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The COVID‐19 pandemic has led to temporary suspensions of many occupational licensing laws in an effort to manage surges in health care demand. The crisis highlights more general concerns about occupational licensing laws, yet convincing empirical evidence on the degree to which such laws have inhibited entry into health care professions is scarce. In this study, we indirectly examine how occupational licensing affects the choice to become an emergency medical technician (EMT) by exploiting the demand‐side shock from the Affordable Care Act (ACA). We find suggestive evidence that while the demand‐side shock from the ACA increased the likelihood of being an EMT, this effect was substantially moderated by more stringent occupational licensing laws. The implied effects for young individuals in the most careful specification suggests virtually complete offset; the ACA demand‐side shock would increase entry by 18 percentage points, while occupational licensing restrictions reduce entry by a similar magnitude. [ABSTRACT FROM AUTHOR]

The employer‐sponsored life insurance (ESLI) market is susceptible to adverse selection due to community‐rated premiums, guaranteed issue coverage, and the existence of an individual market. Using payroll and healthcare claims data from a large university, we find that employees with worse health are more likely to elect coverage causing adverse selection in supplemental ESLI. Nonetheless, we find employees typically do not increase coverage following a severe illness even when they can without providing evidence of insurability. Furthermore, demand estimation shows employees are not price‐sensitive and estimated increases in premiums from adverse selection are unlikely to cause significant welfare loss. [ABSTRACT FROM AUTHOR]

The profitability of life insurance offerings is contingent on accurate projections and pricing of mortality risk. The COVID‐19 pandemic created significant uncertainty, with dire mortality predictions from early forecasts resulting in widespread government intervention and greater individual precaution that reduced the projected death toll. We analyze how life insurance companies changed pricing and offerings in response to COVID‐19 using monthly data on term life insurance policies from Compulife. We estimate event‐study models that exploit well‐established variation in the COVID‐19 mortality rate based on age and underlying health status. Despite the increase in mortality risk and significant uncertainty, the results generally indicate that life insurance companies did not increase premiums or decrease policy offerings due to COVID‐19. Nonetheless, we find some evidence that premiums differentially increased for individuals with very high risk and that some policies were removed for the oldest of the old. [ABSTRACT FROM AUTHOR]

As many as two‐thirds of newly‐released inmates will be arrested for a new offense within 3 years. This study evaluates the impact of job assistance on recidivism rates among ex‐offenders. The job assistance program, run though the private company America Works, uses a network of employers to place clients. Ex‐offenders were randomly assigned to intensive job assistance (treatment group) or the standard program (control group). The intensive program is meant to improve average work readiness for ex‐offenders. It reduces the likelihood of subsequent arrest among nonviolent ex‐offenders, but has little effect on violent ex‐offenders. The rearrest rate for nonviolent ex‐offenders in the treatment group was 19 percentage points lower than those in the control group. The rearrest rate for violent ex‐offenders in the treatment group was indistinguishable from those in the control group. We estimate benefits from intensive job assistance from averted crimes and find that they outweigh the $5,000 up‐front cost for nonviolent ex‐offenders. [ABSTRACT FROM AUTHOR]

Objective: To estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on health care access and self‐assessed health during the first 2 years of the Trump administration (2017 and 2018). Data Source: The 2011‐2018 waves of the Behavioral Risk Factor Surveillance System (BRFSS), with the sample restricted to nonelderly adults. The BRFSS is a commonly used data source in the ACA literature due to its large number of questions related to access and self‐assessed health. In addition, it is large enough to precisely estimate the effects of state policy interventions, with over 300 000 observations per year. Design: We estimate difference‐in‐difference‐in‐differences (DDD) models to separately identify the effects of the private and Medicaid expansion portions of the ACA using an identification strategy initially developed in Courtemanche et al (2017). The differences come from: (a) time, (b) state Medicaid expansion status, and (c) local area pre‐2014 uninsured rates. We examine ten outcome variables, including four measures of access and six measures of self‐assessed health. We also examine differences by income and race/ethnicity. Principal Findings: Despite changes in ACA administration and the political debate surrounding the ACA during 2017 and 2018, including these fourth and fifth years of postreform data suggests continued gains in coverage. In addition, the improvements in reported excellent health that emerged with a lag after ACA implementation continued during 2017 and 2018. Conclusions: While gains in access and self‐assessed health continued in the first 2 years of the Trump administration, the ongoing debate at both the federal and state level surrounding the future of the ACA suggests the need to continue monitoring how the law impacts these and many other important outcomes over time. [ABSTRACT FROM AUTHOR]

