Occupational licensing is intended to protect consumers. Whether it does so is an important, but unanswered, question. Exploiting variation across states and municipalities in the timing and details of midwifery laws introduced during the period 1900-1940, and using a rich data set that we assembled from primary sources, we find that requiring midwives to be licensed reduced maternal mortality by 6 to 7 percent. In addition, we find that requiring midwives to be licensed may have had led to modest reductions in nonwhite infant mortality and mortality among children under the age of 2 from diarrhea. These estimates provide the first econometric evidence of which we are aware on the relationship between licensure and consumer safety, and are directly relevant to ongoing policy debates both in the United States and in the developing world surrounding the merits of licensing midwives.

As interfaith marriage has become more common, religion is thought to be less important for sorting partners. Nevertheless, prior studies on religious assortative mating use samples of prevailing marriages, which miss how local marriage markets shape both partner selection and marriage timing. Drawing on search theory and data from 8,699 young adults (ages 1831 years) in the National Longitudinal Study of Youth 1997, the author examined the association between the concentration of coreligionists in local marriage markets and marriage timing and partner selection using event history methods. Religious concentration is associated with higher odds of transitioning to marriage and religious homogamy (conditional on marriage) for women and men at older ages (2431 years) but not at younger ages (1823 years). The association was also stronger for non-Hispanic Whites when compared with other racial and ethnic groups. The findings indicate that religion remains relevant in sorting partners for many young adults in today's marriage market.

In 2009, student-loan debt became the largest non-housing-related consumer debt in the United States. By 2013, outstanding student debt balances had grown to exceed $1 trillion, and by the end of 2015, had reached $1.23 trillion. These milestones coincided with increasing rates of delinquency and default among borrowers, raising concerns about the affordability of this debt. In addition, researchers have recently found an array of adverse effects from such debt, including the impact on homeownership and vehicle purchases, small-business formation, and retirement preparedness. These factors have led many to call the extent of student-loan debt a “crisis.” For New England, with its highly educated population and large higher-education industry, student-loan debt is a salient economic and policy issue. All six New England states have formed subcommittees, fielded commissions, contracted studies, and proposed or passed legislation targeting student-loan debt. These actions have yielded diverse policy responses, including initiatives aimed at improving financial literacy, boosting child college savings accounts, increasing state aid to state colleges and universities, refinancing student loans, and offering tax credits or loan forgiveness to graduates.

The central question of this paper is what impact labor market conditions have on marginal entrance to the teaching profession, and what ramifications this has on ultimate instructor quality. This paper’s hypothesis is that in times of economic distress and high private sector unemployment, like the recent recession, the expected quality of individuals who are hired for teaching jobs increases. Using data from the American Community Survey, North Carolina Education Data Research Center and The National Bureau of Economic Research, I find recession-caused migration into the education profession and document sorting on observable teacher ability, measured by scores on certification exams.

BACKGROUND Transcatheter aortic valve replacement (TAVR) received US regulatory approval for treatment of severe symptomatic aortic stenosis (AS) in November 2011. After subsequent approvals for expanded indications, it is now performed throughout Michigan but the distribution of these providers and their impact on access is uncertain. As the number of providers and utilization for TAVR grows, how procedural volume is distributed among providers may significantly impact patient outcomes. METHODS We determined geographic access to TAVR in Michigan as of October 2014, and compared it to access of other invasive cardiac services; namely, percutaneous coronary intervention (PCI), non-transplant cardiac surgery, and cardiac transplant surgery. A geographic information systems analysis was performed using recent U.S. Census Survey data and statewide inpatient data to construct maps of service areas around hospitals providing TAVR, PCI, non-transplant cardiac surgery, and cardiac transplant surgery. Service areas ranging across multiple driving distances were included in the analysis. Geographic access was calculated as percentage of the population living within the hospital service areas providing invasive cardiac services. RESULTS In October 2014, 15 hospitals provide TAVR in Michigan. For TAVR sites, the mean number of beds, annual discharges, and annual patient days are 571, 28,946, and 140,859, respectively. Compared to hospitals not offering TAVR, TAVR facilities were more likely to be non-profit (86.7% vs 71.0%), a teaching hospital (93.3% vs 87.1%), and rural (12.1% vs 6.5%). Of the 9,883,640 persons in Michigan, 4,492,941 (45.5%) live within 10 miles, 7,856,455 (79.5%) live within 30 miles, and 9,004,943 (91.1%) live within 50 miles driving distance of TAVR sites. These proportions compare favorably with hospitals providing PCI (8,857,148 [89.6%] living within 30 miles) and non-transplant cardiac surgery (8,814,143 [89.2%] living within 30 miles) as opposed to cardiac transplant surgery (5,481,122 [55.5%] living within 30 miles). For Michigan patients who underwent surgical valve replacement (SAVR) in 2010–2011, the median driving distance to a TAVR site was under 15 miles and under 10 miles to a hospital providing non-transplant cardiac surgery. CONCLUSIONS Nearly 4 of 5 Michigan residents lived within 30 miles of TAVR services early after its approval, suggesting its wide availability despite initial regulations on its use. These findings may encourage growth in TAVR utilization and limit the development of expertise as procedural volume is distributed among more providers. Given procedural volume tends to relate positively with outcomes, increased access to TAVR may have negative effects on patient outcomes.

