IDEAS home Printed from https://ideas.repec.org/a/aea/aecrev/v111y2021i8p2550-93.html
   My bibliography  Save this article

The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes

Author

Listed:
  • Andrew Goodman-Bacon

Abstract

This paper estimates the long-run effects of childhood Medicaid eligibility on adult health and economic outcomes using the program's original introduction (1966–1970) and its mandated coverage of welfare recipients. The design compares cohorts born in different years relative to Medicaid implementation, in states with different preexisting welfare-based eligibility. Early childhood Medicaid eligibility reduces mortality and disability, increases employment, and reduces receipt of disability transfer programs up to 50 years later. Medicaid has saved the government more than its original cost and saved more than 10 million quality adjusted life years.

Suggested Citation

  • Andrew Goodman-Bacon, 2021. "The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes," American Economic Review, American Economic Association, vol. 111(8), pages 2550-2593, August.
    • Handle: RePEc:aea:aecrev:v:111:y:2021:i:8:p:2550-93
    DOI: 10.1257/aer.20171671
    as

    Download full text from publisher

    File URL: https://www.aeaweb.org/doi/10.1257/aer.20171671
    Download Restriction: no
    File URL: https://doi.org/10.3886/E127621V1
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/aer.20171671.appx
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/aer.20171671.ds
    Download Restriction: Access to full text is restricted to AEA members and institutional subscribers.
    File URL: https://libkey.io/10.1257/aer.20171671?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. James P. Smith, 2009. "The Impact of Childhood Health on Adult Labor Market Outcomes," The Review of Economics and Statistics, MIT Press, vol. 91(3), pages 478-489, August.
    2. Orley Ashenfelter & Michael Greenstone, 2004. "Estimating the Value of a Statistical Life: The Importance of Omitted Variables and Publication Bias," American Economic Review, American Economic Association, vol. 94(2), pages 454-460, May.
    3. Prashant Bharadwaj & Katrine Vellesen L?ken & Christopher Neilson, 2013. "Early Life Health Interventions and Academic Achievement," American Economic Review, American Economic Association, vol. 103(5), pages 1862-1891, August.
    4. Flavio Cunha & James J. Heckman & Susanne M. Schennach, 2010. "Estimating the Technology of Cognitive and Noncognitive Skill Formation," Econometrica, Econometric Society, vol. 78(3), pages 883-931, May.
    5. Raj Chetty & John N. Friedman & Jonah E. Rockoff, 2014. "Measuring the Impacts of Teachers II: Teacher Value-Added and Student Outcomes in Adulthood," American Economic Review, American Economic Association, vol. 104(9), pages 2633-2679, September.
    6. Currie, Janet & Gruber, Jonathan, 2001. "Public health insurance and medical treatment: the equalizing impact of the Medicaid expansions," Journal of Public Economics, Elsevier, vol. 82(1), pages 63-89, October.
    7. Jonathan Gruber & Aaron Yelowitz, 1999. "Public Health Insurance and Private Savings," Journal of Political Economy, University of Chicago Press, vol. 107(6), pages 1249-1274, December.
    8. Orley Ashenfelter & Michael Greenstone, 2004. "Estimating the Value of a Statistical Life: The Importance of Omitted Variables and Publication Bias," American Economic Review, American Economic Association, vol. 94(2), pages 454-460, May.
    9. Kenneth Y. Chay & Jonathan Guryan & Bhashkar Mazumder, 2014. "Early Life Environment and Racial Inequality in Education and Earnings in the United States," Working Paper Series WP-2014-28, Federal Reserve Bank of Chicago.
    10. Alan I. Barreca, 2010. "The Long-Term Economic Impact of In Utero and Postnatal Exposure to Malaria," Journal of Human Resources, University of Wisconsin Press, vol. 45(4), pages 865-892.
    11. Anne Case & Angua Deaton, 2015. "Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century," Working Papers 15078.full.pdf, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
