Research

Working Papers
"Labor Policy in a Healthcare Market: Provider Responses to the Home Care Rule" (with Karen Shen)

The home care industry is a fast-growing and important part of the care sector that was affected by the 2013 extension of federal minimum wage, overtime and travel pay requirements to home care workers. We examine how this labor policy translated into employment and service outcomes in an industry where, as in many healthcare markets, there is a large public payer that administratively sets prices. The new regulations increased the cost of providing home care in many states, but some states had already included home care in their own laws decades earlier and experienced less of a change, motivating a difference-in-differences identification strategy. In the three years after enforcement began, we find that personal care agency payrolls were 19% lower in newly covered states, due to a combination of slower growth in employment and base wages. Changes in service provision were not distributed evenly between the private market, where home care agencies can adjust their prices, and the Medicaid market, where they cannot. Older adults with Medicaid were 9 percentage points less likely to use paid helpers, receiving 11 fewer hours of paid care per month on average, while older adults without Medicaid did not see meaningful changes in type or hours of care. We estimate that Medicaid recipients were 2.7 to 5 percentage points more likely to use paid helpers when the Medicaid reimbursement rate increased by $1/hour, suggesting that agencies reduced services to Medicaid clients when reimbursement rates did not keep up with cost increases from the 2013 labor regulations.

"Regulatory Discretion and the Demographic Composition of Healthcare Occupations"

Do occupational licensing boards have too high an incentive to restrict entry to healthcare occupations? Occupational license requirements, such as minimum education requirements and criminal-record-based restrictions, shape who can enter healthcare occupations. These requirements must balance barriers to entry that affect access to and prices of healthcare services with ensuring safe and high-quality care. This balance might be less likely if occupational licensing boards have an incentive to restrict entry. I use felony bans - mandatory, permanent bans on licenses for people with any felony conviction - to test whether occupational licensing boards accept larger entry barriers than a legislature. If they have the same incentives, we would expect the same regulation to have the same effect on the demographic composition of healthcare occupations regardless of whether it is implemented by the legislature or a licensing board. While felony bans implemented by legislatures do not substantially change the share of Black workers in healthcare occupations relative to licensed occupations without a ban, felony bans implemented by licensing boards are associated with 24% lower shares of Black workers. A model of license-requirement-setting shows that information asymmetries alone cannot explain these differences. These results suggest that occupational licensing boards have suboptimal incentives to restrict entry, which in this case influence the demographic composition of healthcare occupations.

Research in Progress
"Thinking Outside the Box: Ban the Box Policies as Delay of Information"

"Supporting Pathways Out of Poverty: A Randomized Evaluation of AMP Up Boston" (with Lawrence Katz and Jonathan Tebes)