CHILDREN;POVERTY

The authors provide direct evidence on the effect of health insurance on health outcomes by examining the dramatic increases in the eligibility of pregnant women for the Medicaid program between 1979 and 1992. They find that the 30-percentage-point rise in Medicaid eligibility significantly lowered the incidence of low birth weight and infant mortality. Targeted changes in Medicaid eligibility that were restricted to specific low-income groups had much larger effects on birth outcomes than broader expansions of eligibility to women with higher income levels because of much lower take-up of this entitlement by the latter group.

Mortality is a crucial indicator of well-being, and recent mortality trends have been a subject of public debate in many Western countries. This paper compares mortality inequality in Canada and the United States over the period 1990/91 through 2010/11. In Canada, mortality inequality remained constant among the youngest but increased for men over 24 and women over 14. In contrast, in the United States, mortality inequality fell for children and youth and either modestly increased or held steady at older ages. By 2010/11, the initially higher US rates of infant and child mortality had almost converged to their Canadian counterparts.

That prenatal events can have life-long consequences is now well established. Nevertheless, research on the fetal origins hypothesis is flourishing and has expanded to include the early childhood (postnatal) environment. Why does this literature have a “second act?” We summarize the major themes and contributions driving the empirical literature since our 2011 reviews, and try to interpret the literature in light of an overarching conceptual framework about how human capital is produced early in life. One major finding is that relatively mild shocks in early life can have substantial negative impacts, but that the effects are often heterogeneous reflecting differences in child endowments, budget constraints, and production technologies. Moreover, shocks, investments, and interventions can interact in complex ways that are only beginning to be understood. Many advances in our knowledge are due to increasing accessibility of comprehensive administrative data that allow events in early life to be linked to long-term outcomes. Yet, we still know relatively little about the interval between, and thus about whether it would be feasible to identify and intervene with affected individuals at some point between early life and adulthood. We do know enough, however, to be able to identify some interventions that hold promise for improving child outcomes in early life and throughout the life course.

Most Americans are now in some form of managed care plan that restricts access to services in order to reduce costs. It is difficult to determine whether these restrictions affect health because individuals and firms self-select into managed care. We investigate the effect of managed care using a California law that required some pregnant women on Medicaid to enter managed care. We use a unique longitudinal database of California births in which we observe changes in the regime faced by individual mothers between births. We find that Medicaid managed care reduced the quality of prenatal care and increased low birth weight, prematurity, and neonatal death.

We examine the effect of air pollution on school absences using administrative data for elementary and middle school children in 39 of the largest school districts in Texas merged with air quality information maintained by the Environmental Protection Agency. We address potentially confounding factors with a difference-in-difference-in-differences strategy that controls for persistent characteristics of schools, years, and attendance periods. Of the pollutants considered, we find that high carbon monoxide (CO) levels, even when below federal air quality standards, significantly increase absences. Our results suggest that the substantial decline in CO levels over the past two decades has yielded economically significant health benefits.