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The centrality of home equity to the balance sheets of American households, and the oppressive legacy of racial exclusion from mortgage markets, compel the design of intentionally anti-racist housing policy capable of building lasting wealth for Black families. In this study, we compare the home-mortgage terms offered to middle-income Whites in the New Deal era, with a contemporary New York City policy offered in formerly redlined districts. The city's Housing Development Fund Corporation policy is for limited-income households but does not limit down payments nor qualify for federal home loans. Using mined listing data and the 2017 Panel Study of Income Dynamics, we find more than 80% of income-eligible urban Black households lack the wealth to purchase the median listing, versus 51% of Whites. Moreover, the policy's market exclusions preclude access to what is now substantial accumulated equity. Unit owners face wide-scale housing-code violations and property seizure, highlighting the limitations of "limited equity" ownership, which counteracts wealth creation. We draw two primary lessons. First, anti-racist policy cannot demand substantial financial assets. Second, financing schemes for building improvement or climate-responsive adaptation, in addition to initial purchase, should be well-tailored to family budgets and designed to deliver equity to the formerly excluded. [ABSTRACT FROM AUTHOR]

While the Affordable Care Act successfully expanded health insurance access, the law's private insurance component drew far fewer participants than projected. This study investigates the attractiveness of Marketplace insurance relative to uncompensated care provisions for those who remain uninsured. Using restricted‐access Medical Expenditure Panel Survey data, I find that for one in four previously uninsured consumers, bankruptcy costs less than meeting the deductible of the subsidized benchmark policy. Marketplace insurance reduces spending in only the top 3% most catastrophic potential scenarios these consumers face, on average. Net financial gain is more common among individuals in poor health (11% vs. 1%) or with assets to protect (3% vs. <1%). High‐deductible insurance aims to protect wealth in catastrophic scenarios. However, hospitals substantially discount care for the uninsured in such scenarios. High‐deductible coverage might not be an effective driver of financial security for the uninsured, which may help to explain low Marketplace enrollment. [ABSTRACT FROM AUTHOR]

The distribution of wealth has grown increasingly unequal, especially along racial lines. Lawmakers and researchers propose to address the issue with universal "baby bonds," paid to every newborn and preserved until young adulthood. Bond values are tied inversely to wealth up to a $50,000 maximum investment. This study uses longitudinal data from the Panel Study of Income Dynamics on the assets of young adults to simulate contemporary racial inequalities under a counterfactual policy environment in which the United States had administered baby bonds when the current cohort of young adults were newborns. Initial bond values are defined categorically by quintiles of household wealth observed in 1989 and 1994, smoothed across the inverse hyperbolic sine of household wealth, and then assumed to grow at 2% per year through 2015. Without baby bonds, young White Americans hold approximately 16 times the wealth of young Black Americans at the median ($46,000 vs. $2,900). Baby bonds reduce the disparity to a factor of 1.4 ($79,143 vs. $57,845), in the absence of intervening behavioral responses to the policy. The share held by the top decile decreases from 72% to 65%, marginally approaching the more egalitarian societies. Baby bonds considerably narrow wealth inequalities while simultaneously improving the net asset position of young adults and alleviating asset concentration. [ABSTRACT FROM AUTHOR]

Several states are considering competitive procurement to help shape Medicaid managed care markets. In New York state, the focus of our study, regulators propose contracts that reward quality improvement and simplify state administration by rewarding plans that operate across several of the state's 62 counties. This case analysis uses novel regulatory data from New York state, obtained via public records request, to examine incentives underlying Medicaid markets and help inform contracting design. The data report plan enrollment by county and plan spending across administrative activities for all 16 Medicaid plans in New York state for 2018. We examine the counties in which plans operate, profitability, and administrative resource allocation. We compare outcomes by tertile of plan profitability, measured as net income per member-month. Plan profitability ranged widely, with the most profitable plan realizing nearly $30 per member-month while the least profitable 5 plans realized net negative earnings. Operational differences across plan profitability emerged most clearly in administrative spending. The most profitable plans reported greater spending on salaries overall and for executive management, and taxes, while the least profitable plans spent more on operational functions including utilization management/ quality improvement, claims processing, and informational systems. We observe modest differences in county rurality and little in geographic breadth. Procurement design that rewards capacity-building in key administrative functions might impact market evolution, given that on average, highly profitable firms spent less on these activities in New York's Medicaid managed care market in 2018., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.