We designed a parent-directed home-visiting intervention targeting socioeconomic status (SES) disparities in children's early language environments. A randomized controlled trial was used to evaluate whether the intervention improved parents' knowledge of child language development and increased the amount and diversity of parent talk. Twenty-three mother-child dyads (12 experimental, 11 control, aged 1;5-3;0) participated in eight weekly hour-long home-visits. In the experimental group, but not the control group, parent knowledge of language development increased significantly one week and four months after the intervention. In lab-based observations, parent word types and tokens and child word types increased significantly one week, but not four months, post-intervention. In home-based observations, adult word tokens, conversational turn counts, and child vocalization counts increased significantly during the intervention, but not post-intervention. The results demonstrate the malleability of child-directed language behaviors and knowledge of child language development among low-SES parents.

As states consider expanding Medicaid to low-income childless adults under the Affordable Care Act, their decisions will depend, in part, on how such coverage may affect the use of medical care. In 2009 Wisconsin created a new public insurance program for low-income uninsured childless adults. We analyzed administrative claims data spanning 2008 and 2009 using a case-crossover study design on a population of 9,619 Wisconsin residents with very low incomes who were automatically enrolled in this program in January 2009. In the twelve months following enrollment in public insurance, outpatient visits for the study population increased 29 percent, and emergency department visits increased 46 percent. Inpatient hospitalizations declined 59 percent, and preventable hospitalizations fell 48 percent. These results demonstrate that public insurance coverage expansions to childless adults have the potential to improve health and reduce costs by increasing access to outpatient care and reducing hospitalizations.

Using longitudinal data from the Fragile Families and Child Well‐being Study (N = 1,162) and the National Evaluation of Welfare‐to‐Work Strategies (N = 1,308), we estimate associations between material and instrumental support available to low‐income mothers and young children’s socioemotional well‐being. In multivariate OLS models, we find mothers’ available support is negatively associated with children’s behavior problems and positively associated with prosocial behavior in both data sets; associations between available support and children’s internalizing and prosocial behaviors attenuate but remain robust in residualized change models. Overall, results support the hypothesis that the availability of a private safety net is positively associated with children’s socioemotional adjustment.

This study provides plausibly causal estimates of the effect of public insurance coverage on the employment of nonelderly, nondisabled adults without dependent children ("childless adults"). We use regression discontinuity and propensity score matching difference-in-differences methods to take advantage of the sudden imposition of an enrollment cap, comparing the labor supply of enrollees to eligible applicants on a waitlist. We find that enrollment into public insurance leads to sizable and statistically meaningful reductions in employment up to at least nine quarters later, with an estimated size of 2-10 percentage points, depending on the model used. JEL Classification Codes: I18, I38, J22

Objective. To assess the ability of different self-reported health (SRH) measures to prospectively identify individuals with high future health care needs among adults eligible for Medicaid. Data Sources. The 1997-2008 rounds of the National Health Interview Survey linked to the 1998-2009 rounds of the Medical Expenditure Panel Survey. Study Design. Multivariate logistic regression models are fitted for the following outcomes: having an inpatient visit; membership in the top decile of emergency room utilization; and membership in the top cost decile. We examine the incremental predictive ability of six different SRH domains (health conditions, mental health, access to care, health behaviors, health-related quality of life (HRQOL), and prior utilization) over a baseline model with sociodemographic characteristics. Models are evaluated using the c-statistic, integrated discrimination improvement, sensitivity, specificity, and predictive values. Principal Findings. Self-reports of prior utilization provide the greatest predictive improvement, followed by information on health conditions and HRQOL. Models including these three domains meet the standard threshold of acceptability (c-statistics range from 0.703 to 0.751). Conclusions. SRH measures provide a promising way to prospectively profile Medicaid-eligible adults by likely health care needs.

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in ABSTRACTThis study provides plausibly causal estimates of the effect of public insurance coverage on the employment of nonelderly, nondisabled adults without dependent children ("childless adults"). We use regression discontinuity and propensity score matching difference-in-differences methods to take advantage of the sudden imposition of an enrollment cap, comparing the labor supply of enrollees to eligible applicants on a waitlist. We find that enrollment into public insurance leads to sizable and statistically meaningful reductions in employment up to at least nine quarters later, with an estimated size of 2-10 percentage points, depending on the model used. JEL Classification Codes: I18, I38, J22

About 7.4 million children were covered by the State Children’s Health Insurance Program (SCHIP) at some point during fiscal year 2008. Many of these children would probably have had private coverage in the absence of SCHIP; recent estimates of the extent of “crowd-out” associated with SCHIP are about 60 percent (Gruber and Simon 2008). The high rate of crowd-out means that the program is not as effective as it could be at reducing the number of uninsured children and has been a political liability for the program. Both political concerns and policy research focusing on crowd-out in SCHIP build on more than a decade of similar attention to the crowd-out associated with the Medicaid expansions of the late 1980s and early 1990s. While there is little doubt that expanding eligibility for public insurance to children who are not poor will lead some to substitute public for private coverage, this substitution should increase total resources available to these households in two ways. First, those who drop private coverage in order to enroll their children in SCHIP can take whatever they had been spending on health insurance and spend it on something else. Second, public insurance requires less cost-sharing than a typical private insurance policy, providing first-dollar coverage with minimal co-payments. This means that switching from private to public coverage reduces a family’s out-of-pocket medical spending, freeing up even more of the family’s resources for other uses. From the perspective of a low-income family, then, crowd-out is a windfall. In this paper we ask: what do these families do with the additional resources? We address this question with an empirical analysis of consumption data from the Consumer Expenditure Survey. We find that eligibility for SCHIP is associated with an increase in overall expenditure, and most of this increase is allocated to consumption of transportation or saving for retirement. These results suggest that the SCHIP expansions substantially improved the material well-being of the low-income families it is intended to assist – including those who had previously been paying for their own coverage. This evidence should allow a better accounting of the benefits and not just the costs of recent expansions in public health insurance programs.

Families across the income spectrum experienced subjective feelings of economic strain during the Great Recession. Existing evidence suggests that much of that economic strain did not arise from individual‐specific economic shocks, such as unemployment or income loss, as much as it did from worry and uncertainty about the future. The authors tested a model in which a measure of subjective perceptions of economic strain was the key predictor of children's behavior problems and objective indicators of economic experiences were treated as control variables. To do so, they used new data from a population‐based sample of children ages 4–17 (N = 303) living in southeast Michigan during the period 2009–2012. They found that economic strain exhibited a qualitatively large independent association with internalizing behavior problems for White—but not Black—children. This association was statistically significant over and above objective indicators of economic experiences and the family psychosocial context.