Abstract: This paper is the first to study the effect of insurance coverage for inpatient psychiatric care on emergency department utilization. I examine this relationship by exploiting Medicaid's Institutions for Mental Disease exclusion, which states that for beneficiaries between the age of 21 and 64, inclusive, Medicaid will not reimburse for medically necessary inpatient psychiatric care administered at an institution with more than sixteen beds. I employ a ``fuzzy" regression discontinuity framework using the near universe of emergency department and inpatient discharge records from 2005 through 2011 for two states. For Medicaid-eligible men, I find that at age 21 reduced coverage for inpatient psychiatric care increases mental health emergency department visits by 11 percent. For Medicaid-eligible women, I tend to find small and statistically insignificant effects. To address the concern that the minimum legal drinking age has a confounding effect at age 21, I define my outcome variable to exclude all alcohol-related visits. I also conduct a placebo test to check that there is no discontinuity in this outcome for private insurance beneficiaries (i.e., individuals that do not experience a change in insurance coverage at age 21). Consistent with the hypothesis that my outcome variable is not confounded by alcohol use at age 21, I find no discontinuity in mental health emergency department visits for this group. We can, therefore, interpret the increase in mental health emergency department visits as the unintended cost of reduced coverage for inpatient psychiatric care.
"The Effect of a Preschool Education on Intellectual and Behavioral Disorder Diagnoses: Evidence from Surveys on Children's Health" Economics of Education Review, Forthcoming
Abstract: Universal Preschool programs, such as those established in Georgia and Oklahoma, are designed to increase the accessibility of a quality preschool education statewide. The literature consistently observes that these programs increase preschool participation, and improve the academic achievement of disadvantaged participants. In this paper, I study the effect of preschool participation on the probability of ever having been diagnosed with certain intellectual and behavioral disorders in childhood. The diagnosis of certain intellectual and behavioral disorders are used as proxies for cognitive and non-cognitive skill. To study this relationship, I employ a two-sample two-stage least squares strategy, where I instrument for preschool participation using an indicator for the availability of universal preschool. Using data from the National Survey of Children's Health and the Current Population Survey October Supplement, I find suggestive evidence that, among low-SES children, participating in preschool reduces the probability of ever having been diagnosed with behavioral or conduct problems, and requiring the use of special therapy.
"Bringing Back the Blue Collar?: The Effect of Reduced Cost for Career Technical Education in Kentucky" Working Paper
Abstract: During the 2013 academic year, Kentucky introduced a policy that reduces the marginal cost of participation in secondary career technical education. In this paper, I study the effect of participation in career technical education on secondary, post-secondary, and labor outcomes. To study this relationship, I instrument for participation using the district-level cost variation induced by this policy. Analyzing linked transcript and workforce data from the Kentucky Center for Education and Workforce Statistics, I find evidence that participation in career technical education increases the probability of completing high school, earning a KOSSA certificate, and attending college. I do not, however, observe a statistically significant relationship between participation and the probability of earning a program certificate, being employed, and annual earnings.