Journal of Policy Analysis and Management最新文献

This study considers whether the Affordable Care Act (ACA) Medicaid expansions resulted in changes in the use of non-physician providers. Medicaid expansions may have impacted both payments to providers as well as insurance availability for patients. Using U.S. birth certificate records, we analyze whether the ACA Medicaid expansions influenced the trade-off between physicians and certified nurse-midwives (CNMs/CMs) for obstetric care. Our findings indicate that the ACA Medicaid expansions led to an increase in the utilization of CNMs/CMs and a decrease in physician-reported deliveries. This shift from physicians to CNMs/CMs is particularly noticeable in states with Medicaid reimbursement parity for CNMs/CMs. These results suggest that health insurance expansions may increase the use of non-physician providers, but only in cases where non-physician providers are reimbursed similarly to physicians.

This paper uses the random assignment of poor families to treatment and control conditions in the Comprehensive Child Development Program (CCDP) to estimate the effects of center-based child care enrollment on child well-being. Implemented in the early-1990s, the CCDP aimed to improve child development and family functioning by offering those in the treatment group 5 years of high-quality child care along with case management. As a result, treated children were substantially more likely to be enrolled in center-based programs throughout the preschool-age years, and I use this variation to estimate the impact of center care on children's language and social skills as well as health. I uncover mixed results: More time spent in center-based settings improves language skills but reduces social skills in the short run, and both effects fade out for most children within 1 to 2 years. I also find that early center care use is strongly predictive of later Head Start enrollment, indicating that a more deliberate “family retention strategy” may be effective at extending children's exposure to high-quality early education.

Black children in the U.S. are twice as likely as white children to spend time in foster care. Such racial disparities raise concerns of discrimination, but might also reflect differences in the underlying need for intervention. This paper estimates unwarranted disparities (UDs)—racial differences in placement rates for children with the same potential for future maltreatment—in national data. We use non-parametric bounds on the potential for future maltreatment that rely on weak and transparent assumptions. Nationwide, we find that Black children are placed into foster care at higher rates than white children with identical potential for subsequent maltreatment. UD varies across states; key predictors are the proportion of Black individuals in the population and the racial makeup of caseworkers. UD is five times larger among children with potential for subsequent maltreatment than among children without and declined from 2008 to 2020, primarily due to a declining placement rate among Black children with subsequent maltreatment potential. The concentration of UD in cases with potential for future maltreatment yields important policy implications, as it may indicate an “underplacement” of white children—with declining racial gaps suggesting an elevated risk of maltreatment for Black children.

Using a differences-in-differences strategy, we estimate the local economic effects of U.S. commercial nuclear power plants (NPPs). Our control group consists of locations where plant construction was planned but ultimately canceled. We find that NPP construction significantly increases local employment and wages, with effects concentrated in the construction and public utilities sectors. However, these gains dissipate once construction concludes and the plant becomes operational, as operational employment requirements are minimal. We find no significant spillover effects on neighboring towns, and commercial operations do not meaningfully impact broader labor market outcomes. Additionally, we find that NPP construction increases local government revenues and expenditures by approximately 10% to 15%, with funds primarily allocated to government administration and public works. These results suggest that while NPPs provide short-term economic stimulus, their long-term labor market and fiscal benefits may be limited.

The federal expansion of the Child Tax Credit (CTC) in 2021 contributed to a record low child poverty rate for the United States; however, the expansion expired after 1 year and Congress is unlikely to reinstate the expansion in the near future. State governments are increasingly interested in implementing their own fully-refundable CTCs, yet face strict budgetary constraints relative to the federal government. This policy report proposes a state-level, fully-refundable CTC that is affordable, strongly targeted at low-income families, and complementary to federal tax credits, yet would make meaningful reductions in states' child poverty rates. Specifically, I demonstrate that the average state government can use existing spending within the Temporary Assistance for Needy Families program to fund 61% of a targeted CTC, and all states could fund the proposal with less than 2% of their total tax revenues. The targeted CTC could reduce child poverty by 10%, and deep child poverty by 21%, for the average state, with a level of spending efficiency that exceeds other income-transfer programs.