This article builds on the national school funding fairness report annually produced by the Education Law Center (ELC) of New Jersey. This article expands prior analyses in two directions. First, while ELC analyses evaluate only the most recent 3 years of data, we track school funding progressiveness (the relative targeting of funding to districts serving economically disadvantaged children) for all states from 1993 to 2012. Second, this article explores in greater depth the consequences of school funding levels, distributions and changes for specific classroom resources provided in schools. The analyses presented herein validate that variations in available revenues and expenditures are associated with variations in children's access to real resources-as measured by the competitiveness of the wages paid to their teachers and by pupil-to-teacher ratios and class sizes.

Purpose: We sought to examine the demographic, market, and policy-related factors influencing first year enrollment rates for the population targeted by the Health Insurance Marketplaces (HIMs) established as part of the Affordable Care Act. In particular, we analyzed differences in enrollment rates across urban and rural counties in 32 states served by the Federally Facilitated Marketplace. Methods: We used enrollment data from the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services and demographic data from the American Community Survey, supplemented with other market and policy-related information. Using multivariate regression, we investigated how county-level enrollment rates are associated with demographic, market and policy-related characteristics, including rurality. Findings: Relative to an adjusted mean enrollment rate of 17.1% for large metropolitan counties, small metropolitan counties have a 2.8% lower enrollment rate and rural counties have a 2.7% lower enrollment rate. States decisions to expand Medicaid and to have the federal government fully manage the HIM are both negatively associated with enrollment rates. Partnership HIMs exhibit a positive association with enrollment rates as do navigator grants, but the latter relationship is only present in counties located in Medicaid expansion states. Conclusions: Enrollment rates vary by rurality, but differences are statistically significant only between large metropolitan counties and all other types of countiessmall metropolitan, micropolitan, and noncore. State-level policies, particularly Medicaid expansion, have the largest association with enrollment rates among the explanatory variables examined in the model.

Occupational segregation and pay gaps by gender remain large while many of the constraints traditionally believed to be responsible for these gaps have weakened over time. Here, we explore the possibility that women and men have different tastes for the content of the work they do. We run regressions of job satisfaction on the share of males in an occupation. Overall, there is a strong negative relationship between female satisfaction and the share of males. This relationship is fairly stable across different specifications and is not attenuated by personal characteristics or proxies of job flexibility. The effect is muted for women but largely unchanged for men when we include three measures that proxy the content and context of the work in an occupation, which we label people, brains, and brawn. These results suggest that women may care more about job content, and this is a possible factor preventing them from entering some male dominated professions.

In recent years, singles have begun to take on a more prominent role in reshaping America. As a group, singles are increasingly becoming influential in politics and in the determination of many macro socioeconomic outcomes. In this descriptive paper we focus on homeownership among a subset of singles, the never married. In particular we investigate potential differences in the relationship between several homeownership determinants for singles in comparison to the married. In addition, we test for heterogeneity across race and skill level in the gender gap in homeownership and the probability of homeownership before and post the recession. Our results suggest that there are some differences in the relationship between certain factors and homeownership for singles versus those who are married. In particular, we find age, gender, and number of children affect the probability of homeownership differently for singles compared to those who are married. We also find that while on average there is a higher probability of homeownership from 2007 onwards for singles, there are gender, education and racial differences. Our results also suggest significant heterogeneity across race and skill level in homeownership probabilities for singles.

Undocumented immigration has been a significant political issue in recent years, and is likely to remain so throughout and beyond the presidential election year of 2016. One reason for the high and sustained level of interest in undocumented immigration is the widespread belief that the trend in the undocumented population is ever upward. This paper shows that this belief is mistaken and that, in fact, the undocumented population has been decreasing for more than a half a decade. Other findings of the paper that should inform the immigration debate are the growing naturalized citizen populations in almost every US state and the fact that, since 1980, the legally resident foreign-born population from Mexico has grown faster than the undocumented population from Mexico.

