In 2014, the Affordable Care Act (ACA) extended more affordable health insurance coverage options to millions of American families. Building on earlier efforts under the Children’s Health Insurance Program Reauthorization Act of 2009, which expanded children’s eligibility for public coverage and simplified enrollment processes, several ACA provisions had the potential to further increase coverage rates for children. In this brief, we explore changes in coverage among children in recent years using data from the National Health Interview Survey. We focus on changes by state Medicaid expansion status, age group, and race and ethnicity. We find the following:  The uninsurance rate for all children fell from 8.3 percent in 2010 to 5.3 percent in 2017.  Children in expansion states experienced a decline in the uninsurance rate from 6.1 percent in 2013 to 4.0 percent in 2015 and sustained these gains through 2017. The uninsurance rate for children in nonexpansion states dropped from 8.6 percent in 2013 to 6.0 percent in 2015 but then increased to 7.8 percent in 2017.

This dissertation includes three chapters on the health insurance markets established by the Affordable Care Act (ACA), known as exchanges. Chapter 1 estimates the demand for each plan in the California exchange using a discrete choice model. The model incorporates heterogeneity in consumer preferences and in product characteristics, including hospital and primary care physician (PCP) networks. Endogeneity of prices is addressed using networking hospital costs as instruments, and prices for any given plan can vary across consumers within a market. Consumers are highly sensitive to prices, with market shares declining by 3%-5% for just a $1 increase in the premium. Demand also responds to hospital and PCP networks, but to a relatively small degree. Along the take-up margin, a $1 increase in premium subsidy increases take-up by 1.4%. Chapter 2 uses a structural model of demand and supply to examine how two insurance market regulations--community rating and risk adjustment--affect prices and enrollment in the ACA exchange in California. Without risk adjustment, community rating in the ACA would lead to a significant reduction in enrollment in desirable plans and in take-up overall. Risk adjustment under the ACA roughly restores relative shares across plans to what they would be without community rating; however, the reduction in take-up is not restored. An alternative risk adjustment method can increase enrollment by 3.0% and would have little impact on government spending. Chapter 3, written jointly with Isaac Menashe and Wesley Yin, examines the impact of information on insurance take-up in the ACA. We exploit experimental variation in the information mailed to 87,000 households in California's exchange to study the role of frictions in insurance take-up. We find that a basic reminder of the enrollment deadline raised enrollment by 1.4 pp (or 16 percent). Compared to the reminder alone, also reporting personalized subsidy benefits increases take-up among low-income individuals, but decreases take-up among higher-income individuals. This is despite reminder-only recipients eventually observing their subsidies before purchase. Finally, the letter interventions induced healthier individuals into the market, lowering aggregate spending risk by 5.9 percent, suggesting these interventions can improve both enrollment and average market risk.

This article reports a benefit-cost evaluation of the Accelerated Study in Associate Programs (ASAP) of the City University of New York (CUNY). ASAP was designed to accelerate associate degree completion within 3 years of degree enrollment at CUNY's community colleges. The program evaluation revealed that the completion rate for the examined cohort increased from 24.1% to 54.9%, and cost per graduate declined considerably (Levin & Garcia, 2012; Linderman & Kolenovic, 2012). The returns on investment to the taxpayer include the benefits from higher tax revenues and lower costs of spending on public health, criminal justice, and public assistance. For each dollar of investment in ASAP by taxpayers, the return was $3 to $4. For each additional graduate, the taxpayer gained an amount equal to a certificate of deposit with a value of $146,000 (net of the costs of the investment). Based on these estimated returns, a cohort of 1,000 students enrolled in ASAP would generate net fiscal benefits for the taxpayer of more than $46 million relative to enrolling in the conventional degree program. ASAP results demonstrate that an effective educational policy can generate returns to the taxpayer that vastly exceed the public investment required. [ABSTRACT FROM AUTHOR]

Wages, labor force participation, and investment in Appalachia have historically lagged when compared to the rest of the United States. Following the Great Recession, the region has seen steady progress in all indicators, and even surpasses non-Appalachian regions within the same state. To fully evaluate the Appalachian specific worker retraining efforts and initiatives, I analyze county level data from the Bureau of Labor Statistics and the Appalachian Regional Commission to determine how Appalachian regions have performed, compared to the national average and to non-Appalachian counties within the same state. Additionally, by utilizing mobility data from the Equality of Opportunity Project, I combined the results from the first research question which looks at those counties that have seen the largest improvements in economic indicators, with absolute mobility indicators throughout the region of Appalachia. Thus a final analysis of counties throughout the region that experienced both increased economic conditions along with absolute mobility, is constructed.

