Insuring the Learning Curve: Does Subsidized Public Health Insurance Improve Education Achievement?

The Medicaid public health insurance program provides children with healthcare access and financial protection from unanticipated adverse health events. Previous research demonstrates that Medicaid expansions are associated with increased healthcare utilization, decreased childhood mortality, and decreased personal bankruptcy rates. Less well studied are the secondary spillover benefits of the Medicaid program. This dissertation investigates whether Medicaid eligibility expansions can be linked to improvements in education achievement. This is a salient question for the Medicaid eligible population: children in low-income families have higher rates of chronic illness, are more likely to delay medical care due to cost, and score lower on math and reading assessments. To the extent the Medicaid program improves health and family income outcomes for children, two crucial inputs in the education production function, the Medicaid program may have the capacity to improve the children’s education achievement as well. The first study of the dissertation assesses whether Medicaid eligibility expansions affect out-of-pocket spending on healthcare and healthcare utilization using the restricted-use data from the Medical Expenditures Panel Survey. This highlights the potential mechanisms through which Medicaid expansions are likely to impact education. The second study of the dissertation combines Medicaid eligibility expansion data at the state, year, and age level with restricted-use individual data from the National Assessment of Education Progress. I test for whether Medicaid eligibility expansions at various ages of a child’s life impact test score and school attendance. The third study uses administrative data from the universe of North Carolina public schools from the North Carolina Education Research Data Center. I exploit a discontinuity in Medicaid eligibility exposure created by a Medicaid expansion mandate that only affected children in poverty born after a specific date. This work tests for whether early life Medicaid eligibility affects school grade advancement, test scores, and school absences.