Objective: To estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after three years.Data Source: The 2011-2016 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults.Design: We estimate a difference-in-difference-in-differences model to separately identify the effects of the nationwide and Medicaid expansion portions of the ACA using the methodology developed in the recent ACA literature. The differences come from time, state Medicaid expansion status, and local area pre-ACA uninsured rates. In order to focus on access disparities, we stratify our sample separately by income, race/ethnicity, marital status, age, gender, and geography.Principal Findings: After three years, the fully implemented ACA eliminated 43% of the coverage gap across income groups, with the Medicaid expansion accounting for this entire reduction. The ACA also reduced coverage disparities across racial groups by 23%, across marital status by 46%, and across age-groups by 36%, with these changes being partly attributable to both the Medicaid expansion and nationwide components of the law.Conclusions: The fully implemented ACA has been successful in reducing coverage disparities across multiple groups. [ABSTRACT FROM AUTHOR]

Premature death of a breadwinner can have devastating financial consequences on surviving dependents. This study investigates the role of life insurance in mitigating the long‐run financial consequences of spousal mortality. Using the Health and Retirement Study, we examine individuals whose spouses died during or soon after his or her peak earnings years. After controlling for socioeconomic status, we find that sizable lump‐sum life insurance payouts do not significantly influence spousal well‐being. (JEL D31, G22, I31, J32, J33, J38) [ABSTRACT FROM AUTHOR]

The goal of the Affordable Care Act (ACA) was to achieve nearly universal health insurance coverage through a combination of mandates, subsidies, marketplaces, and Medicaid expansions, most of which took effect in 2014. We use data from the Behavioral Risk Factor Surveillance System to examine the impacts of the ACA on health care access, risky health behaviors, and self‐assessed health after two years. We estimate difference‐in‐difference‐in‐differences models that exploit variation in treatment intensity from state participation in the Medicaid expansion and pre‐ACA uninsured rates. Results suggest that the ACA led to sizeable improvements in access to health care in both Medicaid expansion and nonexpansion states, with the gains being larger in expansion states along some dimensions. However, we do not find clear effects on risky behaviors or self‐assessed health. [ABSTRACT FROM AUTHOR]

Health insurance reform in Massachusetts lowered the cost of both pregnancy (by increased coverage of pregnancy-related medical events) and pregnancy prevention (by increasing access to reliable contraception). We empirically examine fertility responses and find no overall effect from increased coverage due to the Massachusetts reform. This finding, however, masks substantial heterogeneity. For married women aged 20 to 34-with high latent fertility and pregnancy wantedness-fertility increased by approximately 1%. For unmarried women in the same age range-for whom pregnancies are typically unwanted-fertility declined by 8%. ( JEL I13, I18, J13) [ABSTRACT FROM AUTHOR]

Using data from a university, we analyze a policy designed to increase employer-sponsored life insurance. The university increased basic life insurance holdings, which nudged employees with supplemental coverage to have more life insurance. In large part due to inertia, the nudge increased life insurance holdings one-for-one for those who could have undone it. Additionally, we find that expanding coverage options significantly increased total life insurance holdings for new hires who were not subject to inertia. These policy changes reduced uninsured vulnerabilities for two-thirds of employees. Our findings have important policy implications for addressing widespread disparities in life insurance coverage. ( JEL D31, G22, D03, J32, J33, J38, H20) [ABSTRACT FROM AUTHOR]

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those without a college degree, non-whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage. [ABSTRACT FROM AUTHOR]

