Kosali Simon | Indiana University (original) (raw)

Papers by Kosali Simon

Small firms that offer health insurance to their employees may face variable premiums if the firm... more Small firms that offer health insurance to their employees may face variable premiums if the firm hires an employee with high-expected health costs. To avoid expensive premium variability, a small firm may attempt to maintain a workforce with low expected health costs. In addition, workers with high-expected health costs may prefer employment in larger firms with health insurance rather than in smaller firms. This results in employment distortions. We examine the magnitude of these employment distortions using the Medical Expenditure Panel Survey from 1996 to 2001. We estimate the magnitude of distortions in hiring, employment, and separations. Furthermore, we examine the effect of state small group health insurance reforms that restrict insurers' ability to deny coverage and restrict premium variability on employment distortions in small firms relative to large firms. We find that workers with high-expected health cost are less likely to be new hires in small firms that offer health insurance, and are less likely to be employed in insured small firms. However, we find no evidence that state small group health insurance reforms have reduced the extent of these distortions.

Social Science & Medicine, 2010

Some recent papers have suggested that relative deprivation could be negatively related to health... more Some recent papers have suggested that relative deprivation could be negatively related to health through psychosocial stress and related behaviors. While there is a large literature on the association between absolute deprivation, i.e., income, and child health, little is known about the association between relative deprivation and child health. This paper asks: controlling for a measure of absolute deprivation, is a mother's relative deprivation related to infant health and maternal health behavior? There are many limitations regarding our measures and methods, and we interpret our results only as associations. Using US 2001 Natality Detail data, we find that pregnant women of lower socioeconomic status relative to other expectant mothers in their Metropolitan Statistical Area give birth to very slightly lighter babies and are more likely to smoke. A back-of-the envelope calculation shows the magnitude of the association we observe between relative deprivation and birthweight is close to what medical studies would predict if the probability of prenatal tobacco use were to increase by the amount we estimate.

Demography, 2008

Individuals invest in their own health, but children rely on parents to act on their behalf, espe... more Individuals invest in their own health, but children rely on parents to act on their behalf, especially in the case of prenatal health. In this article, we ask, Do parents in the United States who choose to give birth allocate resources differently in the prenatal health of their sons and daughters when the sex of the child is known in advance? We pay special attention to prenatal health behaviors, which can be viewed as investment decisions, of fi rst-generation immigrant parents from India and China, two countries with demonstrated son preference. Ultrasound receipt proxies for knowing fetal gender, enabling us to separate child sex-related biological differences from investment differences in sons' and daughters' health. There is evidence consistent with sex-selective abortions among Indian and Chinese populations, but among parents who choose to carry the pregnancy to term, our fi ndings do not suggest that knowledge of child sex drives prenatal health investments in the United States, neither in the population as a whole nor among Indian and Chinese immigrants.

Demography, 2008

Individuals invest in their own health, but children rely on parents to act on their behalf, espe... more Individuals invest in their own health, but children rely on parents to act on their behalf, especially in the case of prenatal health. In this article, we ask, Do parents in the United States who choose to give birth allocate resources differently in the prenatal health of their sons and daughters when the sex of the child is known in advance? We pay special attention to prenatal health behaviors, which can be viewed as investment decisions, of first-generation immigrant parents from India and China, two countries with demonstrated son preference. Ultrasound receipt proxies for knowing fetal gender, enabling us to separate child sex-related biological differences from investment differences in sons’ and daughters’ health. There is evidence consistent with sex-selective abortions among Indian and Chinese populations, but among parents who choose to carry the pregnancy to term, our findings do not suggest that knowledge of child sex drives prenatal health investments in the United States, neither in the population as a whole nor among Indian and Chinese immigrants.

We use exogenous variation in Social Security payments created by the Social Security benefits no... more We use exogenous variation in Social Security payments created by the Social Security benefits notch to estimate how retirees' use of prescription medications responds to changes in their incomes.

Journal of Health Economics, 2005

The primary objective of this paper is to improve our understanding of the historic relationship ... more The primary objective of this paper is to improve our understanding of the historic relationship between state and national macroeconomic climate and the health insurance coverage of Americans.

