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Age, Sex, and Racial/Ethnic Disparities and Temporal-Spatial Variation in
Excess All-Cause Mortality During the COVID-19 Pandemic: Evidence from Linked Administrative and Census Bureau Data
May 2022
Working Paper Number:
CES-22-18
Research on the impact of the COVID-19 pandemic in the United States has highlighted substantial racial/ethnic disparities in excess mortality, but reports often differ in the details with respect to the size of these disparities. We suggest that these inconsistencies stem from differences in the temporal scope and measurement of race/ethnicity in existing data. We address these issues using death records for 2010 through 2021 from the Social Security Administration, covering the universe of individuals ever issued a Social Security Number, linked to race/ethnicity responses from the decennial census and American Community Survey. We use these data to (1) estimate excess all-cause mortality at the national level and for age-, sex-, and race/ethnicity-specific subgroups, (2) examine racial/ethnic variation in excess mortality over the course of the pandemic, and (3) explore whether and how racial/ethnic mortality disparities vary across states.
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Employer Concentration and Labor Force Participation
March 2022
Working Paper Number:
CES-22-08
This paper examines the association between employer concentration and labor outcomes (labor force participation and employment). It uses restricted data from the U.S. Census Bureau's Longitudinal Business Database to estimate, at the county level, to what extent more concentrated labor markets have lower labor force participation rates and lower employment. The analysis also examines whether unionization rates and education levels mediate these associations.
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Who Values Human Capitalists' Human Capital? Healthcare Spending and Physician Earnings
July 2020
Working Paper Number:
CES-20-23
Is government guiding the invisible hand at the top of the labor market? We study this question among physicians, the most common occupation among the top one percent of income earners, and whose billings comprise one-fifth of healthcare spending. We use a novel linkage of population-wide tax records with the administrative registry of all physicians in the U.S. to study the characteristics of these high earnings, and the influence of government payments in particular. We find a major role for government on the margin, with half of direct changes to government reimbursement rates flowing directly into physicians' incomes. These policies move physicians' relative and absolute incomes more than any reasonable changes to marginal tax rates. At the same time, the overall level of physician earnings can largely be explained by labor market fundamentals of long work and training hours. Competing occupations also pay well and provide a natural lower bound for physician earnings. We conclude that government plays a major role in determining the value of physicians' human capital, but it is unrealistic to use this power to reduce healthcare spending substantially.
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Addressing Data Gaps:
Four New Lines of Inquiry in the 2017 Economic Census
September 2019
Working Paper Number:
CES-19-28
We describe four new lines of inquiry added to the 2017 Economic Census regarding (i) retail health clinics, (ii) management practices in health care services, (iii) self-service in retail and service industries, and (iv) water use in manufacturing and mining industries. These were proposed by economists from the U.S. Census Bureau's Center for Economic Studies in order to fill data gaps in current Census Bureau products concerning the U.S. economy. The new content addresses such issues as the rise in importance of health care and its complexity, the adoption of automation technologies, and the importance of measuring water, a critical input to many manufacturing and mining industries.
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The Use of Administrative Records and the American Community Survey to Study the Characteristics of Undercounted Young Children in the 2010 Census
May 2018
Working Paper Number:
carra-2018-05
Children under age five are historically one of the most difficult segments of the population to enumerate in the U.S. decennial census. The persistent undercount of young children is highest among Hispanics and racial minorities. In this study, we link 2010 Census data to administrative records from government and third party data sources, such as Medicaid enrollment data and tenant rental assistance program records from the Department of Housing and Urban Development, to identify differences between children reported and not reported in the 2010 Census. In addition, we link children in administrative records to the American Community Survey to identify various characteristics of households with children under age five who may have been missed in the last census. This research contributes to what is known about the demographic, socioeconomic, and household characteristics of young children undercounted by the census. Our research also informs the potential benefits of using administrative records and surveys to supplement the U.S. Census Bureau child population enumeration efforts in future decennial censuses.
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Reporting of Indian Health Service Coverage in the American Community Survey
May 2018
Working Paper Number:
carra-2018-04
Response error in surveys affects the quality of data which are relied on for numerous research and policy purposes. We use linked survey and administrative records data to examine reporting of a particular item in the American Community Survey (ACS) - health coverage among American Indians and Alaska Natives (AIANs) through the Indian Health Service (IHS). We compare responses to the IHS portion of the 2014 ACS health insurance question to whether or not individuals are in the 2014 IHS Patient Registration data. We evaluate the extent to which individuals misreport their IHS coverage in the ACS as well as the characteristics associated with misreporting. We also assess whether the ACS estimates of AIANs with IHS coverage represent an undercount. Our results will be of interest to researchers who rely on survey responses in general and specifically the ACS health insurance question. Moreover, our analysis contributes to the literature on using administrative records to measure components of survey error.
