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The Impact of Expanding Public Health Insurance on Safety Net Program Participation: Evidence From the ACA Medicaid Expansion
May 2026
Working Paper Number:
CES-26-32
We examine spillover effects from the ACA Medicaid expansion to public programs providing cash and food assistance. We consider program participation in contiguous county pairs crossing state borders, where one state took up the Medicaid expansion and the other did not, allowing us to better control for local economic trends that could affect program participation. We find that the Medicaid expansion increased participation in food assistance and one of the cash programs, with impacts mainly due to participation conditional on eligibility, rather than from labor supply responses. Our results demonstrate the potential for spillovers across safety net programs.
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Differences in Disability Insurance Allowance Rates
August 2025
Working Paper Number:
CES-25-54
Allowance rates for disability insurance applications vary by race and ethnicity, but it is unclear to what extent these differences are artifacts of other differing socio-economic and health characteristics, or selection issues in SSA's race and ethnicity data. This paper uses the 2015 American Community Survey linked to 2015-2019 SSA administrative data to investigate DI application allowance rates among non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, non-Hispanic American Indian/Alaska Native, and Hispanic applicants aged 25-65. The analysis uses regression, propensity score matching, and inverse probability weighting to estimate differences in allowance rates among applicants who are similar on observable characteristics. Relative to raw comparisons, differences by race and ethnicity in multivariate analyses are substantially smaller in magnitude and are generally not statistically significant.
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Earnings Through the Stages: Using Tax Data to Test for Sources of Error in CPS ASEC Earnings and Inequality Measures
September 2024
Working Paper Number:
CES-24-52
In this paper, I explore the impact of generalized coverage error, item non-response bias, and measurement error on measures of earnings and earnings inequality in the CPS ASEC. I match addresses selected for the CPS ASEC to administrative data from 1040 tax returns. I then compare earnings statistics in the tax data for wage and salary earnings in samples corresponding to seven stages of the CPS ASEC survey production process. I also compare the statistics using the actual survey responses. The statistics I examine include mean earnings, the Gini coefficient, percentile earnings shares, and shares of the survey weight for a range of percentiles. I examine how the accuracy of the statistics calculated using the survey data is affected by including imputed responses for both those who did not respond to the full CPS ASEC and those who did not respond to the earnings question. I find that generalized coverage error and item nonresponse bias are dominated by measurement error, and that an important aspect of measurement error is households reporting no wage and salary earnings in the CPS ASEC when there are such earnings in the tax data. I find that the CPS ASEC sample misses earnings at the high end of the distribution from the initial selection stage and that the final survey weights exacerbate this.
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Household Wealth and Entrepreneurial Career Choices: Evidence from Climate Disasters
July 2024
Working Paper Number:
CES-24-39
This study investigates how household wealth affects the human capital of startups, based on U.S. Census individual-level employment data, deed records, and geographic information system (GIS) data. Using floods as a wealth shock, a regression discontinuity analysis shows inundated residents are 7% less likely to work in startups relative to their neighbors outside the flood boundary, within a 0.1-mile-wide band. The effect is more pronounced for homeowners, consistent with the wealth effect. The career distortion leads to a significant long-run income loss, highlighting the importance of self-insurance for human capital allocation.
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How Do Health Insurance Costs Affect Firm Labor Composition and Technology Investment?
September 2023
Working Paper Number:
CES-23-47
Employer-sponsored health insurance is a significant component of labor costs. We examine the causal effect of health insurance premiums on firms' employment, both in terms of quantity and composition, and their technology investment decisions. To address endogeneity concerns, we instrument for insurance premiums using idiosyncratic variation in insurers' recent losses, which is plausibly exogenous to their customers who are employers. Using Census microdata, we show that following an increase in premiums, firms reduce employment. Relative to higher-income coworkers, lower-income workers see a larger increase in their likelihood of being separated from their jobs and becoming unemployed. Firms also invest more in information technology, potentially to substitute labor.
