Working Papers
"From Healthcare to Household Welfare: Extended Postpartum Medicaid Coverage and Household Spending" (joint with Hexuan Li)
Abstract: We study how extending coverage of Medicaid can impact household spending and resource reallocation. The Families First Coronavirus Response Act (FFCRA), temporarily mandated continuous Medicaid enrollment during the COVID-19 public health emergency, which effectively extended coverage for all women enrolled in Medicaid during pregnancy. Using monthly product-level purchase records from the NielsenIQ Consumer Panel (2019–2020), linked to state-specific Medicaid income thresholds, we analyze how spending patterns of households with newborns responded to FFCRA. Difference-in-differences estimates show that extended postpartum coverage roughly doubled spending on baby care products and increased total household expenditures by about 21 percent. The increase in spending occurs after 60 days postpartum, providing evidence that coverage extension acted as an expansion to the budget constraint. Further, we find that the increase in household resources translates to an increase in healthcare utilization using data from the Pregnancy Risk Assessment Monitoring Survey (PRAMS). Taken together, the results show how a major public insurance program can shape household resource allocation beyond healthcare use alone.
"Provider Choice, Home Births, and Health Outcomes"
Revisions Requested
Abstract: Home births in the US have increased twofold since the early 2000s, yet little is known about the policies that have driven the increase. Moreover, this increase in births outside of hospitals prompts concerns for maternal and infant health. In this paper, I use natality data from 1989 to 2021 to estimate relative changes in the prevalence of home birth and subsequent health outcomes before and after a change in access to provider choice. Staggered difference-in-differences estimates indicate a 20--30 percent increase in home births when states increase provider choice through non-nursing midwifery licensing. I find the change in access is most salient for college-educated mothers, low-risk pregnancies, and mothers who pay out of pocket. I find little evidence of an effect on other measures of infant health or maternal health.
"Effects of Expanding Contraceptive Choice: New Evidence from Virginia’s Contraceptive Access Initiative" (joint with Analisa Packham)
NBER Link: NBER Working Paper #35108
Conditionally accepted at JPE: Micro
Abstract: In 2018, the Virginia Department of Health implemented the Contraceptive Access Initiative (CAI) to increase access to long-acting reversible contraceptives (LARCs). We use encounter-level data on contraceptive choice in participating CAI clinics and county-level natality data from 2014-2021 to estimate relative changes in LARC take-up and childbearing rates before and after the CAI. Difference-in-differences estimates indicate that the CAI reduced birth rates in participating counties by 1.6-3.5 percent, or less than half of the effect size of other similar, state-level programs. We show that this smaller effect is likely due to existing high LARC take-up and contraceptive substitution.
Peer Reviewed Publications
"How Much Can Hospital-Level Interventions Improve Maternal Health? Evidence from State Perinatal Quality Collaboratives" (2024). Economic Inquiry https://doi.org/10.1111/ecin.13226
Abstract: Over the last 20 years, nearly all states have adopted Perinatal Quality Collaboratives (PQCs), which set guidelines for hospitals to provide higher standards of prenatal care. In this paper, I use individual-level natality data from 1989 to 2019 and a stacked difference in differences design comparing maternal and infant health outcomes in US states that have recently established a PQC to those that have not yet established one. Estimates indicate that PQCs decrease eclampsia, with the effect driven by Black mothers. Evidence also shows that PQCs reduce intensive care unit admissions for mothers.
Works in Progress
"Evaluating the Effectiveness of State-Level Contraceptive Access Initiatives" (with Analisa Packham)
"The Role of Substance Use Disorder Treatment Facilities on Infant and Maternal Health (with Jose Ferdandez, Elizabeth Munnich, and Katherine Yewell)