    12. Gary Solon & Steven J. Haider & Jeffrey M. Wooldridge, 2015. "What Are We Weighting For?," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 301-316.
    13. Eric French & Jae Song, 2014. "The Effect of Disability Insurance Receipt on Labor Supply," American Economic Journal: Economic Policy, American Economic Association, vol. 6(2), pages 291-337, May.
    14. Orley Ashenfelter & Michael Greenstone, 2004. "Estimating the Value of a Statistical Life: The Importance of Omitted Variables and Publication Bias," Working Papers 858, Princeton University, Department of Economics, Industrial Relations Section..
    15. Alston, Lee J. & Ferrie, Joseph P., 1985. "Labor Costs, Paternalism, and Loyalty in Southern Agriculture: A Constraint on the Growth of the Welfare State," The Journal of Economic History, Cambridge University Press, vol. 45(1), pages 95-117, March.
    16. Becker, Gary S & Tomes, Nigel, 1976. "Child Endowments and the Quantity and Quality of Children," Journal of Political Economy, University of Chicago Press, vol. 84(4), pages 143-162, August.
    17. Melvin Stephens Jr. & Dou-Yan Yang, 2014. "Compulsory Education and the Benefits of Schooling," American Economic Review, American Economic Association, vol. 104(6), pages 1777-1792, June.
    18. Hoyt Bleakley, 2007. "Disease and Development: Evidence from Hookworm Eradication in the American South," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 73-117.
    19. Patrick Kline & Christopher R. Walters, 2016. "Evaluating Public Programs with Close Substitutes: The Case of HeadStart," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1795-1848.
    20. Laura R. Wherry & Bruce D. Meyer, 2016. "Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 556-588.
    21. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 431-466.
    22. Beach, Brian & Ferrie, Joseph & Saavedra, Martin & Troesken, Werner, 2016. "Typhoid Fever, Water Quality, and Human Capital Formation," The Journal of Economic History, Cambridge University Press, vol. 76(1), pages 41-75, March.
    23. Mark C. Berger & Dan A. Black, 1998. "The Duration Of Medicaid Spells: An Analysis Using Flow And Stock Samples," The Review of Economics and Statistics, MIT Press, vol. 80(4), pages 667-675, November.
    24. Jeffrey R Kling & Jeffrey B Liebman & Lawrence F Katz, 2007. "Experimental Analysis of Neighborhood Effects," Econometrica, Econometric Society, vol. 75(1), pages 83-119, January.
    25. James J. Heckman & Edward Vytlacil, 2005. "Structural Equations, Treatment Effects, and Econometric Policy Evaluation," Econometrica, Econometric Society, vol. 73(3), pages 669-738, May.
    26. Lee Jin Young & Solon Gary, 2011. "The Fragility of Estimated Effects of Unilateral Divorce Laws on Divorce Rates," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(1), pages 1-11, August.
    27. Mark Duggan & Scott A. Imberman, 2009. "Why Are the Disability Rolls Skyrocketing? The Contribution of Population Characteristics, Economic Conditions, and Program Generosity," NBER Chapters, in: Health at Older Ages: The Causes and Consequences of Declining Disability among the Elderly, pages 337-379, National Bureau of Economic Research, Inc.
    28. Sarah R. Cohodes & Daniel S. Grossman & Samuel A. Kleiner & Michael F. Lovenheim, 2016. "The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 727-759.
    29. Raj Chetty & John N. Friedman & Nathaniel Hilger & Emmanuel Saez & Diane Whitmore Schanzenbach & Danny Yagan, 2011. "How Does Your Kindergarten Classroom Affect Your Earnings? Evidence from Project Star," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 126(4), pages 1593-1660.
    30. David H. Autor & Mark G. Duggan, 2006. "The Growth in the Social Security Disability Rolls: A Fiscal Crisis Unfolding," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 71-96, Summer.
    31. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    32. Bound, John, 1989. "The Health and Earnings of Rejected Disability Insurance Applicants," American Economic Review, American Economic Association, vol. 79(3), pages 482-503, June.
