New Research

The Long-Term Effects of Income for At-Risk Infants: Evidence from Supplemental Security Income

with Amelia Hawkins, Christopher Hollrah, Laura R.Wherry, Mitchell Wong and Gloria Aldana, revise and resubmit, American Economic Review, NBER Working Paper

This paper examines whether a generous cash intervention early in life can ``undo'' some of the long-term disadvantage associated with poor health at birth. We use new linkages between several large-scale administrative datasets to examine the short-, medium-, and long-term effects of providing low-income families with low birthweight infants support through the Supplemental Security Income (SSI) program. This program uses a birthweight cutoff at 1200 grams to determine eligibility. We find that families of infants born just below this cutoff experience a large increase in cash benefits totaling about 27% of family income in the first three years of the infant's life. These cash benefits persist at lower amounts through age 10. Eligible infants also experience a small but statistically significant increase in Medicaid enrollment during childhood. %and are eligible for referrals to other supportive programs. We examine whether this support affects health care use and mortality in infancy, educational performance in high school, post-secondary school attendance and college degree attainment, and earnings, public assistance use, and mortality in young adulthood for all infants born in California to low-income families whose birthweight puts them near the cutoff. We also examine whether these payments had spillover effects onto the older siblings of these infants who may have also benefited from the increase in family resources. Despite the comprehensive nature of this early life intervention, we detect no improvements in any of the study outcomes, nor do we find improvements among the older siblings of these infants. These null effects persist across several subgroups and alternative model specifications, and, for some outcomes, our estimates are precise enough to rule out published estimates of the effect of early life cash transfers in other settings.

Maternal and Infant Health Inequality: New Evidence from Linked Administrative Data

with Kate Kennedy-Moulton, Petra Persson, Maya Rossin-Slater, Laura R. Wherry and Gloria Aldana, NBER Working Paper

We use linked administrative data that combines the universe of California birth records, hospitalizations, and death records with parental income from Internal Revenue Service tax records and the Longitudinal Employer-Household Dynamics file to provide novel evidence on economic inequality in infant and maternal health. We find that birth outcomes vary non-monotonically with parental income, and that children of parents in the top ventile of the income distribution have higher rates of low birth weight and preterm birth than those in the bottom ventile. However, unlike birth outcomes, infant mortality varies monotonically with income, and infants of parents in the top ventile of the income distribution---who have the worst birth outcomes---have a death rate that is half that of infants of parents in the bottom ventile. When studying maternal health, we find a similar pattern of non-monotonicity between income and severe maternal morbidity, and a monotonic and decreasing relationship between income and maternal mortality. At the same time, these disparities by parental income are small when compared to racial disparities, and we observe virtually no convergence in health outcomes across racial and ethnic groups as income rises. Indeed, infant and maternal health in Black families at the top of the income distribution is markedly worse than that of white families at the bottom of the income distribution. Lastly, we benchmark the health gradients in California to those in Sweden, finding that infant and maternal health is worse in California than in Sweden for most outcomes throughout the entire income distribution.

Covering Undocumented Immigrants: The Effects of A Large-Scale Prenatal Care Intervention

with Laura R. Wherry, NBER Working Paper

Undocumented immigrants are ineligible for public insurance coverage for prenatal care in most states, despite their children representing a large fraction of births and having U.S. citizenship. In this paper, we examine a policy that expanded Medicaid pregnancy coverage to undocumented immigrants. Using a novel dataset that links California birth records to Census surveys, we identify siblings born to immigrant mothers before and after the policy. Implementing a mothers' fixed effects design, we find that the policy increased coverage for and use of prenatal care among pregnant immigrant women, and increased average gestation length and birth weight among their children.

Does Increasing Access to Formal Credit Reduce Payday Borrowing?

with Cindy K. Soo, NBER Working Paper 27783

The use of high cost "payday loans" among subprime borrowers has generated substantial concern among policymakers. This paper provides the first evidence of substitution between "alternative" and "traditional" credit by exploiting an unexpected positive shock to traditional credit access among payday loan borrowers: the removal of a Chapter 7 bankruptcy flag. We find that the removal of a bankruptcy flag on a credit report results in a sharp increase in access to traditional credit and raises credit scores, credit card limits, and approval rates. However, despite meaningful increases in access to traditional credit, we find no evidence that borrowers reduce their use of payday loans, and our confidence intervals allow us to rule out even very small reductions in payday borrowing. Furthermore, we find evidence that flag removals increase the use of other alternative credit products such as online subprime installment loans. These results indicate that marginally improving access to less expensive formal credit is insufficient to meaningfully shift borrowers away from high cost subprime products. We discuss likely explanations for this including increased marketing of subprime products associated with the flag removal, the imperfect substitutability between cash and credit for low income borrowers, and an insufficiency in the size of the increase in credit access associated with the flag removal.