Through designs akin to difference-in-differences, Bleakley (2007) produces evidence that the cam-paign to eradicate hookworm from the American South circa 1910 boosted school enrollment in childhood and income in adulthood. This comment works to replicate and reanalyze that study. Innovations include incorporation of the larger U.S. Census samples now available, and fitting of specifications focusing more sharply on the timing of any effects of the campaign, which are the basis of the most credible identification. The long-term convergence between historically low- and high-hookworm areas documented in Bleakley (2007) began decades before the campaign and did not accelerate in a way that would invite hookworm eradication as an explanation. Likewise, in the case of adult income, the convergence continued for decades after. In sum, hookworm eradication did not leave a telltale imprint on the historical record assembled here.

Multiscale segregation measures have the potential to increase understanding of residential context and ultimately a wide range of social and spatial processes. By examining segregation at multiple scales, we have the opportunity to study it as more than the outcome of a single process or a measure describing a single contextual effect. Multiscale segregation encourages us to look for sorting processes and contextual effects operating at different scales and potentially even with different meanings. However, the complexity of multiscale measures introduces significant uncertainty about the role of underlying data and assumptions in producing observed outcomes, particularly at fine geographic scales. While traditional measures of segregation have been exposed to decades of scrutiny, multiscale measures are still relatively novel and less well understood. The theoretical contribution of this paper is to consider the implications of segregation as both an outcome and signifier of sorting processes at multiple scales. The empirical contribution is to consider how zoning and the degree of spatial association shape outcomes expressed as multiscale segregation measures. I examine the effects of different allocation strategies for measuring population at small scales by comparing four delineation methods. I find that the method chosen for allocating population to small areas matters, but that by the time observation units reach about 700 m2 most of the difference between methods has washed out. I also test the effect of changing the degree of assumed spatial association in generating multiscale segregation measures. I find that, as suggested by Reardon and O'Sullivan in their original exposition of their spatial segregation measure, this assumption has a relatively small effect on outcomes and is unlikely to shape substantive findings.

Infibulation – the narrowing of the vaginal opening after the removal of the clitoris and labia – is the most invasive form of female genital cutting. The extent to which it is practiced varies widely within Africa. This paper studies the economic origins of this heterogeneity by testing the anthropological theory that a particular form of pre-industrial economic production – subsisting on pastoralism – favored the adoption of this custom. The hypothesis is based on the fact that pastoralism was characterized by heightened paternity uncertainty due to frequent and often extended periods of male absence from the settlement, implying larger payoffs to controlling female sexuality. Using within-country variation across 80,000 women in 12 African countries, the paper first documents that women from historically more pastoral societies are significantly more likely to be infibulated today. Extending the analysis to a set of 500,000 individuals in 34 countries, the paper then shows that formerly pastoral societies also exhibit a broader set of customs and norms that restrict female sexuality: female descendants of pastoral societies (i) are more constrained in their mobility outside their home; (ii) hold more restrictive norms about female sexuality; and (iii) behave less promiscuously. Given that dependence on pastoralism was largely determined by ecological conditions, these relationships have a direct causal interpretation. I argue and show empirically that the mechanism behind these patterns is indeed male absenteeism, rather than . . .

We examine the relation between employee protection legislation and corporate cash holdings. As wages become less elastic in a firm’s production function, precautionary savings are expected to increase. We show that the staggered passage of legal exceptions to the “at-will” employment doctrine in various U.S. states led to an average increase in cash holdings by 8.7%. Cash holdings increase more for financially unconstrained firms, labor-intensive firms and firms operating in volatile industries. Consistent with the financial flexibility argument of tighter employment protection increasing corporate cash needs, one additional dollar of cash is valued 30% higher post passage of pro-labor regulations compared to before the adoption.

This paper proposes a new microfoundation for the benefits of urban density. Market production of services is efficient because customers effectively share land and other factors of production, leaving them idle for less time. The paper develops a theory in which market-based sharing causes residents of dense areas to purchase services on the market that their suburban counterparts produce at home. The model predicts that residents of dense areas spend more on local services, home produce less, work more, and pay higher land prices - conditional on residents' productivity and proximity to work. The paper presents evidence that these predictions are consistent with the data.

We develop a new method to identify and control for selection when estimating the productivity effects of city size. Selecting out low-performing agents has no effect on modal productivity but reduces the CDF evaluated at the mode. Agglomeration economies have the reverse effect. Estimates based on these principles confirm that selection contributes to productivity among full-time skilled workers but is largely absent for low-skilled workers. Doubling city size causes skilled and low-skilled worker productivity to increase by roughly 2.4 and 4 percent, respectively. Our approach can be applied to other settings provided necessary conditions formalized in the paper are satisfied.