The growing healthcare needs of the baby boom generation are likely to require significant increases in the number or productivity of workers employed in healthcare industries. This paper explores how immigrants may fill these gaps given their current over-representation in certain nursing professions. First, making use of Census and American Community Survey data, we show that although immigrant inflows to a local area have no impact on the wages of registered nurses, these inflows are associated with decreases in wages in lower skilled nursing professions as well as increases in employment in these professions, consistent with a positive increase in the supply of lower skilled nurse occupations. Next, using nursing home data from the Long Term Care Focus project, we show that larger local immigrant shares are associated with fewer falls among nursing home residents and improvements in other measures of quality of care. Last, we show that this mechanism requires highly competitive nursing home markets.

This analysis examines the relationship between child health and per capita health spending in South Sudan. The nexus between public health spending and health outcomes lends insights into state effectiveness in service delivery. Net of background variables, we find that a percent increase in per capita health spending increases early age mortality by 31 percent among infants and 24 percent among children under the age of five. The estimates are, however, statistically insignificant, suggesting that there are no health returns to health investment in South Sudan. These results are not surprising and complement the prevailing knowledge that health spending is often ineffective in contexts immersed in poor governance, corruption, aid misalignment, and institutional weakness. Thus, improved governance and enforcement of robust monitoring and accountability measures in social services provision may make public health investment more effective in the country. Lastly, while South Sudan implements the Agreement on the Resolution of Conflict in South Sudan (ARCISS), foreign aid needs a proper realignment to support recovery priorities, with commitment to service delivery as a lead constituent of its fundamental objectives.

Although there has been significant progress in the long term, achievement gaps among the nations students persist. Many factors have contributed to the disparities in outcomes, and societal changes can explain progress, or lack thereof, over the past few decades. This is well documented in the 2010 Educational Testing Service (ETS) report BlackWhite Achievement Gaps: When Progress Stopped,which explored achievement gap trends and identified the changing conditions that may have influenced those trends. In this report, we extend that work by focusing on the relationship between school funding, resource allocation, and achievement among students from low-income families. We tackle the assumption that greater resources, delivered through fair and equitable school funding systems, could help raise academic outcomes and reduce the achievement gap. The goal is to provide convincing evidence that state finance policies have consequences in terms of the level and distribution of resources, here limited to staffing characteristics, and that the resulting allocation of resources is also associated with changes in both the level of academic achievement and achievement gaps between low-income children and their peers. Using more than 20 years of revenue and expenditure data for schools, we empirically test the idea that increasing investments in schools generally is associated with greater access to resources as measured by staffing ratios, class sizes,and the competitiveness of teacher wages. When the findings presented here are considered with the strong body of academic literature on the positive relationship between substantive and sustained state school finance reforms and improved student outcomes, a strong case can be made that state and federal policy focused on improving state finance systems to ensure equitable funding and improving access to resources for children from low-income families is a key strategy to improve outcomes and close achievement gaps.

