Early Effects of the Affordable Care Act on Health Care Access,Risky Health Behaviors,and Self-Assessed Health

The goal of the Affordable Care Act (ACA) was to achieve nearly universal health insurance coverage through a combination of mandates, subsidies, marketplaces, and Medicaid expansions, most of which took effect in 2014. We use data from the Behavioral Risk Factor Surveillance System to examine the impacts of the ACA on health care access, risky health behaviors, and self-assessed health after two years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from state participation in the Medicaid expansion and pre-ACA uninsured rates. Results suggest that the ACA led to sizeable improvements in access to health care in both Medicaid expansion and nonexpansion states, with the gains being larger in expansion states along some dimensions. However, we do not find clear effects on risky behaviors or self-assessed health.     

An Assessment of the Forward-Looking Hypothesis of the Demand for Cigarettes

In this article, we develop a model of the demand for cigarettes that incorporates forward-looking behavior related to the adverse health consequences of smoking and the addictive nature of cigarettes. The model results in several testable hypotheses that we use to examine the extent to which smokers exhibit forward-looking behavior. Results of our study are generally supportive of the notion that smokers behave in a forward-looking manner.     

Effect of Stress on Later-Life Health: Evidence from the Vietnam War Draft

This article contributes to the literature examining how stress during the early stages of life impacts later-life health using a novel proxy for stress: risk of military induction during the Vietnam War. The article estimates that an increase in induction risk in young adulthood is associated with higher rates of obesity, endocrine disease, and hypertension later in life. These findings do not appear to be cohort effects; these associations exist only for men who did not serve in the war, not for same-aged women. These results suggest stress experienced during early adulthood can have adverse health consequences later in life.     

The Impact of Housing Prices on Health in the United States Before,During, and After the Great Recession

We estimate the effects of U.S. Metropolitan Statistical Area housing prices on a variety of health outcomes and health-related behaviors separately for homeowners and tenants. The constructed data set consists of information on individuals from the 2002–2012 Behavioral Risk Factor Surveillance System combined with homeownership data from the March Current Population Survey and housing prices from Freddie Mac. We estimate positive effects on homeowners' mental health when housing prices increase. We also find negative effects on tenants' health and health-related behaviors with increases in housing prices. These estimated contemporaneous effects are concentrated among low-income homeowners and tenants, and the effects for tenants are not persistent in the long run. However, the cumulative effects of an increase in housing prices on obesity become more pronounced for homeowners in the long run, resulting in worse self-reported health.     

Prenatal Smoking Cessation and Infant Health: Evidence from Sibling Births

This article uses a large data set of sibling births to examine when mothers must quit smoking in pregnancy to deliver healthy babies. It applies sibling fixed effects models to provide robust evidence that smoking cessation in the first trimester has a negligible effect on infant health, but cessation as late as second trimester or smoking throughout pregnancy is associated with substantially lower birth weights and higher risks of delivering low birth weight babies. In particular, about two thirds of the total detrimental smoking impact on birth outcomes occurs in the second trimester. Therefore, reallocating resources on prenatal smoking cessation towards the first trimester can lead to a significant efficiency gain. This study also shows when the timing information of prenatal smoking cessation is improperly used, it will introduce a new nontrivial downward bias in estimating the causality between the conventionally used group measure “prenatal smoker” and infant health.     

Estimating the Associations between SNAP and Food Insecurity,Obesity, and Food Purchases with Imperfect Administrative Measures of Participation

Administrative data are considered the “gold standard” when measuring program participation, but little evidence exists on their potential problems or implications for econometric estimates. We explore these issues using the FoodAPS, a unique data set containing two different administrative measures of Supplemental Nutrition Assistance Program (SNAP) participation and a survey‐based measure. We document substantial ambiguity in the two administrative measures and show that they disagree with each other almost as often as they disagree with self‐reported participation. Estimated participation and misreporting rates can be meaningfully sensitive to choices made to resolve this ambiguity and disagreement. We explore sensitivity in regression estimates of the associations between SNAP and food insecurity, obesity, and the healthy eating index. The signs are unchanged across the three measures, and the estimates are mostly not statistically different from each other. However, there are some meaningful differences in the magnitudes and levels of statistical significance of the estimates.     

