid eligibility is associated with some improvements in maternal health care utilization and mental health, but differences by race and ethnicity imply that inequitable systems and structures that cannot be overcome by insurance alone may also play an important role in postpartum health. Chapter 3: The Effects of State Medical Amnesty Policies on Alcohol Use Medical Amnesty policies (MAP) eliminate legal consequences relating to underage drinking when minors seek emergency assistance. I exploit the variation in state policy enactment in a difference-in-differences framework to examine the effects of MAP on alcohol use. Data on self-reported drinking behaviors for 18–20-year-old comes from the 2011-2018 Behavioral Risk Factor Surveillance System. Using 95% confidence intervals, my results can rule out increases larger than 3.5 and 3.3 percentage points for drinking and binge drinking, respectively. My main results support the conclusion that there is no significant long-term increase in underage drinking behaviors due to state MAP implementations.
Read