Health Economics, 2009

This paper tests whether income affects the body weight and clinical weight classification of eld... more This paper tests whether income affects the body weight and clinical weight classification of elderly Americans using a natural experiment that led otherwise identical retirees to receive significantly different Social Security payments based on their year of birth. We exploit this natural experiment by estimating models of instrumental variables using data from the National Health Interview Surveys. The model estimates rule out even moderate effects of income on weight and on the probability of being underweight or obese, especially for men.

Forum for Health Economics & Policy, 2003

In March 2001, the longest economic expansion in U.S. history ended, and an economic recession be... more In March 2001, the longest economic expansion in U.S. history ended, and an economic recession began. This paper seeks to provide a better understanding of the historical relationship between macroeconomic variables and health insurance coverage.

Health Services Research, 2006

Objective. To measure the change in U.S. women and children's health insurance coverage as a resu... more Objective. To measure the change in U.S. women and children's health insurance coverage as a result of welfare reform (i.e. the creation of Temporary Assistance for Needy Families or TANF) in 1996.Data Source. 1992–1999 longitudinal data from the Survey of Income and Program Participation (SIPP) merged with data on the timing of state implementation of welfare reform after 1996. Two key advantages of the SIPP data are that they permit matching type of insurance coverage to the welfare policy environment in each state in each month, and permit controlling for individual-level fixed effects.Study Design. We measure how much insurance coverage changed after welfare reform using a difference in differences method that eliminates the influence of time-invariant unobserved individual heterogeneity and of statewide trends in insurance coverage. Models also control for individual, state, and year fixed effects, individual-level characteristics such as education, age, and number of children, plus state-level variables such as real per capita income, real minimum wage, and Medicaid eligibility.Data Collection/Extraction Methods. We limit our analysis to the SIPP data specific to the month just completed prior to the interview; as a result, we have up to twelve observations for each individual in the SIPP. This paper uses pooled data from the 1992–1996 panels of the SIPP covering the period 1992–1999. Publicly available state identifiers permit the merger of state policies and macroeconomic variables with the SIPP.Principal Findings. TANF implementation is associated with an 8.1 percent increase in the probability that a welfare-eligible woman was uninsured. Welfare reform had less of an impact on the health insurance coverage of children. For example, TANF implementation was associated with a 3.0 percent increase in the probability that a welfare-eligible child lacked health insurance.Conclusions. An unintended consequence of welfare reform was to adversely impact the health insurance coverage of economically vulnerable women and children, and that this impact was several times larger than the previous literature implies.

Forum for Health Economics & Policy, 2005

Objective. To measure the change in U.S. women and children's health insurance coverage as a resu... more Objective. To measure the change in U.S. women and children's health insurance coverage as a result of welfare reform (i.e. the creation of Temporary Assistance for Needy Families or TANF) in 1996. Data Source. 1992-1999 longitudinal data from the Survey of Income and Program Participation (SIPP) merged with data on the timing of state implementation of welfare reform after 1996. Two key advantages of the SIPP data are that they permit matching type of insurance coverage to the welfare policy environment in each state in each month, and permit controlling for individual-level fixed effects. Study Design. We measure how much insurance coverage changed after welfare reform using a difference in differences method that eliminates the influence of timeinvariant unobserved individual heterogeneity and of statewide trends in insurance coverage. Models also control for individual, state, and year fixed effects, individuallevel characteristics such as education, age, and number of children, plus state-level variables such as real per capita income, real minimum wage, and Medicaid eligibility. Data Collection/Extraction Methods. We limit our analysis to the SIPP data specific to the month just completed prior to the interview; as a result, we have up to twelve observations for each individual in the SIPP. This paper uses pooled data from the 1992-1996 panels of the SIPP covering the period 1992-1999. Publicly available state identifiers permit the merger of state policies and macroeconomic variables with the SIPP. Principal Findings. TANF implementation is associated with an 8.1 percent increase in the probability that a welfare-eligible woman was uninsured. Welfare reform had less of an impact on the health insurance coverage of children. For example, TANF implementation was associated with a 3.0 percent increase in the probability that a welfare-eligible child lacked health insurance.