    33. Raj Chetty & Nathaniel Hendren & Patrick Kline & Emmanuel Saez, 2014. "Where is the land of Opportunity? The Geography of Intergenerational Mobility in the United States," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 129(4), pages 1553-1623.
    34. Daniel Feenberg & Elisabeth Coutts, 1993. "An introduction to the TAXSIM model," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 12(1), pages 189-194.
    35. Raj Chetty & Nathaniel Hendren & Patrick Kline & Emmanuel Saez & Nicholas Turner, 2014. "Is the United States Still a Land of Opportunity? Recent Trends in Intergenerational Mobility," American Economic Review, American Economic Association, vol. 104(5), pages 141-147, May.
    36. Marianne P. Bitler & Janet Currie, 2004. "Medicaid at Birth, WIC Take Up, and Children's Outcomes," Working Papers 172, RAND Corporation.
    37. Hilary Hoynes & Diane Whitmore Schanzenbach & Douglas Almond, 2016. "Long-Run Impacts of Childhood Access to the Safety Net," American Economic Review, American Economic Association, vol. 106(4), pages 903-934, April.
    38. Boudreaux, Michel H. & Golberstein, Ezra & McAlpine, Donna D., 2016. "The long-term impacts of Medicaid exposure in early childhood: Evidence from the program's origin," Journal of Health Economics, Elsevier, vol. 45(C), pages 161-175.
    39. Charles, Kerwin Kofi & DeCicca, Philip, 2008. "Local labor market fluctuations and health: Is there a connection and for whom?," Journal of Health Economics, Elsevier, vol. 27(6), pages 1532-1550, December.
    40. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-1296, December.
    41. Sarah Miller & Laura R. Wherry, 2019. "The Long-Term Effects of Early Life Medicaid Coverage," Journal of Human Resources, University of Wisconsin Press, vol. 54(3), pages 785-824.
    42. Laura R. Wherry & Sarah Miller & Robert Kaestner & Bruce D. Meyer, 2018. "Childhood Medicaid Coverage and Later-Life Health Care Utilization," The Review of Economics and Statistics, MIT Press, vol. 100(2), pages 287-302, May.
    43. Levine Phillip B & Schanzenbach Diane, 2009. "The Impact of Children's Public Health Insurance Expansions on Educational Outcomes," Forum for Health Economics & Policy, De Gruyter, vol. 12(1), pages 1-28, May.
    44. David R. Agrawal & William H. Hoyt, 2018. "Commuting and Taxes: Theory, Empirics and Welfare Implications," Economic Journal, Royal Economic Society, vol. 128(616), pages 2969-3007, December.
    45. Chul-In Lee & Gary Solon, 2009. "Trends in Intergenerational Income Mobility," The Review of Economics and Statistics, MIT Press, vol. 91(4), pages 766-772, November.
    46. Marianne P. Bitler & Janet Currie, 2004. "Medicaid at Birth, WIC Take Up, and Children's Outcomes," Working Papers WR-172, RAND Corporation.
    47. Anna Aizer & Shari Eli & Joseph P. Ferrie & Adriana Lleras-Muney, 2014. "The Long Term Impact of Cash Transfers to Poor Families," NBER Working Papers 20103, National Bureau of Economic Research, Inc.
    48. Carolyn M. Moehling, 2007. "The American Welfare System and Family Structure: An Historical Perspective," Journal of Human Resources, University of Wisconsin Press, vol. 42(1).
    49. Amy Finkelstein & Nathaniel Hendren & Erzo F. P. Luttmer, 2019. "The Value of Medicaid: Interpreting Results from the Oregon Health Insurance Experiment," Journal of Political Economy, University of Chicago Press, vol. 127(6), pages 2836-2874.
    50. Currie, Janet & Decker, Sandra & Lin, Wanchuan, 2008. "Has public health insurance for older children reduced disparities in access to care and health outcomes?," Journal of Health Economics, Elsevier, vol. 27(6), pages 1567-1581, December.
    51. Jeffrey B. Liebman, 2015. "Understanding the Increase in Disability Insurance Benefit Receipt in the United States," Journal of Economic Perspectives, American Economic Association, vol. 29(2), pages 123-150, Spring.
    52. Kenneth Y. Chay & Jonathan Guryan & Bhashkar Mazumder, 2009. "Birth Cohort and the Black-White Achievement Gap: The Roles of Access and Health Soon After Birth," NBER Working Papers 15078, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Hull, Marie & Yan, Ji, 2024. "The impact of children's access to public health insurance on their cognitive development and behavior," Journal of Health Economics, Elsevier, vol. 98(C).