One pillar of the Affordable Care Act (ACA) was its expected impact on the growing burden of uncompensated care costs for the uninsured at hospitals. However, little is known about how this burden changed as a result of the ACAs enactment. We examine how the Affordable Care Act (ACA)s coverage expansions affected uncompensated care costs at a large, diverse sample of hospitals. We estimate that in states that expanded Medicaid under the ACA, uncompensated care costs decreased from 4.1 percentage points to 3.1 percentage points of operating costs. The reductions in Medicaid expansion states were larger at hospitals that had higher pre-ACA uncompensated care burdens and in markets where we predicted larger gains in coverage through expanded eligibility for Medicaid. Our estimates suggest that uncompensated care costs would have decreased from 5.7 percentage points to 4.0 percentage points of operating costs in nonexpansion states if they had expanded Medicaid. Thus, while the ACA decreased the variation in uncompensated care costs across hospitals within Medicaid expansion states, the difference between expansion and nonexpansion states increased substantially. Policy makers and researchers should consider how the shifting uncompensated care burden affects other hospital decisions as well as the distribution of supplemental public funding to hospitals. The Affordable Care Act (ACA) represents the largest expansion in health insurance coverage in the United States since the creation of Medicare and Medicaid in the 1960s. According to the Census Bureau, nearly nine million previously uninsured Americans gained health coverage between 2013 and 2014, largely through the state-based Medicaid expansions that were enacted in twenty-eight states plus the District of Columbia and through the new individual insurance Marketplaces established in states nationwide. An often stated reason for the ACAs passage was the rising burden on both patients and hospitals as a result of uncompensated care for uninsured people. However, little is known to date about new insurance enrollees hospitalization rates or whether they were able to pay for medical services before the ACA took effect. Given this fact, it is unclear by how much the uncompensated care burden on hospitals should have fallen as a result of the ACA. To address this gap in knowledge, we provide the first broad-based national estimates of the decline in uncompensated care resulting from the enactment of the ACA. These estimates are important for several reasons. First, we show which components of the ACA have had the most immediate impact on uncompensated care. Specifically, we find that reductions in uncompensated care costs almost exclusively occurred in states with Medicaid expansions, with little additional reduction to date in nonexpansion states. Our analysis implies that uncompensated care costs in Medicaid expansion states fell from 4.1 percentage points of operating costs to 3.1 percentage points of operating costs. In nonexpansion states, uncompensated care costs continued close to their existing trend, remaining at approximately 5.7 percentage points of hospitals operating costs. We present a number of facts to corroborate that the decreases in uncompensated care costs in expansion states were in fact due to the Medicaid expansion. Then, using the experience of expansion states as a guide, we predict that had nonexpansion states expanded Medicaid, uncompensated care costs in those states would be nearly 30 percent lower than they are today. Although this estimate is hardly dispositive, the absence of a decrease and the lack of a break from trend in uncompensated care costs in nonexpansion states suggest that the other coverage expansion policiesthe individual mandate and the health insurance Marketplaces that also pertain to nonexpansion states, for examplehave to date had little effect on the uncompensated care burden faced by hospitals. Our analysis also provides important information about the evolving incidence of uncompensated care costs both within and across states. Hospitals vary dramatically in the burden of uncompensated care costs that they face, which in turn affects both access to health care and the generosity of existing charity care programs. We find that within expansion states, ACA policies have eliminated about one-third of the differences in uncompensated care burdens across hospitals, but substantial differences still remain. Because uncompensated care costs were higher in nonexpansion states prior to the ACA, the differences in uncompensated care burdens across hospitals located in expansion and nonexpansion states are especially evident. A burgeoning literature exists on the ACAs effects on hospital finances. Peter Cunningham, Rachel Garfield, and Robin Rudowitz examined how financial outcomes changed at Ascension Health during the first nine months of 2014. Their study compares changes at hospitals in Medicaid expansion and nonexpansion states. Sayeh Nikpay, Thomas Buchmueller, and Helen Levy examined the effects of Connecticuts Medicaid expansion on Medicaid discharges and on uncompensated care. The Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation recently estimated that the ACA caused a 21 percent reduction in hospital uncompensated care, but this was based on only a sample of for-profit hospital financial reports and lacked specific data the impact of the expansion in particular hospital markets. Our study adds to this literature by examining a larger and more diverse sample of hospitals. This sample enabled us to examine variation in the ACAs impact on uncompensated care across different types of hospitals based on both ownership status and the estimated local impact of the Medicaid expansion. And we do use the actual effect of the ACA on a wide set of hospitals to predict how much Medicaid expansions would decrease uncompensated care in nonexpansion states.

Can early exposure to demand reductions improve the performance of firms during future demand shocks? I focus on the American brewing industry during prohibition in the early twentieth century. Some breweries faced early reductions in demand when nearby counties introduced prohibition at the local level. Other breweries were insulated from local prohibitions until the start of federal prohibition, when the entire US prohibited the production and distribution of alcoholic drinks. I follow 1,300 breweries throughout both local and federal prohibitions, using firm-level data that I collected. Breweries that faced early reductions in demand were 12% more likely to survive the full prohibition period, from before local prohibition until the end of federal prohibition, than breweries that did not face early reductions in demand. This increase in survival occurred because a group of breweries made early investments in machinery that later facilitated product switching into soda and other foodstuffs. Based on a theoretical model and my identification strategy, I argue that this group of breweries would not have survived prohibition, had they not faced an early reduction in demand.

This analysis examines the impact of automation on the composition of occupational employment for the United States, Wisconsin and Central Wisconsin. Specifically, we analyze how computer-based technologies and robotics have contributed to job polarization by reducing the number of middle-skilled jobs while bolstering employment in both low-and-high skilled jobs.

