Restrictions on abortion are pervasive, yet relatively little is known about the financial and economic impact of being denied an abortion on pregnant women who seek one. This paper evaluates the economic consequences of being denied an abortion on the basis of the gestational age of the pregnancy. Our analysis relies on new linkages to ten years of administrative credit report data for participants in the Turnaway Study, the first study to collect high-quality, longitudinal data on women receiving or being denied a wanted abortion in the United States. Some women had pregnancies close to the facility's gestational age limit, but below it, and received a wanted abortion (Near Limit Group). A second group of women had pregnancies just over the facility's gestational age limit and were turned away without receiving an abortion (Turnaway Group). Using these linked data, we compare differences in credit report outcomes for the two groups of women over time using an event study design. We find evidence of a large and persistent increase in financial distress for the women who were denied an abortion that is sustained for the 6 years following the intended abortion.
Over the past 30 years, the criteria used to diagnose and treat many common illnesses have become more relaxed, resulting in millions more relatively healthy individuals receiving medical treatment. This paper explores the impact of receiving a diagnosis of a common disease among patients who are close to the diagnostic threshold. Our approach exploits the diagnostic criteria for diabetes that uses a sharp cutoff in blood sugar levels to classify patients as having diabetes. Using a regression discontinuity design, we compare patients with similar underlying health who fall close to the diabetes diagnostic threshold and follow them for 6 years after diagnosis. We find that a marginally diagnosed patient with diabetes spends $1,097 more on drugs and diabetes-related care annually after diagnosis, but find no corresponding changes in self-reported health or healthy behaviors. These increases in spending persist over the 6-year period we observe the patients, despite the fact that many who are not initially diagnosed receive a later diagnosis during this time frame. These marginally diagnosed patients experience improved blood sugar after the first year of diagnosis, but this improvement does not persist in subsequent years. Other clinical measures of health, such as BMI, blood pressure, cholesterol, and mortality show no improvement. The diagnosis rates for preventable disease-related conditions such as diabetic retinopathy, neuropathy, and kidney disease increase following a diagnosis, likely due to more intensive screening. Because a large fraction of diabetes patients have lab values close to the diagnosis threshold, our results imply that even a small relaxation in the diagnosis cutoff, as has been recently observed for several other chronic illnesses, would increase total spending on diabetes-related care by about $2.4 billion annually and minimally impact patient health, at least in the medium term.
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 and 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, states that opted to expand experienced significant reductions in mortality 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.
We examine multi-generational impacts of positive in utero and early life health interventions. We focus on the 1980s Medicaid expansions, which targeted low-income pregnant women, and were adopted differently across states and over time. We use Vital Statistics Natality files to create unique data linking individuals’ in utero Medicaid exposure to the next generation’s health outcomes at birth. We find strong evidence that the health benefits associated with treated generations’ in utero access to Medicaid extend to later offspring in the form of higher average birth weight and decreased incidence of very low birth weight. Later childhood exposure to Medicaid does not lead to persistent health effects across generations. The return on investment is substantially larger than suggested by evaluations of the program that focus only on treated cohorts.