National Bureau of Economic Research

The Affordable Care Act (ACA) reshaped how Americans obtain health insurance by expanding Medicaid eligibility and creating Marketplace exchanges for subsidized private plans. In How Efficient Was the Affordable Care Act at Reducing Uninsured Rates? (NBER Working Paper 35263), Anuj Gangopadhyaya and Robert Kaestner exploit variation in the timing of ACA implementation and Medicaid expansion across states to assess the impact of access to publicly supported coverage on the fraction of the population that is uninsured and that has employer-sponsored insurance (ESI). The researchers use data from the 2008–2024 American Community...

In research conducted in collaboration with Arkey Barnett at the University of Michigan and Meghan Beal at the National Sheriffs’ Association, we investigate the effects of innovative investments in local jails that aim to improve health and rehabilitation outcomes for incarcerated individuals and their communities. The US has one of the highest incarceration rates in the world, with nearly 2 million people detained in correctional facilities every year. While most people are held in state or federal prisons, local jails house 546,000 individuals across 3,116 facilities, the majority of whom are not convicted. Local jails serve as the front door to the criminal justice system, with more than 7.6 million admissions per year and a significant share of those released being rebooked within the same year, revealing a persistent…

Nursing homes certified by the Centers for Medicare & Medicaid Services to provide care and receive public reimbursement through Medicare and Medicaid are subject to mandatory annual inspections. While inspections are unannounced, they typically occur on an approximately yearly basis, as 74 percent of inspections take place between 40 and 60 weeks after the previous one. The average gap is around 53 weeks. Due to the cyclical nature of inspections, nursing home operators are able to anticipate when an inspection is likely and adjust their behavior accordingly. They appear to devote more effort to patient care when inspections are approaching.

In Predictably Unpredictable Inspections (NBER Working Paper 34491), Ashvin Gandhi, Andrew Olenski, and Maggie Shi study how the predictability of nursing home inspections shapes facility effort and patient...

Roughly one-quarter of new employer businesses in the United States are started by immigrants. Immigrant inventors have been responsible for approximately 23 percent of US patents produced since 1976 despite making up only 16 percent of the total US-based inventor population. Yet immigrant entrepreneurs usually do not build companies in isolation—many cofound startups alongside US-born entrepreneurs. In Native-Immigrant Entrepreneurial Synergies (NBER Working Paper 33804), Zhao Jin, Amir Kermani, and Timothy McQuade examine whether startups cofounded by immigrant and native entrepreneurs outperform those with founders from exclusively one...