The federal government spends billions of dollars each year on programs designed to increase the resources available to hospitals that serve the poor. This paper explores the intended and unintended effects of such targeted funds. First, how do these funds distort the behavior of state and local governments who wish to appropriate the funds for other uses? Second, to the extent that these funds do increase resources in the targeted hospitals, do patients benefit? We use the rapid and uneven growth in Medicaid Disproportionate Share Hospital (DSH) payments across states and hospitals to answer these questions. We identify states that were most able to appropriate DSH funds and show that, while DSH payments to public hospitals in these states were systematically diverted, DSH payments to other hospitals and in other states were not diverted. Additional resources that were made available to hospitals (rather than appropriated by the state) were associated with significant declines in infant and post-heart attack mortality. A range of evidence suggests that these improvements were due to better hospital care. Overall, our analysis implies that public subsidies can be an effective mechanism for improving medical care and outcomes for the poor, but that the impact is limited by the ability of state and local government to divert the targeted funds.

We investigate the effect of abortion access on teen birthrates using county-level panel data. Past research suggested that prohibiting abortion led to higher teen birthrates. Perhaps surprisingly, we find that more recent restrictions in abortion access, including the closing of abortion clinics and restrictions on Medicaid funding, had the opposite effect. Small declines in access were related to small declines among in-wedlock births; out-of-wedlock births were relatively unaffected. Both results are consistent with a simple model in which pregnancy is endogenous and women gain new information about the attractiveness of parenthood only after becoming pregnant.

We examine the impact of increased abortion availability on the average living standards of children through a selection effect. Would the marginal child who was not born have grown up in different circumstances than the average child? We use variation in the timing of abortion legalization across states to answer this question. Cohorts born after legalized abortion experienced a significant reduction in a number of adverse outcomes. We find that the marginal child would have been 40–60 percent more likely to live in a single-parent family, to live in poverty, to receive welfare, and to die as an infant.