Laura Wherry

This paper explores the impact of receiving a diagnosis of type 2 diabetes among patients who are close to the diagnostic threshold using a regression discontinuity design. Using data from a large national insurer, we find that a marginally diagnosed patient with diabetes spends $1,097 more on drugs and diabetes-related care annually after diagnosis. This increase in spending persists over the 6-year period we observe the patients, despite many who are not initially diagnosed receiving a later diagnosis during this time frame. These marginally diagnosed patients experience improved blood sugar after the first year of diagnosis. However,  this improvement is not statistically significant in subsequent years,  and in some post-test years our confidence intervals rule out any improvement in this measure. Other clinical measures of health, cholesterol and mortality, do not change significantly at the cutoff, although our confidence intervals include meaningfully-sized effects. The diagnosis rates for preventable dise     ase-related conditions such as diabetic retinopathy, neuropathy, and kidney disease increase following a diagnosis, likely due to more intensive screening.           

This paper evaluates the financial and economic consequences of being denied an abortion. We link credit report data to the Turnaway Study, which collected high-quality, longitudinal data on women receiving or being denied a wanted abortion in the United States. We compare financial outcomes over a ten-year period for women who had pregnancies just above and below a gestational age limit allowing for a wanted abortion. Outcomes evolved similarly for the two groups prior to the abortion encounter. Following the encounter, women who were denied an abortion experience a large increase in financial distress that remains for several years.

We examine multigenerational impacts of positive in utero health interventions using a new research design that exploits sharp increases in prenatal Medicaid eligibility that occurred in some states. Our analyses are based on US Vital Statistics natality files, which enables linkages between individuals' early life Medicaid exposure and the next generation's health at birth. We find evidence that the health benefits associated with treated generations' early life program exposure extend to later offspring. Our results suggest that the returns on early life health investments may be substantively underestimated.

The Affordable Care Act (ACA) Medicaid expansions increased preconception and postpartum insurance coverage among low-income birthing people, leading to greater use of outpatient care. In this study we evaluated whether the expansions affected rates of postpartum hospitalization. Our analyses took advantage of underused longitudinal hospital data from the period 2010–17 to examine hospitalizations after childbirth. We compared changes in hospitalizations among birthing people with a Medicaid-financed delivery in states that did and did not expand Medicaid under the ACA. We found a 17 percent reduction in hospitalizations during the first sixty days postpartum associated with the Medicaid expansions and some evidence of a smaller decrease in hospitalizations between sixty-one days and six months postpartum. Our findings indicate that expanding Medicaid coverage led to improved postpartum health for low-income birthing people.

Kaestner (2021) asserts that the analysis of Miller, Johnson, and Wherry (2021) lacks statistical power to uncover mortality effects. However, the power calculations provided by Kaestner (2021) contain several implementation errors. Furthermore, Kaestner (2021) relies on implausible assumptions to interpret the results. In this response, we show that the analysis conducted in Miller, Johnson, and Wherry (2021) is well-powered to detect reasonably-sized effects once these errors are corrected and more realistic assumptions are used for interpretation.

This article estimates changes in all-cause mortality due to the COVID-19 pandemic by socioeconomic characteristics and occupation for nonelderly adults in the US, using large-scale, national survey data linked to administrative mortality records. Mortality increases were largest for adults living in correctional facilities or in health care–related group quarters, those without health insurance coverage, those with family incomes below the federal poverty level, and those in occupations with limited work-from-home options. For almost all subgroups, mortality increases were higher among non-Hispanic Black respondents than among non-Hispanic White respondents. Hispanic respondents with health insurance, those not living in group quarters, those with work-from-home options, and those in essential industries also experienced larger increases in mortality during the COVID-19 crisis compared with non-Hispanic Whites in those categories. Occupations that experienced the largest mortality increases were related to installation, maintenance, and repair and production. This research highlights the relevance of individual economic, social, and demographic characteristics during the COVID-19 crisis.

We use large-scale federal survey data linked to administrative death records to investigate the relationship between Medicaid enrollment and mortality. Our analysis compares changes in mortality for near-elderly adults in states with and without Affordable Care Act Medicaid expansions. We identify adults most likely to benefit using survey information on socioeconomic status, citizenship status, and public program participation. We find that, prior to the ACA expansions, mortality rates across expansion and non-expansion states trended similarly, but beginning in the first year of the policy, there were significant reductions in mortality in states that opted to expand relative to non- expanders. Individuals in expansion states experienced a 0.132 percentage point decline in annual mortality, a 9.4 percent reduction over the sample mean, as a result of the Medicaid expansions. The effect is driven by a reduction in disease-related deaths and grows over time. A variety of alternative specifications, methods of inference, placebo tests, and sample definitions confirm our main result.

The period before pregnancy is critically important for the health of a woman and her infant, yet not all women have access to health insurance during this time. We evaluated whether increased access to health insurance under the Affordable Care Act Medicaid expansions affected ten preconception health indicators, including the prevalence of chronic conditions and health behaviors, birth control use and pregnancy intention, and receipt of preconception health services. By comparing changes in outcomes for low-income women in expansion and nonexpansion states, we document greater preconception health counseling, prepregnancy folic acid intake, and postpartum use of effective birth control methods among low-income women associated with Medicaid expansion. We do not find evidence of changes on the other preconception health indicators examined. Our findings indicate that expanding Medicaid led to detectable improvements on a subset of preconception health measures.

Some states have not adopted the Affordable Care Act (ACA) Medicaid expansions due to concerns that the expansions may impair access to care and utilization for those who are already insured. We investigate such negative spillovers using a large panel of Medicare beneficiaries. Across many subgroups and outcomes, we find no evidence that the expansions reduced utilization among Medicare beneficiaries and can rule out all but very small changes in utilization or spending. These results indicate that the expansions in Medicaid did not impair access to care or utilization for the Medicare population.

We provide a brief overview of the Turnaway Study, the first study to collect longitudinal data on individual women who received versus were denied a wanted abortion in the United States. The study team collected data on nearly 1,000 women seeking an abortion from 30 facilities around the country and followed them for 5 years. We discuss some of the main findings from the study related to the health, labor, and human capital outcomes of the women who were denied abortions and gave birth. We conclude by describing future opportunities to learn from the study with new linkages to administrative data.

A growing body of literature examining the effects of the Affordable Care Act (ACA) on nonelderly adults provides promising evidence of improvements in health outcomes through insurance expansions. Our review of forty-three studies that employed a quasi-experimental research design found encouraging evidence of improvements in health status, chronic disease, maternal and neonatal health, and mortality, with some findings corroborated by multiple studies. Some studies further suggested that the beneficial effects have grown over time and thus may continue to grow if the ACA insurance expansions remain in force. However, not all studies reported a significant positive relationship between ACA provisions that expanded insurance coverage and health status. We highlight the challenges facing researchers, including the importance of nonmedical factors in determining individual health and the use of outcome data predominantly drawn from self-reports. In closing, we identify opportunities to enhance researchers' understanding of the relationship between the ACA insurance expansions and health outcomes using new data sources, including electronic health records.