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Social Insurance Programs and Health Outcomes

Paper Session

Friday, Jan. 5, 2024 8:00 AM - 10:00 AM (CST)

Grand Hyatt, Independence
Hosted By: Health Economics Research Organization
  • Chair: Hilary Hoynes, University of California-Berkeley

Determinants and Effects of WIC Rollout: Evidence from Newly Digitized Data from the National Archives

Marianne Bitler
University of California-Davis
Maria Rosales-Rueda
Rutgers University-Newark


The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides eligible low-income, nutritionally at-risk postpartum and pregnant women, infants, and children under age five with nutritious food. The WIC program was created during the War on Poverty in the 1970s, with the first clinic opening in January 1974.
Previous work by Hoynes, Page, and Stevens (2011) examined the effect of WIC adoption on birth outcomes using two-way fixed effects models. We have augmented their rollout data with extensive new data from the National Archives on State WIC plans through 1980, allowing us to detect with more granularity when-and-where WIC was implemented. We also bring new methods to deal with detecting pre-trends and obtaining estimates that are robust to treatment effect heterogeneity across places and over time.
We find robust evidence that access to WIC in a mother’s county of residence by the second trimester leads to higher birth weight and a reduction in the probability of low birthweight mainly for black mothers. We find that exposure to WIC increases birth weight by around 5.3 grams, while it decreases the probability of low birth weight by 1.5% of the mean. We roughly convert these to treatment on the treated estimates by inflating by the national participation rate in 1979, 8.6 percent of pregnant women obtained WIC. This suggests treatment on the treated effects on the order of 62 grams, which is clearly economically meaningful. These results hold whether we focus on standard two-way fixed-effect models or newer approaches to deal with treatment effect heterogeneity (e.g., Sun and Abraham, 2021). The sizes of the intent-to-treat effects are similar to those for Food Stamps for Blacks found by Almond, Hoynes, and Schanzenbach (2011). Effects for whites are smaller and in some specifications, not statistically significant. Ongoing work

In-Kind Welfare Benefits and Reincarceration Risk: Evidence from Medicaid

Laura Dague
Texas A&M University


Of the 600,000 persons returning to the community from state and federal prisons each year in the US, more than 44% are re-arrested within one year. Most adults who serve prison sentences carry substantial debt, have low income and relatively low education, and limited formal employment experience prior to entering prison. Reentry into the community is characterized by a high incidence of adverse outcomes for individuals and their communities - financial hardship, morbidity and mortality, and re-offense. Medicaid coverage, as a means-tested transfer program providing subsidized health insurance, may influence reincarceration through both financial and health channels. In this paper, we provide a comprehensive look at the effects of public health insurance coverage on the post-release behavior of formerly incarcerated adults. We study a natural experiment in which two separate state policy changes resulted in a 60 percentage point increase in Medicaid enrollment at the time of release. Using a series of individual level linked administrative datasets, we estimate the effects of this large change in Medicaid enrollment on reincarceration, employment and health care use. We find resulting declines in reincarceration at 6 months, increased employment, and increased health care use. We then leverage data from the population about their financial concerns and need for mental health and substance use treatment to examine financial and health channels as explanatory mechanisms by which Medicaid enrollment may influence reincarceration. We find weak support for the hypothesis that Medicaid’s effect on reincarcerations operate through a health channel, and if so, it is driven by mental health rather than substance use treatment; instead, our findings more strongly indicate that Medicaid enrollment’s effect on reincarceration operates through the provision of financial security, consistent with a growing body of evidence in the general population.

The Impact of Losing Childhood Supplemental Security Income Benefits on Long-Term Education and Health Outcomes

Priyanka Anand
George Mason University


Many youth with disabilities rely on Supplemental Security Income (SSI) as an important source of income for their families, but they must go through a redetermination process at age 18 if they are to continue receiving those benefits into adulthood. Our project uses data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine the long-term impact of losing child SSI after turning 18 years old, due to the 1996 welfare reform, on education and health. We compare the long-term outcomes of those who turned 18 just after August 1996 with those who turned 18 just before given that the reform increased the strictness of medical reviews for 18-year old beneficiaries. Because the respondents are in their 30s and 40s in the later waves of the survey, we also examine the outcomes of their children. We find that losing SSI benefits results in a decrease in educational attainment; specifically, those who were likely to lose SSI are less likely to attend college and have fewer years of education than those who were less likely to lose their benefits. We also find suggestive evidence of worse health outcomes for the children of those who were likely to lose their SSI benefits. Our findings suggest that lower educational attainment caused by losing SSI may be contributing towards long-term labor market outcomes and that the negative impact of losing SSI benefits may continue into the next generation.

Becoming Dual: Measuring the Impact of Gaining Medicaid Coverage for Medicare Beneficiaries

Gina Li
Stanford University


I study the effect of having dual public health insurance coverage on healthcare utilization among US patients. Specifically, I focus on Medicare beneficiaries who gain additional Medicaid coverage, which eliminates out-of-pocket costs for healthcare services. While the lower cost may increase patients' demand for healthcare, I identify a countervailing force: providers are less willing to treat Medicaid patients due to lower reimbursement rates and higher administrative burdens. Using administrative Medicare claims data and variation from a substantial expansion in dual-Medicaid eligibility in the state of Connecticut, I find that dual enrollment increases patients' total health care utilization by 51 percent, and that much of this increase is driven by a higher use of the emergency department (83 percent increase at the sample mean). At the same time, dual enrollment leads to a 24 percent decline in the number of outpatient physician visits, especially for preventive care. I demonstrate that the decline in outpatient care is concentrated among providers with a low share of Medicaid patients. My findings thus demonstrate the unintended consequences of policies that increase enrollment in dual-Medicaid among patients without changing provider side constraints regarding their willingness to treat Medicaid patients. More broadly, my results speak to the role of the interaction between Medicare and Medicaid -- the two primary public health insurance programs in the US -- in driving access to care and healthcare spending.

Katherine Meckel
University of California-San Diego
Michael Mueller-Smith
University of Michigan
Melissa McInerney
Tufts University
Yulya Truskinovsky
Wayne State University
JEL Classifications
  • I3 - Welfare, Well-Being, and Poverty
  • H4 - Publicly Provided Goods