Households are generally responsible for filing and remitting various federal and state employment taxes, commonly subsumed under the moniker "the Nanny Tax", when they employ domestic help, such as a nanny, senior caregiver, housekeeper, health aide, cook, or gardener. The largest of these taxes are the federal Social Security and Medicare taxes administered under the Federal Insurance Contributions Act (FICA), which are applied at a combined rate of 15.3% to the wages of any household employee who is paid more than $2,100 over the course of a year. Household employers are also responsible for federal unemployment taxes administered under the Federal Unemployment Tax Act (FUTA). Besides these federal taxes, a household employer is generally required to remit certain state payroll taxes.

Feminist scholars define ‘postfeminism’ as a set of ideas that bothendorse and disavow feminism. Recent work documentspostfeminism in interviews of women talking about experienceswith gender inequality at work. The present study extends existingtheorizations by showing how postfeminism obfuscates ongoinginequality at work. To do this I specify postfeminism in the termsof two mechanisms by which work becomes gender typed: genderessentialization and feminine devaluation. By relating the literatureon postfeminism to sociological research on the persistence of gen-der typing of work, I show how ‘postfeminist ideology’ amounts to adouble entanglement with gender typed work. In other words, post-feminist ideology drives distinct stances towards genderessentialization and feminine devaluation. I draw on 40 interviewswith product designers in the United States to show this presentsempirically. Designers essentialize differences between men andwomen designers, even mobilizing difference to claim greater inclu-sion of women designers, who are thought to empathize best withwomen consumers. Yet when essentialization is accompanied byfeminine devaluation, designers deny it and it goes unrecognized.Because of this, the postfeminist ideology celebrates essentializedgendered differences, but insists on overlooking devaluation, whichis a key element of ongoing gender inequality.

While racial and ethnic differences in mortality are pervasive and well documented, less is known about how mortality risk varies by neighborhood socioeconomic status across racial and ethnic identity. We conducted a prospective analysis on a sample of adults living at or below 300% poverty with 8 years of the National Health Interview Survey (N = 159,400) linked to 11,600 deaths to examine the association between neighborhood disadvantage and mortality for non-Hispanic whites, non-Hispanic blacks, and U.S.- and foreign-born Hispanics. Using multilevel logistic regression, we find that the probability of death from any cause for lower-income adults is higher in more-disadvantaged neighborhoods, compared to less-disadvantaged neighborhoods, but only for whites. The adjusted likelihood of death for blacks and foreign-born Hispanics is not associated with neighborhood disadvantage, and the likelihood of death for U.S.-born Hispanics is lower in more-disadvantaged neighborhoods. While future research and policy should focus on improving health-promoting resources in all communities, care should be given to better understanding why race/ethnic groups have differential mortality returns with respect to area-specific socioeconomic conditions.

Time use studies analyze how individuals allocate their time. Data on time use allow researchers to document and understand human behavior and population lifestyles and to implement policies for development and planning policies (Harvey & Pentland, 1999). Time is a scarce resource that each person uses differently, and through the study of time we can analyze whether these differences are voluntary or forced and predict change in future population behavior (Duran, 2010). Time use data have been widely used to analyze changes over time and differences between cultures. For example, Bianchi et al (2006) used time use data for the United States from 1965 forward to analyze the time allocation patterns of changing American families. They found that decreases in housework and increases in multitasking help explain how mothers' time with children has remained steady despite increases in paid work. Gershuny (2000) found convergence in time use patterns both across time and across countries with different social and cultural backgrounds. In this chapter we introduce time use data as a resource for studying work and family. While we broadly introduce different types of time use data, our primary focus is on time diary data. We review the historical relevance of time use studies, and we describe data collecton methods. We discuss challenges for comparing time diary data across time and space. Finally, we include a case study illustrating how time diary data may be used to compare family time in the United States and Spain.

