New Research

The Economic Consequences of Being Denied an Abortion


with Laura R. Wherry and Diana Greene Foster, NBER Working Paper 26662

Restrictions on abortion are pervasive, yet relatively little is known about the financial and economic impact of being denied an abortion on pregnant women who seek one. This paper evaluates the economic consequences of being denied an abortion on the basis of the gestational age of the pregnancy. Our analysis relies on new linkages to administrative credit report data for participants in the Turnaway Study, the first study to collect high-quality, longitudinal data on women receiving or being denied a wanted abortion in the United States. Some women had pregnancies close to the facility's gestational age limit, but below it, and received a wanted abortion (Near Limit Group). A second group of women had pregnancies just over the facility's gestational age limit and were turned away without receiving an abortion (Turnaway Group). We link study participants to ten years of credit report data including several years prior to their recruitment into the study. This linked dataset allows us to observe economic trajectories for the two groups of women prior to the abortion denial or receipt. Using these data, we compare differences in credit report outcomes for the two groups of women over time using an event study design. We find that the trajectories for these outcomes are similar for the two groups of women prior to the abortion encounter. However, following their visit to the abortion provider, we find evidence of a large and persistent increase in financial distress for the women who were denied an abortion that is sustained for the 6 years following the intended abortion. In particular, we find that being denied an abortion increases the amount of debt 30 days or more past due by 78 percent and increases negative public records, such as bankruptcies and evictions, by 81 percent. We conduct additional analyses that use a regression discontinuity design to compare outcomes for women just above and just below the gestation limit at each clinic and find results that are consistent with the event study analyses. Overall, our results highlight important financial and economic consequences of restrictions on abortion access.

What Difference Does a Diagnosis Make? Evidence from Marginal Patients


with Mattan Alalouf and Laura R. Wherry, NBER Working Paper 26363

Over the past 30 years, the criteria used to diagnose many illnesses have been relaxed, resulting in millions more relatively healthy individuals receiving treatment. This paper explores the impact of receiving a diagnosis of a common disease among such “marginally ill” patients. We apply a regression discontinuity design to the cutoff in blood sugar levels used to classify patients as having diabetes. We find that a marginally diagnosed patient with diabetes spends $1,097 more on drugs and diabetes-related care annually after diagnosis, but find no corresponding changes in self-reported health or healthy behaviors. These increases in spending persist over the 6-year period we observe the patients. These marginally diagnosed patients experience improved blood sugar after the first year of diagnosis, but this improvement does not persist in subsequent years. Other clinical measures of health, such as BMI, blood pressure, cholesterol, and mortality show no improvement. The diagnosis rates for preventable disease-related conditions such as diabetic retinopathy, neuropathy, and kidney disease increase following a diagnosis, likely due to more intensive screening. Our results imply that a small relaxation in the diagnosis cutoff would increase total spending on diabetes-related care by about $2.4 billion annually and minimally impact patient health.

Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data


with Sean Altekruse, Norman Johnson and Laura R. Wherry, revise and resubmit, Quarterly Journal of Economics. NBER Working Paper 26081

We use large-scale federal survey data linked to administrative death records to investigate the relationship between Medicaid enrollment and mortality. Our analysis compares changes in mortality for near-elderly adults in states with and without Affordable Care Act Medicaid expansions. We identify adults most likely to benefit using survey information on socioeconomic and citizenship status, and public program participation. We find a 0.13 percentage point decline in annual mortality, a 9.3 percent reduction over the sample mean, associated with Medicaid expansion for this population. The effect is driven by a reduction in disease-related deaths and grows over time. We find no evidence of differential pre-treatment trends in outcomes and no effects among placebo groups.

The ACA Medicaid Expansion in Michigan and Financial Health


with Luojia Hu, Robert Kaestner, Bhashkar Mazumder, Ashley Wong Revise and resubmit, Journal of Policy Analysis and Management. NBER Working Paper 25053

This article examines the impact of the Affordable Care Act Medicaid expansion in Michigan, the Healthy Michigan Program (HMP), on the financial well-being of new Medicaid enrollees. Our analysis uses a dataset on credit reports matched to administrative data on HMP enrollment and use of health care services. We find that enrollment is associated with large improvements in several measures of financial health, including reductions in unpaid bills, medical bills, over limit credit card spending, delinquencies, and public records (such as evictions, judgments, and bankruptcies). These benefits are apparent across several subgroups, although individuals with greater medical need (such as those with chronic illnesses) experience the largest improvements.

Press Coverage: Detroit News, Michigan Public Radio, Forbes

Multi-generational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation's Health


with Chloe East, Marianne Page, and Laura Wherry, "Reject and resubmit," American Economic Review. NBER Working Paper 23810

We examine multi-generational impacts of positive in utero and early life health interventions. We focus on the 1980s Medicaid expansions, which targeted low-income pregnant women, and were adopted differently across states and over time. We use Vital Statistics Natality files to create unique data linking individuals’ in utero Medicaid exposure to the next generation’s health outcomes at birth. We find strong evidence that the health benefits associated with treated generations’ in utero access to Medicaid extend to later offspring in the form of higher average birth weight and decreased incidence of very low birth weight. Later childhood exposure to Medicaid does not lead to persistent health effects across generations. The return on investment is substantially larger than suggested by evaluations of the program that focus only on treated cohorts.

Press Coverage: Wall Street Journal, Bloomberg News, NBER Digest

Drug Firms' Payments and Physicians' Prescribing Behavior in Medicare Part D


with Colleen Carey and Ethan Lieber. Revise and resubmit, AEJ: Economic Policy.

In a pervasive but controversial practice, drug firms frequently make monetary or in-kind payments to medical providers. Critics are concerned that drug firms are distorting prescribing behavior away from the best interests of patients, while defenders of the practice claim that payments arise from the need to educate providers about changing drug technologies. Using two different identification strategies, we investigate the effect of payments from drug firms on individual-level prescribing behavior in Medicare Part D. We find that individuals whose providers receive payments from a drug firm tend to increase expenditure on the firm's products. Our method accounts for the selection of physicians into payments (which may result if, e.g., pharmaceutical firms target payments to physicians who see a large number of patients) and our finding holds even when we look over time within individuals who change providers. However, using hand-collected efficacy data on four major therapeutic classes, we find that those receiving payments also prescribe higher-quality drugs on average. In addition, we examine four case studies of major drugs going off patent. Providers receiving payments from the firms experiencing the patent expiry transition their patients just as quickly to generics as prescribers who do not receive such payments. These results suggest that, absent other interventions to facilitate education, policies such as the Physician Payments Sunshine Act may reduce the efficacy of drugs prescribed.