Unemployment and Health Behaviors over the Business Cycle: A Longitudinal View

We examine the first-order internal effects of unemployment and nonemployment on a range of health behaviors during the most recent recession using longitudinal data from the Panel Study of Income Dynamics and the National Longitudinal Survey of Youth-1979. Ours is the first study to analyze the effect of own-unemployment on energy intake, energy expenditure, and the net effect (body mass index) using longitudinal records. Exploiting information enveloping the recent steep recession and prolonged recovery is valuable since recent job losers will modify their behavior little if they expect soon to be re-employed, whereas if they expect joblessness to last, they will adjust to a possibly prolonged decline in income and increase in nonwork time. We find that becoming unemployed is associated with a small increase in leisure-time exercise, a moderate decrease in smoking, and a substantial decline in total physical activity. We also find that unemployment and nonemployment are associated with a decline in purchases of fast food. Together, these results imply that both energy consumption and expenditure may decline in the United States during recessions, the net result being essentially no change in body weight. There is considerable heterogeneity in these effects across specific health behaviors, across the intensive and extensive margins, across the outcome distribution, and across gender.     

Identifying the Link Between Food Security and Incarceration

Previous work has found that incarceration (defined as confinement in an adult correctional facility) has a variety of impacts on the incarcerated individual and their families including effects on employment and income, educational outcomes of children, and food insecurity (Wallace and Cox 2012 ). However, previous literature does not identify a causal impact of incarceration on food insecurity. From a policy perspective, identification of a causal link may aid in understanding why some affected families experience food insecurity, while similarly situated families do not. In this article, we utilize microlevel data from the Fragile Families and Child Well Being Study to provide evidence of a causal impact of incarceration on food insecurity. This is an important dynamic to understand because the prevalence of incarceration in the United States is relatively high, especially among groups where food insecurity is more prevalent (e.g., Blacks), and the associated externalities can have substantial impacts on families that may reach well beyond traditional costs associated with incarceration. The complex relationship between food insecurity and incarceration is estimated within a causal inference approach. We find evidence that incarceration leads to roughly a 4 percentage point increase in the likelihood of food insecurity among households with children that have experienced a parental incarceration.     

Intergenerational Inequality and the Contract Out Policy in Public Health Care

This study investigates the impact of a Japanese public health care reform—called the contract out policy—on intergenerational inequality and the probability of a surplus in medical saving accounts. First, I investigate the change in the lifetime net burdens for each generation and public health expenditures and conduct simulation analyses to consider the effects of contracting out public health insurance on intergenerational inequality using the generational accounting method. Next, I simulate the probability of a surplus in medical savings accounts using the transition probability of health care expenses based on individual health data, such as receipt data. According to the simulation results, the net lifetime burden on future generations after contracting out shows a 1% reduction compared to the base case, which is not implemented in public health care reform. In addition, the probability of medical savings accounts remaining in surplus, including cases of zero medical expenses, is 69.6%.     

The Wage Elasticity of Informal Care Supply: Evidence from the Health and Retirement Study

This article focuses on the wage elasticity of informal care supply to elderly parents employing an instrumental variable approach to account for the fact that the wage rate is likely to be correlated with omitted variables. Using the 1998 wave of the 1998 ), the wage elasticity of informal care supply is estimated to be negative and larger in magnitude than found previously. The lower bound of this elasticity is estimated to be ?1.8 for males and ?3.6 for females. Additional findings suggest that this wage elasticity differs by the type of care provided to elderly parents and that it is larger in magnitude among individuals with siblings and those with independently living parents. Overall the reductions in the informal care constitute about 18% of the labor supply response for men and about 56% of the labor supply response for women, which are not compensated by monetary transfers.     

新疆农村医疗卫生事业供求状况的实证分析

改革开放以来新疆经济社会发生了巨大变化,但是主要依靠市场机制、实行经济效率优先的经济体制改革也造成了严重的社会经济发展的不均衡。特别是新疆农村医疗卫生事业的发展远远落后于城市,公共财政对农村医疗卫生的支持不足是重要因素。因此,通过对新疆农村医疗卫生财政支持现状的分析,可以为今后政府的公共决策提供依据和参考。