Previous evidence has identified potential racial disparities in access to community water and sewer service in peri-urban areas adjacent to North Carolina municipalities. We performed the first quantitative, multi-county analysis of these disparities. Using publicly available data, we identified areas bordering municipalities and lacking community water and/or sewer service in 75 North Carolina counties. Logistic regression was performed to evaluate the relationship between race and access to service in peri-urban areas, controlling for population density, median home value, urban status, and percent white in the adjacent municipality. In the peri-urban areas analyzed, 67% of the population lacked community sewer service, and 33% lacked community water service. In areas other than those with no black residents, odds of having community water service (p<0.01) or at least one of the two services (p<0.05) were highest for census blocks with a small proportion of black residents and lowest in 100% black census blocks, though this trend did not hold for access to community sewer service alone. For example, odds of community water service were 85% higher in areas that were greater than 0% but less than 22% black than in 100% black areas (p<0.001). Peri-urban census blocks without black populations had the lowest odds of community water service, community sewer service, and at least one of the two services, but this difference was only statistically significant for sewer. Peri-urban areas lacking service with no black residents were wealthier than 100% black areas and areas with any percent black greater than 0%. Findings suggest two unserved groups of differing racial and socioeconomic status: (1) lower-income black populations potentially excluded from municipal services during the era of legal racial segregation and (2) higher-income non-black populations. Findings also suggest greater racial disparities in community water than community sewer services statewide.

Nurses have a high prevalence of musculoskeletal symptoms from patient handling tasks such as lifting, transferring, and repositioning. Comorbidities such as musculoskeletal symptoms may negatively affect engagement in leisure-time physical activity (LTPA). However, limited data are available on the relationship between musculoskeletal symptoms and LTPA among nurses. The purpose of this study was to describe musculoskeletal symptoms and LTPA, and to examine the relationships of musculoskeletal symptoms, sociodemographics, and body mass index with LTPA among nurses. Cross-sectional data on sociodemographics, employment characteristics, musculoskeletal symptoms, body mass index, and LTPA were collected from a statewide random sample of 454 California nurses from January to July 2013. Descriptive statistics, bivariate and multiple logistic regressions were performed. We observed that non-White nurses were less likely to engage in regular aerobic physical activity than White nurses (odds ratio [OR] = 0.61; 95% confidence interval [CI] = [0.40, 0.94]). Currently working nurses were less likely to engage in regular aerobic physical activity than their counterparts (OR = 0.48; 95% CI = [0.25, 0.91]). Nurses with higher body mass index were less likely to perform regular aerobic physical activity (OR = 0.93; 95% CI = [0.89, 0.97]) or muscle-strengthening physical activity (OR = 0.92; 95% CI = [0.88, 0.96]). This study found no evidence that musculoskeletal symptoms may interfere with regular engagement in LTPA. Physical activity promotion interventions should address employment-related barriers, and particularly target racial minority nurses and those who have a high body mass index.

In this paper, I analyze how locational compatibility of married couples' occupations affect their household migration decisions. I find that if spouses' careers are concentrated in similar locations or if spouses have similar preferred locations, they are more likely to both earn more and move more. I then build a structural model in which households decide whether to move as a function of occupation-location match and individual location preference shocks. I estimate the model using full information maximum likelihood with data from the National Longitudinal Survey of Youth 1979, with separate estimation for households with married couples and for households with individuals. Using this model, I show that migration costs vary across occupation groups, with those in occupations that are more locationally disperse having lower migration costs. I then use the parameters estimates from model to show that differences in migration rates across household types is strongly associated with mismatch in locational preferences across couples by testing a counterfactual in which I match individuals to a spouse in their same occupation. Finally, I estimate the effects of a relocation incentive policy on migration rates and demonstrate that models which ignore family ties will overestimate the effects of such a policy.

State and local policymakers are very interested in how attending college in one’s home state affects the likelihood of living in that state after college. This paper uses cohort-level data from the American Community Survey, decennial censuses, and other sources to examine how birth-state college enrollment affects birth-state residence several years later. Ordinary least squares and instrumental variables estimates both suggest a statistically significant positive relationship. The preferred instrumental variable estimates suggest that a one percentage point increase in birth-state enrollment rates increases later life birth-state residence by roughly 0.41 percentage points. Implications for policy are discussed.

Audits of public school budgets routinely find evidence of waste. Also, recent evidence finds that when school budgets are strained, public schools can employ cost-saving measures with no ill- effect on students. We theorize that if budget cuts induce schools to eliminate wasteful spending, the effects of spending cuts may be small (and even zero). To explore this empirically, we examine how student performance responded to school spending cuts induced by the Great Recession. We link nationally representative test score and survey data to school spending data and isolate variation in recessionary spending cuts that were unrelated to changes in economic conditions. Consistent with the theory, districts that faced large revenue cuts disproportionately reduced spending on non-core operations. However, they still reduced core operational spending to some extent. A 10 percent school spending cut reduced test scores by about 7.8 percent of a standard deviation. Moreover, a 10 percent spending reduction during all four high-school years was associated with 2.6 percentage points lower graduation rates. While our estimates are smaller than some in the literature, spending cuts do matter.