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The Underserved Have Less Access to Employer-Sponsored Telemedicine Coverage
September 2022
Working Paper Number:
CES-22-40
Telemedicine has been proposed as one means of improving health care access for underserved communities, and information about insurance coverage for telemedicine (TMC) is important in understanding its utilization and provision. We use 2018-2019 Medical Expenditure Panel Survey-Insurance Component data on employer-sponsored coverage to examine pre-pandemic TMC relative to employer, worker, and health plan characteristics. We find that the share of employees in private sector establishments offering TMC was lower in the most rural counties, in smaller firms, in establishments without unionized employees, and in establishments where most workers were low wage, part-time and older when compared to other establishments. These findings reflect differences across establishments in insurance offers, as well as differences in TMC conditional on an insurance offer, which suggests that TMC may function as a premium plan feature with limited availability and potential support for improving healthcare access for the underserved.
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Introducing the Medical Expenditure Panel Survey-Insurance Component with Administrative Records (MEPS-ICAR): Description, Data Construction Methodology, and Quality Assessment
August 2022
Working Paper Number:
CES-22-29
This report introduces a new dataset, the Medical Expenditure Panel Survey-Insurance Component with Administrative Records (MEPS-ICAR), consisting of MEPS-IC survey data on establishments and their health insurance benefits packages linked to Decennial Census data and administrative tax records on MEPS-IC establishments' workforces. These data include new measures of the characteristics of MEPS-IC establishments' parent firms, employee turnover, the full distribution of MEPS-IC workers' personal and family incomes, the geographic locations where those workers live, and improved workforce demographic detail. Next, this report details the methods used for producing the MEPS-ICAR. Broadly, the linking process begins by matching establishments' parent firms to their workforces using identifiers appearing in tax records. The linking process concludes by matching establishments to their own workforces by identifying the subset of their parent firm's workforce that best matches the expected size, total payroll, and residential geographic distribution of the establishment's workforce. Finally, this report presents statistics characterizing the match rate and the MEPS-ICAR data itself. Key results include that match rates are consistently high (exceeding 90%) across nearly all data subgroups and that the matched data exhibit a reasonable distribution of employment, payroll, and worker commute distances relative to expectations and external benchmarks. Notably, employment measures derived from tax records, but not used in the match itself, correspond with high fidelity to the employment levels that establishments report in the MEPS-IC. Cumulatively, the construction of the MEPS-ICAR significantly expands the capabilities of the MEPS-IC and presents many opportunities for analysts.
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Covering Undocumented Immigrants: The Effects of a Large-Scale Prenatal Care Intervention
August 2022
Working Paper Number:
CES-22-28
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.
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Measuring the Impact of COVID-19 on Businesses and People: Lessons from the Census Bureau's Experience
January 2021
Working Paper Number:
CES-21-02
We provide an overview of Census Bureau activities to enhance the consistency, timeliness, and relevance of our data products in response to the COVID-19 pandemic. We highlight new data products designed to provide timely and granular information on the pandemic's impact: the Small Business Pulse Survey, weekly Business Formation Statistics, the Household Pulse Survey, and Community Resilience Estimates. We describe pandemic-related content introduced to existing surveys such as the Annual Business Survey and the Current Population Survey. We discuss adaptations to ensure the continuity and consistency of existing data products such as principal economic indicators and the American Community Survey.
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Why are employer-sponsored health insurance premiums higher in the public sector than in the private sector?
February 2019
Working Paper Number:
CES-19-03
In this article, we examine the factors explaining differences in public and private sector health insurance premiums for enrollees with single coverage. We use data from the 2000 and 2014 Medical Expenditure Panel Survey-Insurance Component, along with decomposition methods, to explore the relative explanatory importance of plan features and benefit generosity, such as deductibles and other forms of cost sharing, basic employee characteristics (e.g., age, gender, and education), and unionization. While there was little difference in public and private sector premiums in 2000, by 2014, public premiums had exceeded private premiums by 14 to 19 percent. We find that differences in plan characteristics played a substantial role in explaining premium differences in 2014, but they were not the only, or even the most important, factor. Differences in worker age, gender, marital status, and educational attainment were also important factors, as was workforce unionization.
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