Master of Arts, Miami University, 2019, Economics

Medicare and Medicaid are U.S. Federal health insurance programs established in 1965 as an amendment to the Social Security Act of 1935. They provide coverage to the aged population (65+), low-income individuals, and to other subsets of the U.S. population. After reviewing the foundations of Medicare/Medicaid, I analyze the political economy of Members of Congress vote choices on the original 1965 Medicare/Medicaid law. I find evidence that the number of doctors per 100,000 individuals in a state is a strong predictor of vote choice and there is statistically significant interaction between percentage of Black Americans and the South. Moreover, there is evidence to suggest that party alignment of constituencies and geographic region played roles in persuading Republicans in party-contested states to defect. The behavior of these defectors is dependent on their party alignment and the party alignment of the majority in Congress. To assess the strength of the model across time and legislation, I run a fully interacted, pooled OLS regression on both the 1965 legislation, and the Medicare Modernization Act of 2003. I find the effects of hospitals do not hold across time. However, I find evidence target populations remain insignificant in both datasets, suggesting they are not strong influencers of vote choice.

Committee: Melissa Thomasson (Advisor); Gregory Niemesh (Committee Member); Deborah Fletcher (Committee Member) Subjects: Economic History; Economics; Health Care; Political Science; Public Policy

Master of Arts, Miami University, 2020, Economics

Medicaid is a joint federal-state health insurance program targeting the low-income population. The program covers nearly 20% of Americans and accounted for $592 billion in 2017. Medicaid was originally introduced in 1965 as an optional program without mandatory financial eligibility minimums. By 1982, all 50 states had established a program but at vastly different levels of eligibility. In this paper, I analyze the factors that impacted a state's adoption of Medicaid and the factors affecting eligibility generosity for pregnant women, infants, children, and other adults. I find that politics and health environment factors were insignificant in explaining the adoption of Medicaid. However, with respect to eligibility, these same health environment and political factors become significant in explaining differential levels of eligibility generosity. In both models, demographic factors provide conflicting evidence to support the basic ideas of the Median Voter Theorem. Regression findings for adoption and eligibility generosity are generally robust across models. Finally, future work might examine eligibility generosity for other populations benefiting from Medicaid or apply the models to a variety of optional benefits.

Committee: Melissa Thomasson (Advisor); Gregory Niemesh (Committee Member); Austin Smith (Committee Member) Subjects: Economic History; Economics; Health Care; Political Science; Public Policy

Doctor of Philosophy, The Ohio State University, 2019, Environment and Natural Resources

I consider contributions and limitations of traditional approaches to disability and inequality, noting a lack of quantitative empirical studies to address persistent poverty and underemployment since passage of the Americans with Disabilities Act (ADA). I find that the majority of literature is predicated upon assumptions of interpersonal discrimination and accessibility, without corresponding empirical study of how these factors influence the economic well-being of people with disabilities. Using newly-available county prevalence data from the American Community Survey (ACS), I present three studies to address areas of disability and inequality that have been neglected in sociological research. In the first, I address rising disability prevalence across U.S. counties and test prominent explanations involving health behaviors against place-based deprivation measures. Increasing disability prevalence is often attributed to rising obesity rates in the United States. Poverty and inequality, although commonly explored in studies of health disparities, have not been well-studied in their relationship to disability. I examine differences in disability prevalence across 2,964 U.S. counties to compare these competing explanations. I find that poverty is consistent in explaining the prevalence of overall disability and four subcategories of disability, while health behaviors are only significant when explaining some specific categories of disability. I further find that industrial composition of places plays an overlooked role in shaping disability prevalence, presumably from occupational hazards associated with extractive industrial activities across counties. In the second, I address the increasing gap in disabled employment that has persisted since the implementation of the ADA. The ADA offered protections against discriminatory hiring and workplace accessibility, but did not address other place-based and individual determinants of disability employment. I (open full item for complete abstract)

Committee: Linda Lobao Professor (Advisor); Jeff Sharp Professor (Committee Member); Cathy Rakowski Professor (Committee Member) Subjects: Demographics; Social Research; Sociology

Doctor of Philosophy, The Ohio State University, 2005, Physical Activity and Educational Services

The purpose of this project was to explore and describe the opinions and attitudes of potential Employment Networks (ENs) as factors in the successful implementation of the Ticket to Work-Work Incentives Improvement Act, PL 106-170. This groundbreaking legislation, which allows for beneficiary choice in a vocational rehabilitation provider, can be conceptualized in terms of supply and demand. The “demand” side of the law is reflected in the number of beneficiaries who are interested in receiving services to become employed. The “supply” side is simply the number of rehabilitation providers who are equally interested in becoming ENs, and assisting beneficiaries in obtaining employment. To date, much time and effort has been expended on notifying beneficiaries of their rights and incentives for returning to work. Meanwhile, relatively less effort has taken place in exploring and describing the attitudes of providers who have not become ENs. The overall success of the Ticket to Work and Work Incentives Improvement Act (TWWIIA) can be measured not only by the number of beneficiaries who take advantage of these new incentives, but also by the number and quality of the providers who become and remain an Employment Network. This survey research accomplished two primary objectives. The first objective was to determine which factors most heavily influenced the decision of potential ENs not to participate in this program. Factors explored were the following: 1) the payment system; 2) payment options/ issues; 3) delays in reimbursement; 4) the relationship between state vocational rehabilitation agencies (SVRAs) and ENs; 5) EN reporting requirements; 6) EN requirements/credentials; 7) criteria for the evaluation of ENs; and finally, 8) capitalization/start-up costs. The second objective was to determine the relationship between (a) the Ticket program components, and the demographic characteristics of participants, and (b) the decision of rehabilitation providers not to partici (open full item for complete abstract)

Committee: Bruce Growick (Advisor) Subjects: