Two discrete choice experiments conducted at the beginning of Covid-19 vaccination campaign show that people undervalued the Covid-19 vaccine relative to benchmarks implied by the standard value of a statistical life (VSL). Our first experiment found that median willingness to pay (WTP) for initial vaccination was around $50, only 2 percent of the WTP implied by standard VSL calculations. Our second experiment found the median person’s willingness to accept (WTA) was about $200 to delay the second dose, only 32 percent of the WTA implied by standard VSL calculations. While standard economic models imply that vaccines are undervalued because of their large externalities, this evidence that people undervalue even the private benefits of vaccination suggests that there may be a role for policy beyond conventional efforts to correct externalities.

Indian Health Service provides healthcare for 2.5 million Alaskan Natives and Native Americans. However, health disparities between Native Americans and other groups have been widening. One important factor for this trend is funding. In this paper, I document the effect of funding constraints on mortality outcomes using fixed effects models. I find that, at the end of the fiscal year, deaths disproportionately increased for Native Americans by approximately 3.2 per 100,000. Specifically, I find evidence of increased heart attack, drug, diabetes, and flu mortality and that the effect is concentrated among older adults. These results show that it is crucial for there to be adequate resources in the healthcare system so that policies aimed at addressing health disparities can indeed improve health outcomes.

Mask mandates were controversial policies during the pandemic. Although there is considerable research on the benefits of masks, there has been no research on the distribution of perceived costs of compliance with mask mandates. This article presents the results from a hypothetical set of questions related to mask-wearing behavior and opinions that were asked of a nationally representative sample of over 4,000 participants in early 2022. We use survey valuation methods to assess how much participants would be willing to pay to be exempted from rules of mandatory community masking. The survey asks specifically about a 3-month exemption. We find that the majority of respondents (56%) are not willing to pay to be exempted from mandatory masking. However, the average person was willing to pay $525, and a small segment of the population (0.9%) stated they were willing to pay over $5,000 to be exempted from the mandate. Younger respondents stated higher willingness to pay to avoid the mandate than older respondents. Combining our results with standard measures of the value of a statistical life, we estimate that a 3-month masking order was perceived as cost-effective through willingness to pay questions only if at least 13,333 lives were saved by the policy.

Soda taxes are implemented in several cities across the US with the aim of reducing sugar intake from sugar sweetened beverages (SSBs). Sugar is linked to obesity and to higher risk of diabetes and cardiovascular conditions. Sodas are targeted with these taxes since they are the main source of sugar for consumers in the US. In presence of potential substitutes, the policy can be undermined by consumers changing their sources of sugar. We examine the heterogeneous effects of the 2017 Philadelphia soda tax on purchases of other items containing sugar.We present an empirical evaluation focusing on the potential substitution towards additional sugary foods in Philadelphia and counties bordering Philadelphia. We find an increase in sugar from purchases of sweetened foods of about 4.3% following the introduction of the tax in Philadelphia and of 3.7% in the neighboring localities. The substitution to sugary foods in Philadelphia offsets 19% of the decrease of sugar from SSBs. Additionally, we find that the substitution offsets 37% of the decrease of sugar from SSBs when including counties bordering Philadelphia. These results suggest that while SSB taxes might be effective at lowering consumption of SSBs, substitution patterns may limit the effectiveness of the tax to reduce overall sugar intake.

We compare COVID-19 case loads and mortality across counties that hosted more versus fewer NHL hockey games, NBA basketball games, and NCAA basketball games during the early months of 2020, before any large outbreaks were identified. We find that hosting one additional NHL/NBA game in March 2020 leads to an additional 7520 cases and 658 deaths. Similarly, we find that hosting an additional NCAA Division 1 men’s basketball game in March 2020 results in an additional 34 deaths. Back-of-the-envelope calculations suggest that the per-game fatality costs were 200–300 times greater than per-game spending.

We investigate the impact of the expansions of Medicaid coverage due to the Affordable Care Act (ACA) on under-served populations using claims data from the period 1999-2021. These panel data include the universe of American Indian and Alaska Native (AIAN) Medicare and Medicaid populations and a twenty percent random sample from the rest of the US which allows us to trace out enrollments and utilization of various health care services over time. We focus on AIAN individuals and the utilization of mental health and substance abuse treatment services in particular. We find an increase in the enrollment in Medicaid for the AIAN population aged 18-65 of 5-13. We also find a large increase in mental health and substance abuse prevention visits in the wake of ACA state expansions. Our results clearly indicate that Medicaid coverage increased mental health and substance-abuse related treatment in the adult (18-64) and elderly (65 and over) population of AIAN. These increases are not due to newly enrolled patients' increased utilization of health services but arise in large part from increased utilization by individuals who were already enrolled in Medicaid at the time of the expansions. Supply-side effects, such as the expansion of substance-abuse and mental health services in response to the ACA, likely account for rise in utilization. In addition to AIAN, we present evidence on African Americans' enrollment, heath care use, and outcomes for mental health and substance use disorders.

Self-governance is an important legal right as well as a political and moral goal for many Native Americans in the United States. In this paper, I study policy changes that make it easier for tribal governments to exercise their self-governance rights to assume managerial control over the operation of Indian Health Service (IHS) facilities through specialized contracts called “compacts”. Since compacting with IHS was allowed in the 1990s, tribal governments have assumed control over more than half of IHS facilities. I gather data on IHS facilities from 1990 to 2019, which provides a way to measure the self-governance status of IHS facilities. I use the CDC Multiple Cause of Death county-level data to construct measures of mortality rates over time. Using a staggered adoption difference-in-differences design, I estimate that all-cause mortality increased by 16.3% following the change to self-governance. Therefore, on average, health outcomes worsen after take-up of tribal control. However, I find substantial treatment effect heterogeneity. For example, the Alaska region- which has more funding and reportedly higher administrative capacity- experiences an 15.1% decrease in mortality. Furthermore, I show that the presence of a tribal casino completely negates the negative impact. To better understand how to interpret these results, I also use a logistic model as well as a logistic LASSO to explore several potential explanatory factors to predict take-up of compacts with IHS. Mortality leads are generally not predictive, but regional fixed effects as well as exposure to laws decreasing tribal control are predictive. Therefore, tribal governments and citizens likely see a large benefit beyond direct impacts on health. Taken together, these results suggest that there is a decrease in health following the take-up of compacts which can be negated with higher revenue and administrative capacity.

In the early phases of the COVID-19 epidemic labor markets exhibited considerable churn, which we relate to three primary findings. First, reopening policies generated asymmetrically large increases in reemployment of those out of work, compared to modest decreases in job loss among those employed. Second, most people who were reemployed appear to have returned to their previous employers, but the rate of reemployment decreases with time since job loss. Lastly, the groups that had the highest unemployment rates in April also tended to have the lowest reemployment rates, potentially making churn harmful to people and groups with more and/or longer job losses. Taken together, these estimates suggest that employment relationships are durable in the short run, but raise concerns that employment gains requiring new employment matches may not be as rapid and may be particularly slow for hard-hit groups including Hispanic and Black workers, youngest and oldest workers, and women.