We evaluate a randomized outreach study in which the IRS sent informational letters to 3.9 million households that paid a tax penalty for lacking health insurance coverage under the Affordable Care Act. Drawing on administrative data, we study the effect of this intervention on taxpayers subsequent health insurance enrollment and mortality. We find the intervention led to increased coverage during the subsequent two years and reduced mortality among middle-aged adults over the same time period. The results provide experimental evidence that health insurance coverage can reduce mortality in the United States.

We use administrative data from the Internal Revenue Service to examine long-term impacts of childhood Medicaid eligibility expansions on outcomes in adulthood at each age from 19 to 28. Greater Medicaid eligibility increases college enrolment and decreases fertility, especially through age 21. Starting at age 23, females have higher contemporaneous wage income, although male increases are imprecise. Together, both genders have lower mortality. These adults collect less from the earned income tax credit and pay more in taxes. Cumulatively from ages 19 to 28, at a 3% discount rate, the federal government recoups 58 cents of each dollar of its “investment” in childhood Medicaid.

We use administrative data from the IRS to examine the long-term impact of childhood Medicaid expansions. We use eligibility variation by cohort and state that we can relate to outcomes graphically. We find that children with greater Medicaid eligibility paid more in cumulative taxes by age 28. They collected less in EITC payments, and the women had higher cumulative wages. Our estimates imply that the government will recoup 56 cents of each dollar spent on childhood Medicaid by the time these children reach age 60. This return does not include estimated private gains from increased college attendance and decreased mortality.

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A growing number of U.S. states have adopted “millionaire taxes” on top income-earners. This increases the progressivity of state tax systems, but it raises concerns about tax flight: elites migrating from high-tax to low-tax states, draining state revenues, and undermining redistributive social policies. Are top income-earners “transitory millionaires” searching for lower-tax places to live? Or are they “embedded elites” who are reluctant to migrate away from places where they have been highly successful? This question is central to understanding the social consequences of progressive taxation. We draw on administrative tax returns for all million-dollar income-earners in the United States over 13 years, tracking the states from which millionaires file their taxes. Our dataset contains 45 million tax records and provides census-scale panel data on top income-earners. We advance two core analyses: (1) state-to-state migration of millionaires over the long-term, and (2) a sharply-focused discontinuity analysis of millionaire population along state borders. We find that millionaire tax flight is occurring, but only at the margins of statistical and socioeconomic significance.