Three Essays on Health Economics and Policy

Government policies are frequently implemented with promises of improvements to health outcomes and reduced spending on healthcare. I analyze three instances where the intersection of policy and health have ambiguous effects. In chapter one, I explore two policies endorsed by public health authorities, state-level alcohol excise taxes and laws mandating the placement of signs at the point-of-sale warning of the dangers of drinking during pregnancy. I study these policies across six data sources covering thirty years, using contemporary difference-in-difference methods. I also use a novel approach for standardizing alcohol taxes that vary across different products and in their administration. Contrary to earlier research, I find that neither policy leads to significant changes in drinking behavior or fetal health outcomes. In chapter two, I use difference-in-differences methods and individual longitudinal data from the 2012-2022 National Health and Aging Trends Study (NHATS) to examine the impacts of Medicaid hearing aid coverage on hearing aid use among adults dually eligible for Medicare and Medicaid. I estimate a 5.99 percentage-point, or 66% relative increase in hearing aid use and also find suggestive evidence of a reduction in activity impairment. Thirty-two state Medicaid programs cover hearing aids, but research on the effectiveness of these policies is extremely sparse. My findings contribute to this limited evidence base and may also have implications for proposals to include a hearing aid benefit in traditional Medicare. In chapter three, I study the effect of paid sick leave laws on aggregate private insurance spending data from the Centers for Medicare and Medicaid Services, and household spending data from the Bureau of Labor Statistics. I find evidence that paid sick leave laws significantly increase per-capita private insurance spending as well as out-of-pocket spending on prescription drugs. My results show a 7.5% increase in per-capita private health insurance spending, and a 25% increase in prescription drug spending among households most likely to newly gain paid sick leave. I conclude that reducing healthcare spending is not one of the likely benefits of paid sick leave laws.