UC Santa Barbara

This dissertation consists of three essays in health economics. The first two essays investigate how the benefit structure of the United States' two largest public insurance programs -- Medicare and Medicaid -- affects beneficiaries and their families. The first essay examines the impact of an older spouse's Medicare eligibility at age 65 on the insurance coverage of a younger, Medicare-ineligible spouse. I find that Medicare eligibility of an older spouse can crowd-out the health insurance coverage of a younger spouse, reducing coverage on the extensive margin as well as the generosity of coverage. Medicare eligibility of an older wife increases the likelihood that a Medicare-ineligible husband is uninsured. After an older husband turns 65, younger wives are less likely to be covered through an employer-based insurance plan and more likely to have non-group coverage.

The second essay investigates the effect of Medicaid coverage of smoking cessation therapies on smoking behavior. Since 1994, most state Medicaid programs have introduced coverage for smoking cessation therapies such as the nicotine patch, nicotine gum, prescription medication, and counseling. I show that lowering the cost of these cigarette substitutes through Medicaid coverage reduces smoking among low-income parents who have ever smoked and are likely to be eligible for Medicaid. Importantly, the effect is concentrated among women with infants, suggesting that these policies potentially reduce children's secondhand smoke exposure.

The third essay provides evidence that family structure is an important factor influencing attention deficit/hyperactivity disorder (ADHD) diagnosis, especially for boys. First, we document that a non-traditional family structure is positively correlated with ADHD diagnosis. Next, we compare the gender gap in ADHD diagnosis across traditional, single parent, and blended families, finding that the negative impact of a non-traditional family structure is much larger for boys. The male-female gap in ADHD is approximately twice as large in non-traditional families. This excess gender gap in ADHD diagnosis in non-traditional families is pervasive across child age groups, family income levels, and family size. Our findings demonstrate that family structure itself is a key factor affecting ADHD diagnosis and that boys in non-traditional families are especially vulnerable.