Small firms that offer health insurance to their employees may face variable premiums if the firm... more Small firms that offer health insurance to their employees may face variable premiums if the firm hires an employee with high-expected health costs. To avoid expensive premium variability, a small firm may attempt to maintain a workforce with low expected health costs. In addition, workers with high-expected health costs may prefer employment in larger firms with health insurance rather than in smaller firms. This results in employment distortions. We examine the magnitude of these employment distortions using the Medical Expenditure Panel Survey from 1996 to 2001. We estimate the magnitude of distortions in hiring, employment, and separations. Furthermore, we examine the effect of state small group health insurance reforms that restrict insurers' ability to deny coverage and restrict premium variability on employment distortions in small firms relative to large firms. We find that workers with high-expected health cost are less likely to be new hires in small firms that offer health insurance, and are less likely to be employed in insured small firms. However, we find no evidence that state small group health insurance reforms have reduced the extent of these distortions.

Social Science & Medicine, 2010

Some recent papers have suggested that relative deprivation could be negatively related to health... more Some recent papers have suggested that relative deprivation could be negatively related to health through psychosocial stress and related behaviors. While there is a large literature on the association between absolute deprivation, i.e., income, and child health, little is known about the association between relative deprivation and child health. This paper asks: controlling for a measure of absolute deprivation, is a mother's relative deprivation related to infant health and maternal health behavior? There are many limitations regarding our measures and methods, and we interpret our results only as associations. Using US 2001 Natality Detail data, we find that pregnant women of lower socioeconomic status relative to other expectant mothers in their Metropolitan Statistical Area give birth to very slightly lighter babies and are more likely to smoke. A back-of-the envelope calculation shows the magnitude of the association we observe between relative deprivation and birthweight is close to what medical studies would predict if the probability of prenatal tobacco use were to increase by the amount we estimate.

Demography, 2008

Individuals invest in their own health, but children rely on parents to act on their behalf, espe... more Individuals invest in their own health, but children rely on parents to act on their behalf, especially in the case of prenatal health. In this article, we ask, Do parents in the United States who choose to give birth allocate resources differently in the prenatal health of their sons and daughters when the sex of the child is known in advance? We pay special attention to prenatal health behaviors, which can be viewed as investment decisions, of fi rst-generation immigrant parents from India and China, two countries with demonstrated son preference. Ultrasound receipt proxies for knowing fetal gender, enabling us to separate child sex-related biological differences from investment differences in sons' and daughters' health. There is evidence consistent with sex-selective abortions among Indian and Chinese populations, but among parents who choose to carry the pregnancy to term, our fi ndings do not suggest that knowledge of child sex drives prenatal health investments in the United States, neither in the population as a whole nor among Indian and Chinese immigrants.

Demography, 2008

Individuals invest in their own health, but children rely on parents to act on their behalf, espe... more Individuals invest in their own health, but children rely on parents to act on their behalf, especially in the case of prenatal health. In this article, we ask, Do parents in the United States who choose to give birth allocate resources differently in the prenatal health of their sons and daughters when the sex of the child is known in advance? We pay special attention to prenatal health behaviors, which can be viewed as investment decisions, of first-generation immigrant parents from India and China, two countries with demonstrated son preference. Ultrasound receipt proxies for knowing fetal gender, enabling us to separate child sex-related biological differences from investment differences in sons’ and daughters’ health. There is evidence consistent with sex-selective abortions among Indian and Chinese populations, but among parents who choose to carry the pregnancy to term, our findings do not suggest that knowledge of child sex drives prenatal health investments in the United States, neither in the population as a whole nor among Indian and Chinese immigrants.

We use exogenous variation in Social Security payments created by the Social Security benefits no... more We use exogenous variation in Social Security payments created by the Social Security benefits notch to estimate how retirees' use of prescription medications responds to changes in their incomes.

Journal of Health Economics, 2005

The primary objective of this paper is to improve our understanding of the historic relationship ... more The primary objective of this paper is to improve our understanding of the historic relationship between state and national macroeconomic climate and the health insurance coverage of Americans.