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Labor Market Effects of the Affordable Care Act: Evidence from a Tax Notch
July 2017
Working Paper Number:
carra-2017-07
States that declined to raise their Medicaid income eligibility cutoffs to 138 percent of the federal poverty level (FPL) under the Affordable Care Act (ACA) created a "coverage gap'' between their existing, often much lower Medicaid eligibility cutoffs and the FPL, the lowest level of income at which the ACA provides refundable, advanceable "premium tax credits'' to subsidize the purchase of private insurance. Lacking access to any form of subsidized health insurance, residents of those states with income in that range face a strong incentive, in the form of a large, discrete increase in post-tax income (i.e. an upward notch) at the FPL, to increase their earnings and obtain the premium tax credit. We investigate the extent to which they respond to that incentive. Using the universe of tax returns, we document excess mass, or bunching, in the income distribution surrounding this notch. Consistent with Saez (2010), we find that bunching occurs only among filers with self-employment income. Specifically, filers without children and married filers with three or fewer children exhibit significant bunching. Analysis of tax data linked to labor supply measures from the American Community Survey, however, suggests that this bunching likely reflects a change in reported income rather than a change in true labor supply. We find no evidence that wage and salary workers adjust their labor supply in response to increased availability of directly purchased health insurance.
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DOES PARENTS' ACCESS TO FAMILY PLANNING INCREASE CHILDREN'S OPPORTUNITIES? EVIDENCE FROM THE WAR ON POVERTY AND THE EARLY YEARS OF TITLE X
January 2017
Working Paper Number:
CES-17-67
This paper examines the relationship between parents' access to family planning and the economic resources of their children. Using the county-level introduction of U.S. family planning programs between 1964 and 1973, we find that children born after programs began had 2.8% higher household incomes. They were also 7% less likely to live in poverty and 12% less likely to live in households receiving public assistance. After accounting for selection, the direct effects of family planning programs on parents' incomes account for roughly two thirds of these gains.
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Planning Parenthood: The Affordable Care Act Young Adult Provision and Pathways to Fertility
January 2017
Working Paper Number:
CES-17-65
This paper investigates the effect of the Affordable Care Act young adult provision on fertility and related outcomes. The expected effect of the provision on fertility is not clear ex ante. By expanding insurance coverage to young adults, the provision may affect fertility directly through expanded options for obtaining contraceptives as well as through expanded options for obtaining pregnancy-, birth-, and infant-related care, and these may lead to decreased or increased fertility, respectively. In addition, the provision may also affect fertility indirectly through marriage or labor markets, and the direction and magnitude of these effects is difficult to determine. This paper considers the effect of the provision on fertility as well as the contributing channels by applying difference-in-differences-type methods using the 2008-2010 and 2012-2013 American Community Survey, 2006-2009 and 2012-2013 Centers for Disease Control and Prevention abortion surveillance data, and 2006-2010 and 2011-2013 National Survey of Family Growth. Results suggest that the provision is associated with decreases in the likelihood of having given birth and abortion rates and an increase in the likelihood of using long-term hormonal contraceptives.
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Estimating the Costs of Covering Dependents through Employer-Sponsored Plans
January 2017
Working Paper Number:
CES-17-48
Several health reform microsimulation models use synthetic firms to estimate how changes in federal and state policies will affect employers' offers of health insurance, as well as the price of health insurance for workers and firms. These models typically rely on distinct measures of the average costs of single and dependent coverage, for employees and employers, which do not capture the joint distribution of these costs. Since some firms pay a large share of the premium for single polices but a lower share for dependent coverage, or the reverse, simulation models that do not account for the joint distribution of premium costs may not be sufficient to answer certain policy questions. To address this issue, we developed a method to extract estimates of the joint distribution of employer and employee costs of health insurance coverage from the Medical Expenditure Panel Survey ' Insurance Component (MEPS-IC). This paper describes how these distributions were constructed and how they were incorporated into the Urban Institute's Health Insurance Policy Simulation Model (HIPSM). The estimates presented in this paper and those available in supplementary datasets may be useful for other simulation models that need to utilize information on the joint distribution of single and dependent employee premium contributions.
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