The efficiency of publicly-subsidized, privately-provisioned social insurance programs depends on the interaction between strategic insurers and the subsidy mechanism. We study this interaction in the context of Medicare's prescription drug coverage program. We find that the observed mechanism is successful in keeping "raise-the-subsidy" incentives relatively low, acts much like a flat voucher, and obtains a level of welfare close to the optimal voucher. Across a range of counterfactuals, we find that more efficient subsidy mechanisms share three features: they retain the marginal elasticity of demand, limit the exercise of market power, and preserve the link between prices and marginal costs.

We use linked survey and administrative data to document differences across multiple socio-economic and demographic groups in the extent of adverse economic and health impacts of the first two years of the COVID-19 pandemic in the United States. Across a wide set of characteristics-including race/ethnicity, education, industry, and occupation-the impacts of the pandemic on all-cause mortality and on employment were disproportionately concentrated in the same groups in the population. As the pandemic progressed, disparities in the pandemic's mortality impacts narrowed substantially between Black and White Americans and between Hispanic and White Americans, but persisted along the educational divide. For economic damages, only Hispanic-White disparities narrowed; Black-White and educational disparities persisted for the first two years of the pandemic. We also document greater mortality impacts for lower income individuals, with this negative income-excess mortality gradient becoming steeper in the pandemic's second year. Together our findings-using a consistent set of methods and measures on nationally representative data with a wide set of measures of socio-economic status-paint a detailed picture of the heterogeneous impacts of the first two years of the COVID-19 pandemic on health and economic well-being.