Research

This paper assesses the impact of in utero and early-childhood exposure to wildfire smoke on longevity as well as economic achievement, human capital accumulation, and disability in mid-to-late adulthood. To identify areas that were exposed to wildfire pollution, we leverage mid-20th century (1930-1969) California wildfires and smoke dispersion modeling. We then combine these wildfire pollution data with comprehensive, restricted-use administrative data from the Social Security Administration and Census Bureau. These linked data allow us to measure childhood wildfire smoke exposure for four decades of birth cohorts and to observe a rich set of later-life outcomes. Using these data, we exploit plausibly exogenous variation in smoke exposure--which is a function of fire timing and size as well as wind direction and speed--to identify long-run effects. We find that moving from the 25th to 75th percentile of early-life wildfire smoke exposure results in 1.7 additional deaths before age 55 per 1,000 individuals, conditional on surviving past early childhood. Aggregating these effects across ages 30 to 80 translates to 46 life years lost per 1,000 persons. We further find that smoke exposure results in unfavorable changes to a wide range of later-life outcomes across economic achievement, educational attainment, and disability measures. From these results, we estimate that each child born in California during our sample period sustained, on average, approximately $22,000 of discounted damages in lost life expectancy and lost earnings due to wildfire smoke. These findings suggest that warming temperatures, which exacerbate the duration and intensity of wildfire seasons, are already meaningfully affecting the life cycles of exposed children through increased smoke exposure.

This paper identifies an important spillover associated with public health insurance: reduced incarceration. In 1990, Congress passed legislation that increased Medicaid eligibility for individuals born after September 30, 1983. We show that Black children born just after the cutoff are 5 percent less likely to be incarcerated by age 28, driven primarily by a decrease in incarcerations connected to financially motivated offenses. Children of other races, who experienced almost no gain in Medicaid coverage as a result of the policy, demonstrate no such declines. We find that reduced incarceration in adulthood substantially offsets the initial costs of expanding eligibility.

In this paper, we examine the importance of individual physicians in explaining the significant variation in prescription drug spending in Medicare Part D. By tracking prescribing behavior before and after physician relocations, we find that movers’ prescribing converges toward the average of their new location. However, this convergence is far from complete, highlighting the importance of idiosyncratic physician-specific factors. Overall, these physician-specific factors explain about 60 to 70 percent of the cross-sectional variation in prescription drug spending, suggesting that physicians are one of the most important supply-side determinants of this variation. We investigate several potential mechanisms behind this partial convergence.

This paper exploits spatial discontinuities in Medicare payment rates to estimate the effect of reimbursements on primary care physicians’ choice of organizational structure. I find that a 1 percent increase in Medicare reimbursement leads to a 1.7 to 2.2 percentage point increase in primary care doctors who practice with a small group (defined as 25 providers or fewer). This effect is driven by changes in the tails of the practice size distribution: a 1.8 percentage point increase in physicians who are affiliated with the smallest (1- or 2-provider) practice groups with a corresponding decrease in physicians joining very large practices (≥ 150 providers). I do not, however, detect any evidence of physician sorting or bunching around the boundary in response to differential payment, supporting the underlying assumptions of my regression discontinuity design. Accordingly, my findings suggest that Medicare pricing may be a factor in the trend of consolidation in the physician and clinical services market.