Research

Peer Reviewed Publications

“Medicaid Expansion Associated With Some Improvements in Perinatal Mental Health” with Claire Margerison, Robert Kaestner, Sidra Goldman-Mellor, and Danielle Gartner. Health Affairs, (link).

Abstract

Poor perinatal mental health is a common pregnancy-related morbidity with potentially serious impacts that extend beyond the individual to their families. A possible contributing factor to poor perinatal mental health is discontinuity in health insurance coveragem which is particularly important among low-income individuals. We examined impacts of Medicaid expansion on pre-pregnancy depression screening and self-reported depression and postpartum depressive symptoms and wellbeing among low-income individuals giving birth. Medicaid expansion was associated with a 16% decline in self-reported pre-pregnancy depression but was not associated with postpartum depressive symptoms or wellbeing. Associations between Medicaid expansion and pre-pregnancy mental health measures increased with time since expansion. Expanding health insurance to low-income individuals prior to pregnancy may improve perinatal mental health.

Working Papers

“Intertemporal Substitution in Response to High-Deductible Health Insurance” (Job Market Paper) (intro link)


Abstract


Non-linear health insurance contracts featuring high deductibles followed by coinsurance rates have become increasingly popular. This work studies whether individuals in the modern U.S. healthcare system optimize spending by consuming elective healthcare at a lower price in the calendar year when the coinsurance arm of the plan is unexpectedly met, and then in the next year reducing elective healthcare consumption. To obtain a causal effect of reaching the coinsurance arm on healthcare consumption in the following year, I use a fuzzy regression discontinuity design comparing those with specific injuries on either side of the new year. Using claim-level data from large firms following privately insured individuals from 2010-2012, I show evidence suggesting there is intertemporal substitution in healthcare consumption. Local average treatment effects indicate that reaching the coinsurance arm in one year leads to $13,263 less healthcare consumed, $788 less paid out of pocket, and 7.4 fewer care dates in the following year. For those induced to consume more healthcare by reaching the coinsurance arm of their plan, I find that that for every $1 spent on healthcare in the year the coinsurance arm is reached, roughly $0.25 less is spent in the following year. Ignoring this intertemporal substitution would cause previous estimates using a single year to overstate the cost-saving benefits of high-deductible plans.




"Postpartum Medicaid Eligibility Expansions and Postpartum Health Measures" with Claire Margerison (under review) (link)


Abstract


Maternal mortality and morbidity in the US are high compared to similar countries, and racial disparities exist, with many of these events occurring in the later postpartum period. Proposed federal and recently enacted state policy interventions extend pregnancy Medicaid from covering 60 days to a full year postpartum. We estimate the association between maintaining Medicaid eligibility in the later postpartum period (relative to only having pregnancy Medicaid eligibility) with postpartum checkup attendance and depressive symptoms using regression analysis, overall and stratified by race/ethnicity. People with postpartum Medicaid eligibility were 1.0-1.4% more likely to attend a postpartum checkup relative to those with only pregnancy Medicaid eligibility overall, primarily driven by a 3.8-4.0% higher likelihood among Hispanic postpartum people. Conversely, postpartum Medicaid is associated with a 2.2-2.3% lower likelihood of postpartum checkup attendance for Black postpartum people. Postpartum eligibility is also associated with a 9.7-11.6% lower likelihood of self-reported depressive symptoms compared to only pregnancy Medicaid eligibility for white postpartum people only. Postpartum Medicaid eligibility is associated with some improvements in maternal healthcare utilization and mental health, but differences by race and ethnicity imply that inequitable systems and structures that cannot be overcome by insurance alone may also play an important role in postpartum health.


"The ACA and Racial Disparities in Women’s Health: A Review of the Literature" with Colleen MacCallum-Bridges, Claire Margerison, Danielle Gartner, and Yasamean Zamani-Hanks


Abstract

Background: In the United States, substantial racial and ethnic health disparities among women of reproductive age persist, emphasizing the need to promote health equity through public policy. Among women of reproductive age, there is evidence that the Affordable Care Act (ACA) increased health insurance coverage, access to healthcare, and healthcare utilization, and may have affected some health outcomes (e.g., preterm delivery). It is unclear, however, whether these impacts were equitably distributed across race and ethnicity. This work fills that gap by summarizing the peer- reviewed evidence regarding the impact of the ACA on racial/ethnic disparities in health insurance coverage, utilization of care, health behaviors, and health outcomes among women of reproductive age. Methods: We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews(PRISMA- ScR), using broad search terms to identify relevant peer-reviewed medical, biomedical, and public health literature in PubMed/MEDLINE. We identified and reviewed n=8 studies. Results: We found evidence that the ACA is associated with reduced uninsurance among Hispanic, NH Black, NH other, and NH White women of reproductive age. Little work has been done, however, to investigate whether this translated into reduced racial/ethnic disparities in health insurance coverage, utilization of care, health behaviors, or health outcomes. Conclusions: To improve our collective understanding and increase the potential to reduce racial/ethnic disparities in women’s health through public policy, rigorous peer- reviewed contributions should estimate the impact of the ACA on racial/ethnic disparities and expand inclusivity of racial/ethnic groups in data collection and analyses.

Other Published Works

"Did Cash Transfers from the 2021 Child Tax Credit Expansion Improve Maternal and Infant Health? A Policy Brief" with Elizabeth Vickers, Yasamean Zamani-Hanks, and Claire Margerison (link)

Works In Progress

“A Guide to Triple Differencing for Health Disparities Research” with Colleen MacCallum-Bridges, Claire Margerison, Danielle Gartner

“Quality of Care During the Year-End Deductible Rush”


Research Assistant

Research Assistant, Michigan State University, Spring 2020-Present

Claire Margerison, Dept. of Epidemiology and Biostatistics

Economics Department Research Assistant, Hope College, Spring 2016-Fall 2016

David Phillips (Spring 2016), Steven McMullen (Fall 2016)


Research Assistant, Hope College, Summer 2016

Estelle, S.M. and D.C. Phillips (2018) “Smart Sentencing Guidelines: The Effect of Marginal Policy Changes on Recidivism.” Journal of Public Economics, 164.