Panel: Can Public Polices Affect Infant Health?

Saturday, November 9, 2019: 1:30 PM-3:00 PM
Plaza Building: Concourse Level, Plaza Court 8 (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Organizer:  Ted Joyce, Baruch College, City University of New York
Panel Chair:  Kerry Anne McGeary, Robert Wood Johnson Foundation
Discussants:  Dhaval Dave, Bentley University and Bowen Garrett, Urban Institute

Over the past 30 years numerous public policies in the U.S. have been directed at improving infant health.  Some specifically target pregnant women such as the Medicaid eligibility expansions and the Supplemental Nutrition Program for Women, Infants and Children (WIC).  Other policies directed at the whole population, such as the Affordable Care Act (ACA), expanded health care access for mothers and infants.   A third set of public policies not directed at improving infant health, such as the Earned Income Tax Credit (EITC), may have important impacts through income transfers.  The four papers in this panel evaluate each of the three types of policies.

 The first paper by (Dubay et al.) evaluates the Strong Start program, a Center for Medicare and Medicaid Innovation (CMMI) demonstration project that looks at the effect of three alternative delivery systems on infant health: maternity care homes, group prenatal care, and birth centers.  The authors match Medicaid eligibility and claims data with birth certificates in 12 states –the first time a linkage of this magnitude had been done. The authors find major improvements in birth outcomes among women in the birth centers but none among women in the other two delivery systems. 

The second paper by Laura Wherry examines the effect of the ACA Medicaid expansions on insurance coverage for low-income women prior to, during, and following pregnancy, effects on health care utilization and health behaviors, and the consequences for infant health. She finds evidence of a significant increase in pre-pregnancy insurance coverage, earlier initiation of prenatal care, and improved infant health among low-income women in states adopting the Medicaid expansions. 

The last two papers assess the effect of labor market policies on infant health.   The first, by Dench and Joyce, challenges the results from a recent paper by Hoynes, Miller and Simon (HMS, 2015) that finds the EITC improves birth outcomes among low-earning women.  HMS aggregate of over 32,000,000 births into 47,000 cells across year, states and demographics.  Despite the seemingly large sample, identification in the difference-in-difference model reduces to changes in low birth weight over eight and three family sizes.  Dench and Joyce show that assumptions underlying the DD are violated and key results fail a basic placebo test.  Dench and Joyce provide evidence that a more plausible explanation for HMS’s findings is the waning of the crack cocaine epidemic.

In a similar analysis Dhaval and Kaestner, authors of the fourth paper, examine the effect of changes in the minimum wage on birth outcomes.  Unlike with the EITC, there have been many changes in the state and federal minimum wage over time.   The authors use a two-way fixed effects DD to exploit the time and geographic variation in the minimum wage.  They find improvements in infant health driven by increases in prenatal care use and a decline in smoking during pregnancy.

Covering the Undocumented: The Effects of a Large-Scale Prenatal Care Intervention
Laura Wherry, University of California, Los Angeles and Sarah Miller, University of Michigan

The Impact of Strong Start on Birth Outcomes and Expenditures Among Women Covered By Medicaid.
Lisa Dubay1, Bowen Garrett1, Fredric Blavin1, Emily M. Johnston1, Embry Howell1, Justin Morgan1, Brigette Courtot1, Sarah Benatar1, Ian Hill1 and Caitlin Cross-Barnet2, (1)Urban Institute, (2)Centers for Medicare & Medicaid Services

Effects of the Minimum Wage on Infant Health
Robert Kaestner, University of Chicago, Dhaval Dave, Bentley University and George L. Wehby, University of Iowa

The Earned Income Tax Credit and Infant Health Revisited
Ted Joyce, Baruch College, City University of New York and Daniel Dench, Graduate Center, City University of New York

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