ORCID

https://orcid.org/0000-0003-4392-1136

Date of Award

Summer 2025

Language

English

Embargo Period

7-6-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College/School/Department

Department of Economics

Program

Economics

First Advisor

Pinka Chatterji

Second Advisor

Chun-Yu Ho

Third Advisor

Gerald Marschke

Keywords

Medicare Part D, Retirement, Trade Liberalization, Mortality, Targeted Regulation of Abortion Providers, Maternal Care Providers

Subject Categories

Health Economics

Abstract

The first chapter examines whether Medicare Part D---the largest expansion of Medicare in recent decades---had a lasting impact on retirement behavior by providing subsidized prescription drug coverage to older adults. We employ a difference-in-difference-in-differences framework that compares changes in labor supply among individuals aged 65–68 versus 55–64 in a treatment group with employer-sponsored retiree health insurance (RHI) only until age 65, relative to a control group with lifetime RHI, before and after the 2006 implementation of Part D. Using data from Health and Retirement Study (2000-2018), we find that Part D reduces full-time employment by 6.52 percentage points among the treated older group, with approximately 31% of the effect driven by transitions from full-time to part-time work within the same job. The response is most pronounced among those with multiple chronic conditions, women, whites, non-Hispanics, the unmarried, and individuals without a college degree. Additional analysis shows that these effects are weakened after the Affordable Care Act, particularly among low-educated individuals in states that expanded Medicaid. This suggests that Medicaid expansion diminished the marginal insurance value of Medicare Part D by offering alternative public coverage, thereby reducing its effect on retirement behavior.

The second chapter examines the effects of increased trade between Japan and the U.S. on mortality rates in the U.S. using a shift-share instrumental variables approach. Overall, we find that an increase in Japanese imports is associated with higher rates of drug-related mortality and cardiovascular disease (CVD) mortality, and lower rates of mortality from accidents. These effects exhibit significant racial disparities. Specifically, a $1,000 increase in import competition is associated with a 13.5% increase in drug-related deaths per 100,000 Black individuals aged 20-64 years old compared to a 7.8% increase among white individuals. Additionally, a $1,000 increase in import competition is associated with a 3.0% increase in CVD deaths per 100,000 Black individuals aged 20-64 years old, while there is no statistically significant effect among whites. Effects on mortality rates from accidents are driven by deaths among whites. Our findings also indicate that the rise in drug-related and CVD mortality is concentrated among males and in regions with relatively high shares of employment in the automobile or computer industries.

The third chapter examines the impacts of Targeted Regulation of Abortion Providers (TRAP laws) on the supply of maternal care providers by exploiting the staggered enactment of TRAP laws across states. Our findings indicate a significant decrease in the number of Obstetrician-Gynecologists (OB/GYNs) by 3.38 to 3.55 per 100,000 females aged 15-44 following the enactment of TRAP laws. Furthermore, the enactment of TRAP laws affects the composition of OB/GYNs. The decline in response to TRAP laws is particularly pronounced among OB/GYNs under the age of 34 and those between the ages of 55 and 64. Newly graduated OB/GYNs, especially those from lower-ranked medical schools, also reduce their presence in states enacting TRAP laws. Although we do not find significant changes in applicants to OB/GYN residency programs or medical schools in response to TRAP laws, in-state applicants tend to shift their applications from private medical schools, which are often higher-ranked, to public medical schools.

The fourth chapter evaluates the density of maternal health care providers across urban and rural ZIP Code Tabulation Areas (ZCTAs) and across ZCTAs with relatively high Black, Hispanic, and white populations. The data show striking urban-rural disparities in OB/GYN density, as well as differences in OB/GYN density across high white vs. high Black and high Hispanic ZCTAs. Including nurse practitioners, physician assistants, and the estimated ten percent of family practice physicians who provide maternal health care, in addition to OB/GYNs, increases maternity care provider density nationwide but exacerbates urban-rural and racial/ethnic disparities.

License

This work is licensed under the University at Albany Standard Author Agreement.

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