Objective: To estimate the impact of different forms of Medicaid managed care (MMC) delivery on racial and ethnic disparities in utilization.Data Source: Longitudinal, administrative data on 101,649 children in Kentucky continuously enrolled in Medicaid between January 1997 and June 1999. Outcomes considered are monthly professional, outpatient, and inpatient utilization.Study Design: We apply an intent-to-treat, instrumental variables analysis using the staggered geographic implementation of MMC to create treatment and control groups of children.Principal Findings: The implementation of MMC reduced monthly professional visits by a smaller degree for non-whites than whites (3.8 percentage points vs. 6.2 percentage points), thereby helping to equalize the initial racial/ethnic disparity in utilization. The Passport MMC program in the Louisville-centered region statistically significantly reduced disparities for professional visits (closing the gap by 8.0 percentage points), while the Kentucky Health Select MMC program in the Lexington-centered region did not. No substantive impact on disparities was found for either outpatient or inpatient utilization in either program.Conclusions: We find evidence that MMC has the possibility to reduce racial/ethnic disparities in professional utilization. More work is needed to determine which managed care program characteristics drive this result. [ABSTRACT FROM AUTHOR]

The most significant pieces of the Affordable Care Act (exchanges, subsidies, Medicaid expansion, and individual mandate), implemented in 2014, were associated with sizable gains in coverage nationally that were divided equally between gains in Medicaid and private coverage. These national trends mask heterogeneity in gains by state Medicaid expansion status, age, income level, and source of coverage. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This article estimates the impact of the introduction of Medicaid managed care (MMC) on the formal Medicaid participation of children. We employ a quasi-experimental approach exploiting the location-specific timing of MMC implementation in Kentucky. Using data from the March Current Population Survey from 1995 to 2003, our findings suggest that the introduction of MMC increases the likelihood of being uninsured and decreases formal Medicaid participation. This finding is consistent with an increase in 'conditional coverage,' waiting until medical care is needed to sign up or re-enroll in Medicaid. These effects are concentrated among low-income children and absent for high-income children. We find no evidence of 'crowd-in,' substituting private coverage for Medicaid. These results are robust to multiple placebo tests and imply the potential for less formal participation (i.e., more conditional coverage) among the Affordable Care Act-Medicaid expansion population (which is likely to be primarily covered under MMC) than is typically predicted. [ABSTRACT FROM AUTHOR]

The competitiveness of the residential real estate brokerage industry has attracted much attention. Anecdotal evidence suggests some local markets are concentrated, yet no systematic market structure study has been conducted. We collected cross-sectional data on real estate brokers in 90 diverse markets across the United States and collected longitudinal data for Louisville, Kentucky. In medium and large markets, no evidence exists that market concentration might create problems for competition. Small markets, on average, have higher Herfindahl-Hirschman Indexes than medium and large markets. The longitudinal data reveal that many small brokers sell a house or two one year and none the next year. [ABSTRACT FROM AUTHOR]

Some goods are consumed not just for their intrinsic utility but also for the impression their consumption has on others. We analyze the market for such a commodity—diamonds. We collect data on price and other attributes from the inventories of three large online retailers of diamonds. We find that people are willing to pay premiums upward of 18% for a diamond that is one-half carat rather than slightly less than a half carat and between 5% and 10% for a one-carat rather than a slightly less than one-carat stone. Since a major portion of larger gem-quality diamonds are used for engagement rings, such an outcome is consistent with Bernheim's model of conformism, where individuals try to conform to a single standard of behavior that is often established at a focal point. In this case, prospective grooms signal their desirability as a mate by the size of the diamond engagement ring they give their fiancées. ( JEL A1, D4) [ABSTRACT FROM AUTHOR]

This article assesses the importance of receiving supplemental health insurance on participation in Supplemental Security Income (SSI) for the elderly. The implementation of the Qualified Medicare Beneficiary (QMB) program offered a substitute for Medicaid, and expanded health insurance eligibility to a higher income level. Using a sample of elderly respondents aged 66 to 75, I find that the QMB program reduced SSI participation. More than half of the QMB participants were previously covered by SSI and Medicaid. The calculations suggest that the QMB program was not as expensive as it might first appear because of reductions in SSI expenditure. (JEL H53, I38, J14) [ABSTRACT FROM AUTHOR]