California Policy Lab

Key Points

Question: Did emergency department (ED) use decrease among the top 5% of high users of health care and social services in San Francisco County during the COVID-19 pandemic?

Findings: In this cohort study of 8967 individuals, the rate of ED visits decreased by approximately 25% during the pandemic compared with nonpandemic years.

Meaning: Factors associated with decreased ED encounters and health outcomes during the COVID-19 pandemic among previously high users are not clear and warrant further investigation.

This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants M21PR3278.

States have begun to pass legislation to provide automatic relief for eligible criminal records, potentially reducing the lifelong collateral consequences of criminal justice involvement. Yet numerous historical examples suggest that racially neutral policies can have profoundly disparate effects across racial groups. In the case of criminal record relief, racial equity in eligibility for a clean slate has not yet been examined. We find that in California, one in five people with convictions met criteria for full conviction relief under the state's automatic relief laws. Yet the share of Black Americans eligible for relief was lower than White Americans, reproducing racial disparities in criminal records. We identify two policy amendments that would reduce the share of Black men in California with convictions on their criminal records from 22% to 9%, thereby narrowing the difference compared to White men from 15 to seven percentage points. Put another way, an additional one in seven Black men currently has a conviction record, compared to their White counterparts. This would decline to an additional one in 14 if both hypothetical policy amendments were incorporated. We close with discussion of criminal history data quality limitations, which pose a second key challenge to equitable implementation of automatic criminal record relief reforms nationwide.

This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants MRP-19-600774 and M21PR3278.

A subset of undergraduate applicants to the University of California, Berkeley were invited to submit letters ofrecommendation as part of their applications. I use scraped text of the submitted letters, natural languageprocessing tools, and a within-subject experimental design wherein applications were read in parallel with andwithout their letters to understand the role that this qualitative information plays in admissions. I show thatletters written on behalf of underrepresented applicants were modestly distinctive. I also construct an index ofletter strength, measuring the predicted impact of the letter on the student’s application score. I show thatunderrepresented applicants tend to get weaker letters, but that readers pay less attention to letter strength forunderrepresented students. Overall, the inclusion of letters modestly improved application outcomes for theaverage underrepresented student.

This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants MRP-19-600774 and M21PR3278.

Key Points

Question: Was placement in a shelterin-place (SIP) hotel during the COVID-19 pandemic associated with health system utilization among people experiencing homelessness with a history of high use of acute health services?

Findings: In this cohort study of 686 high users of acute county services experiencing homelessness, those who received a SIP hotel placement had significantly fewer emergency department visits, hospital admissions, inpatient days, and psychiatric emergency department visits compared with matched controls without a placement.

Meaning: These findings suggest that provision of noncongregate shelter with supportive services in SIP hotels during the COVID-19 pandemic was associated with reduced use of acute health services among people with prior high use.

This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants MRP-19-600774 and M21PR3278

This study examines how the first two years of the COVID-19 pandemic affected life expectancy in California and the relationship between census tract income and life expectancy relative to prepandemic years. In this retrospective analysis of 1, 988, 606 deaths in California during 2015 to 2021, life expectancy declined from 81.40 years in 2019 to 79.20 years in 2020 and 78.37 years in 2021. Life expectancy differences between the census tracts in the highest and lowest income percentiles increased from 11.52 years in 2019 to 14.67 years in 2020 and 15.51 years in 2021. This ecological study of deaths in the state of California demonstrated that life expectancy declines in 2020 increased in 2021 and that the life expectancy gap by income level increased during the first 2 years of the COVID-19 pandemic relative to the prepandemic period.

This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants MRP-19-600774 and M21PR3278.

The authors use de-identified data from California personal income tax returns to measure the frequency and nature of independent contracting and self-employment in California. They identify this work by the presence of a Schedule C on the tax return and/or the receipt of a Form 1099 information return. The authors estimate that 14.4% of California workers aged 18 to 64 in tax year 2016 had some independent contracting or self-employment income and approximately half of this subgroup also had earnings from traditional W-2 jobs during the year. Only a small share (1.4%) of workers had earnings from online labor platforms (often called gig work). Workers with low earnings were significantly more likely to earn independent contracting or self-employment income and to rely primarily or exclusively on that income. The article explores the characteristics of workers engaging in independent contracting and self-employment and their distribution across family type, geography, and industry.

This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants MRP-19-600774 and M21PR3278

This paper studies the effect of a restorative justice intervention targeted at youth ages 13 to 17 facing felony charges of medium severity (e.g., burglary, assault). Eligible youths were randomly assigned to participate in the Make-it-Right (MIR) restorative justice program or a control group where they faced standard criminal prosecution. We estimate the effects of MIR on the likelihood that a youth will be rearrested in the four years following randomization. Assignment to MIR reduces the probability of a rearrest within six months by 19 percentage points, a 44 percent reduction relative to the control group. Moreover, the reduction in recidivism persists even four years after randomization. Thus, our estimates show that restorative justice conferencing can reduce recidivism among youth charged with relatively serious offenses and can be an effective alternative to traditional criminal justice practices.