Health Economics, 2009

This paper tests whether income affects the body weight and clinical weight classification of eld... more This paper tests whether income affects the body weight and clinical weight classification of elderly Americans using a natural experiment that led otherwise identical retirees to receive significantly different Social Security payments based on their year of birth. We exploit this natural experiment by estimating models of instrumental variables using data from the National Health Interview Surveys. The model estimates rule out even moderate effects of income on weight and on the probability of being underweight or obese, especially for men.

Forum for Health Economics & Policy, 2003

In March 2001, the longest economic expansion in U.S. history ended, and an economic recession be... more In March 2001, the longest economic expansion in U.S. history ended, and an economic recession began. This paper seeks to provide a better understanding of the historical relationship between macroeconomic variables and health insurance coverage.

Health Services Research, 2006

Objective. To measure the change in U.S. women and children's health insurance coverage as a resu... more Objective. To measure the change in U.S. women and children's health insurance coverage as a result of welfare reform (i.e. the creation of Temporary Assistance for Needy Families or TANF) in 1996.Data Source. 1992–1999 longitudinal data from the Survey of Income and Program Participation (SIPP) merged with data on the timing of state implementation of welfare reform after 1996. Two key advantages of the SIPP data are that they permit matching type of insurance coverage to the welfare policy environment in each state in each month, and permit controlling for individual-level fixed effects.Study Design. We measure how much insurance coverage changed after welfare reform using a difference in differences method that eliminates the influence of time-invariant unobserved individual heterogeneity and of statewide trends in insurance coverage. Models also control for individual, state, and year fixed effects, individual-level characteristics such as education, age, and number of children, plus state-level variables such as real per capita income, real minimum wage, and Medicaid eligibility.Data Collection/Extraction Methods. We limit our analysis to the SIPP data specific to the month just completed prior to the interview; as a result, we have up to twelve observations for each individual in the SIPP. This paper uses pooled data from the 1992–1996 panels of the SIPP covering the period 1992–1999. Publicly available state identifiers permit the merger of state policies and macroeconomic variables with the SIPP.Principal Findings. TANF implementation is associated with an 8.1 percent increase in the probability that a welfare-eligible woman was uninsured. Welfare reform had less of an impact on the health insurance coverage of children. For example, TANF implementation was associated with a 3.0 percent increase in the probability that a welfare-eligible child lacked health insurance.Conclusions. An unintended consequence of welfare reform was to adversely impact the health insurance coverage of economically vulnerable women and children, and that this impact was several times larger than the previous literature implies.

Forum for Health Economics & Policy, 2005

Objective. To measure the change in U.S. women and children's health insurance coverage as a resu... more Objective. To measure the change in U.S. women and children's health insurance coverage as a result of welfare reform (i.e. the creation of Temporary Assistance for Needy Families or TANF) in 1996. Data Source. 1992-1999 longitudinal data from the Survey of Income and Program Participation (SIPP) merged with data on the timing of state implementation of welfare reform after 1996. Two key advantages of the SIPP data are that they permit matching type of insurance coverage to the welfare policy environment in each state in each month, and permit controlling for individual-level fixed effects. Study Design. We measure how much insurance coverage changed after welfare reform using a difference in differences method that eliminates the influence of timeinvariant unobserved individual heterogeneity and of statewide trends in insurance coverage. Models also control for individual, state, and year fixed effects, individuallevel characteristics such as education, age, and number of children, plus state-level variables such as real per capita income, real minimum wage, and Medicaid eligibility. Data Collection/Extraction Methods. We limit our analysis to the SIPP data specific to the month just completed prior to the interview; as a result, we have up to twelve observations for each individual in the SIPP. This paper uses pooled data from the 1992-1996 panels of the SIPP covering the period 1992-1999. Publicly available state identifiers permit the merger of state policies and macroeconomic variables with the SIPP. Principal Findings. TANF implementation is associated with an 8.1 percent increase in the probability that a welfare-eligible woman was uninsured. Welfare reform had less of an impact on the health insurance coverage of children. For example, TANF implementation was associated with a 3.0 percent increase in the probability that a welfare-eligible child lacked health insurance.