    2. Huang, Wei & Liu, Hong, 2023. "Early childhood exposure to health insurance and adolescent outcomes: Evidence from rural China," Journal of Development Economics, Elsevier, vol. 160(C).
    3. Almond, Douglas & Currie, Janet, 2011. "Human Capital Development before Age Five," Handbook of Labor Economics, in: O. Ashenfelter & D. Card (ed.), Handbook of Labor Economics, edition 1, volume 4, chapter 15, pages 1315-1486, Elsevier.
    4. Chloe N. East & Sarah Miller & Marianne Page & Laura R. Wherry, 2023. "Multigenerational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation's Health," American Economic Review, American Economic Association, vol. 113(1), pages 98-135, January.
    5. Qureshi, Javaeria A. & Gangopadhyaya, Anuj, 2021. "Childhood Medicaid Eligibility and Human Capital," Economics of Education Review, Elsevier, vol. 82(C).
    6. Douglas Almond & Janet Currie & Valentina Duque, 2018. "Childhood Circumstances and Adult Outcomes: Act II," Journal of Economic Literature, American Economic Association, vol. 56(4), pages 1360-1446, December.
    7. Gong, Jie & Lu, Yi & Xie, Huihua, 2020. "The average and distributional effects of teenage adversity on long-term health," Journal of Health Economics, Elsevier, vol. 71(C).
    8. Noghanibehambari, Hamid, 2022. "Intergenerational health effects of Medicaid," Economics & Human Biology, Elsevier, vol. 45(C).
    9. Stock, Wendy & Schultz, Gunnar, 2025. "Public health insurance and special education enrollment," Economics of Education Review, Elsevier, vol. 105(C).
    10. Thompson, Owen, 2017. "The long-term health impacts of Medicaid and CHIP," Journal of Health Economics, Elsevier, vol. 51(C), pages 26-40.
    11. Boudreaux, Michel H. & Golberstein, Ezra & McAlpine, Donna D., 2016. "The long-term impacts of Medicaid exposure in early childhood: Evidence from the program's origin," Journal of Health Economics, Elsevier, vol. 45(C), pages 161-175.
    12. O'Donnell, Owen, 2024. "Health and health system effects on poverty: A narrative review of global evidence," Health Policy, Elsevier, vol. 142(C).
    13. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters, in: Economics of Means-Tested Transfer Programs in the United States, Volume 1, pages 21-136, National Bureau of Economic Research, Inc.
    14. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1783-1829.
    15. Hilary W. Hoynes & Diane Whitmore Schanzenbach, 2018. "Safety Nets Investments in Children," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 49(1 (Spring), pages 89-150.
    16. Rucker C. Johnson, 2018. "Addressing Racial Health Disparities: Looking Back to Point the Way Forward," The ANNALS of the American Academy of Political and Social Science, , vol. 680(1), pages 132-171, November.
    17. repec:mrr:papers:wp341 is not listed on IDEAS
    18. Gabriella Conti, 2013. "The Developmental Origins of Health Inequality," Research on Economic Inequality, in: Health and Inequality, volume 21, pages 285-309, Emerald Group Publishing Limited.
    19. Patrick Kline & Christopher R. Walters, 2016. "Evaluating Public Programs with Close Substitutes: The Case of HeadStart," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1795-1848.
    20. Sarah R. Cohodes & Daniel S. Grossman & Samuel A. Kleiner & Michael F. Lovenheim, 2016. "The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 727-759.
    21. Toshiaki Iizuka & Hitoshi Shigeoka, 2018. "Free for Children? Patient Cost-sharing and Healthcare Utilization," NBER Working Papers 25306, National Bureau of Economic Research, Inc.

    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I32 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Measurement and Analysis of Poverty
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:aea:aecrev:v:111:y:2021:i:8:p:2550-93. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Michael P. Albert (email available below). General contact details of provider: https://edirc.repec.org/data/aeaaaea.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.