This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants MRP-19-600774 and M21PR3278

Abstract: As US college costs continue to rise, governments and institutions have quadrupled financial aid. Yet, the administrative process of receiving financial aid remains complex, raising costs for families and deterring students from enrolling. In two large-scale field experiments (N= 265,570), we test the impact of nudging high-school seniors in California to register for State financial aid. We find that simplifying communication and affirming belonging each significantly increase registrations, by 9% and 11% respectively. Yet, these nudges do not impact the final step of the financial aid process -- college enrollment. In contrast, a simplified letter that affirms belonging while also making comparable cost calculations more salient significantly impacts college choice, increasing enrollment in the lowest-cost option by 10.4%. Our findings suggest that different nudges are likely to address different types of administrative burdens, and their combination may be the most effective way to shift educational outcomes.

This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants MRP-19-600774 and M21PR3278.

Most labor market policy in the United States is designed for long-term employment relationships. Self-employed workers, including independent contractors and on-demand platform (“gig”) workers, are excluded from labor market protections such as wage and hour laws, occupational safety and health regulations, unemployment insurance, and employer-provided health insurance and retirement programs. They are also poorly covered by our tax collection system, which relies heavily on employer reporting of worker earnings for enforcement. Growth in independent contracting could undermine labor market arrangements, with implications for regulation, tax collection, and worker wellbeing.

This paper uses California tax data to provide an alternative lens on many of the outstanding empirical questions about independent contracting. We use de-identified, individual-level data from California personal income tax returns for tax years 2012 through 2017 to measure the prevalence and nature of self-employment and independent contracting. We estimate that 14.4% of California workers aged 18-64 in tax year 2016 had some independent contracting income. Over half of independent contractors also had traditional jobs generating W-2s, and most of these received the bulk of their earnings from their traditional jobs. Workers with low earnings are significantly more likely to earn independent contracting income and to rely primarily or exclusively on that income. We explore the characteristics of independent contractors and their distribution across family type, geography, and industry.

This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants MRP-19-600774 and M21PR3278.

Importance  Several jurisdictions in the United States have secured hotels to temporarily house people experiencing homelessness who require isolation or quarantine for confirmed or suspected coronavirus disease 2019 (COVID-19). To our knowledge, little is known about how these programs serve this vulnerable population outside the hospital setting.

Objective  To assess the safety of a hotel-based isolation and quarantine (I/Q) care system and its association with inpatient hospital capacity.

Design, Setting, and Participants  This retrospective cohort study of a hotel-based I/Q care system for homeless and unstably housed individuals in San Francisco, California, was conducted from March 19 to May 31, 2020. Individuals unable to safely isolate or quarantine at home with mild to moderate COVID-19, persons under investigation, or close contacts were referred from hospitals, outpatient settings, and public health surveillance to 5 I/Q hotels. Of 1009 I/Q hotel guests, 346 were transferred from a large county public hospital serving patients experiencing homelessness.

Exposure  A physician-supervised team of nurses and health workers provided around-the-clock support, including symptom monitoring, wellness checks, meals, harm-reduction services, and medications for opioid use disorder.

Main Outcomes and Measures  Characteristics of I/Q hotel guests, program retention, county hospital readmissions, and mean length of stay.

Results  Overall, the 1009 I/Q hotel guests had a median age of 44 years (interquartile range, 33-55 years), 756 (75%) were men, 454 (45%) were Latinx, and 501 (50%) were persons experiencing sheltered (n = 295) or unsheltered (n = 206) homelessness. Overall, 463 (46%) received a diagnosis of COVID-19; 303 of 907 (33%) had comorbid medical disorders, 225 of 907 (25%) had comorbid mental health disorders, and 236 of 907 (26%) had comorbid substance use disorders. A total of 776 of 955 guests (81%) completed their I/Q hotel stay; factors most strongly associated with premature discontinuation were unsheltered homelessness (adjusted odds ratio, 4.5; 95% CI, 2.3-8.6; P < .001) and quarantine status (adjusted odds ratio, 2.6; 95% CI, 1.5-4.6; P = .001). In total, 346 of 549 patients (63%) were transferred from the county hospital; of 113 ineligible referrals, 48 patients (42%) had behavioral health needs exceeding I/Q hotel capabilities. Thirteen of the 346 patients transferred from the county hospital (4%) were readmitted for worsening COVID-19. Overall, direct transfers to I/Q hotels from emergency and outpatient departments were associated with averting many hospital admissions. There was a nonsignificant decrease in the mean hospital length of stay for inpatients with confirmed or suspected COVID-19 from 5.5 to 2.7 days from March to May 2020 (P = .11).

Conclusions and Relevance  To support persons experiencing homelessness during the COVID-19 pandemic, San Francisco rapidly and safely scaled a hotel-based model of I/Q that was associated with reduced strain on inpatient capacity. Strategies to improve guest retention and address behavioral health needs not met in hotel settings are intervention priorities.

This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants M21PR3278.