The Obama administration has developed two broad programs to defer immigration enforcement actions against undocumented persons living in the United States: (1) Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA); and (2) Deferred Action for Childhood Arrivals (DACA). The DACA program, which began in August 2012, was expanded on November 20, 2014. DAPA and the DACA expansion (hereinafter referred to as “DACA-plus”) are currently under review by the US Supreme Court and subject to an active injunction. This paper offers a statistical portrait of the intended direct beneficiaries of DAPA, DACA, and DACA-plus. It finds that potential DAPA, DACA, and DACA-plus recipients are deeply embedded in US society, with high employment rates, extensive US family ties, long tenure, and substantial rates of English-language proficiency. The paper also notes various groups that would benefit indirectly from the full implementation of DAPA and DACA or, conversely, would suffer from the removal of potential beneficiaries of these programs. For example, all those who would rely on the retirement programs of the US government will benefit from the high employment rates and relative youth of the DACA population, while many US citizens who rely on the income of a DAPA-eligible parent would fall into poverty or extreme poverty should that parent be removed from the United States. This paper offers an analysis of potential DAPA and DACA beneficiaries. In an earlier study, the authors made the case for immigration reform based on long-term trends related to the US undocumented population, including potential DAPA and DACA beneficiaries (Warren and Kerwin 2015). By contrast, this paper details the degree to which these populations have become embedded in US society. It also compares persons eligible for the original DACA program with those eligible for DACA-plus. As stated, the great majority of potential DAPA and DACA recipients enjoy strong family ties, long tenure, and high employment rates in the United States. Nearly one-half of the DAPA population and far higher percentages of the two DACA populations speak English well, very well, or exclusively. An unknown, albeit not insubstantial percentage of both the DAPA- and DACA-eligible may already qualify for an immigration benefit or relief that would put them on a path to permanent residency and US citizenship. These mostly low-wage populations have relatively high rates of poverty and low rates of health insurance. Not surprisingly, the educational attainment, school enrollment rates, and English-language proficiency of the DACA-eligible substantially exceed those of the DAPA-eligible. Both populations enjoy high levels of computer and Internet access. The Center for Migration Studies (CMS) derived its estimates on the DAPA- and DACA-eligible from statistics on the foreign-born population collected in the US Census Bureau’s American Community Survey (ACS), as described in Warren (2016). It first derived detailed estimates for all undocumented residents, and then used the characteristics of this population (e.g., year of entry, age at entry, etc.) to tabulate the numbers of those who would be eligible for DAPA and DACA in 2014, which is the most recent year available.

As immigration has become a global phenomenon in recent years, a number of European countries, including Ireland, have experienced an influx of immigrants, causing a shift in their national demographics. Therefore, it is important that the EU-LFS yield reliable labour-force estimates not only for the whole population, but also for the immigrant population. This article uses simulation techniques to compare the effectiveness of four different weighting mechanisms in order to improve the precision of the labour-force estimates from the Irish component of the European Union Labour Force Survey (EU-LFS) called the Quarterly National Household Survey (QNHS). The four weighting methodologies for comparison include the original and the current weighting scheme of the QNHS as well as our two proposed alternative weighting schemes. The simulation results show that by modifying the current QNHS weighting mechanism, we can improve the accuracy of the labour-force estimates of the immigrant population in Ireland without affecting the estimates of the whole population and the Irish nationals. This article highlights potential issues that other countries with new immigrant populations may face when using the EU-LFS for immigration research, and our recommendations may be useful to researchers and national statistical offices in such countries.

My internship at African Community Education (ACE) took place from May to December 2015, where I worked with GISDE alum, Joshua Plisinski. My summer was split as a volunteer at ACE and GIS Analyst in partnership with a Worcester nonprofit Cultural Exchange Through Soccer (CETS). My duties at ACE included tutoring, mentoring, and leading the students in homework assignments and various recreational activities. I also completed several GIS tasks and instructed a GIS tutorial for the high school students of ACE. The other time during my summer was spent conducting a spatial network analysis of Worcester soccer fields for CETS and presenting my final aggregated report at Worcester City Hall to the Parks, Recreation, and Cemetery Division. The purpose of that report is to locate strategic areas in need of additional funds for the construction of proposed fields and improving existing fields. This internship report details the aim of ACE, the specific tasks conducted as a volunteer, and a review of the network analysis presented to the city of Worcester.

Over the past several decades, many states have pursued substantive changes to their state school finance systems. Some reforms have been stimulated by judicial pressure resulting from state constitutional challenges and others have been initiated by legislatures. But despite gains in school funding equity and adequacy made over the past few decades, in recent years we have witnessed a substantial retreat from equity and adequacy. This chapter builds on the national school funding fairness report annually published by the Education Law Center. We track school funding fairness (the relative targeting of funding to districts serving economically disadvantaged children) for all states from 1993 to 2012. This chapter explores in greater depth the consequences of school funding levels, distributions, and changes in specific classroom resources provided in schools. We find that states and districts applying more effortspending a greater share of their fiscal capacity on schoolsgenerally spend more on schools, and that these higher spending levels translate into higher staffing levels and lower class sizes as well as more competitive teacher wages.