Research
Working Papers
Get Fit with MA? Estimating the Impact of Medicare Advantage on Physical Activity Paper
(with Li J.)
Medicare Advantage (MA) plans increasingly offer fitness benefits, yet evidence on their causal impact remains limited. Using a regression discontinuity in difference in difference (RDDD) design centered at the age-65 Medicare eligibility threshold, this study provides first quasi-experimental evidence on how MA enrollment affects seniors’ physical activity. Linking nationally representative survey data on workout behavior with insurance coverage information, we find that the discontinuity in vigorous workout days at age 65 is significantly larger for MA enrollees than for non-MA beneficiaries, who do not receive comparable fitness benefits. Robustness checks including placebo cutoffs and a donut-hole analysis yield consistent results. These findings highlight how insurance design can shape health behavior and suggest that fitness benefits in Medicare Advantage encourage more active lifestyles, offering timely insights for policymakers seeking to promote healthy aging through targeted benefit structures.
Do Seniors Follow Their Neighbors? Causal Evidence on Social Spillovers in Medicare Advantage Enrollment
Medicare Advantage (MA) enrollment continues to rise, yet little is known about whether seniors’ plan choices respond to the behavior and information circulating within their social environments and day-to-day networks. This study examines peer spillovers in MA take-up using quasi-exogenous variation from neighboring counties’ Urban Floor (UF) payment status, which expands MA plan availability in adjacent markets while leaving the focal county’s own payment rules unchanged.Using nationally representative survey data linked to restricted geographic identifiers, I construct cross-county social exposure networks based on tract and neighborhood adjacency. A leave-one-out measure of peer MA penetration is instrumented with neighbors’ UF status, providing variation that is unaffected by mechanical reflection, shared shocks, or correlated preferences.I find sizable social spillovers: Higher adjacent-county MA penetration significantly increases an individual’s likelihood of MA enrollment through mechanisms operating within seniors’ social networks and community-based social activities. Evidence points to informational diffusion and visible health-behavior channels through which peers transmit plan information and shape perceptions of MA benefits. These results highlight the critical role of social environments in Medicare plan choice and reveal previously unrecognized externalities embedded in MA payment policy.
Where Seniors Sweat: Geographic Variation in SilverSneakers Uptake
(with Rovniak L.)
Abstract forthcoming.
Cross-national Analysis of the Determinants of Dementia Prevalence: Evidence from the United States and Caribbean Countries
(with Li J. & Dow W.)
Abstract forthcoming.
Predictors of Discontinued Participation in a Fruit and Vegetable Voucher Program: The Role of Community Organizations in Engaging Non-English Speakers
(with Chaparro, P., Wallace, J., Baquero, B., Jones-Smith, J., & Knox, M.)
Healthy food voucher programs (HFVPs) are an important fiscal tool for addressing inequities in healthy food consumption. Fresh Bucks, a HFVP in Seattle, Washington, USA, provides US$40/month for fruit and vegetable (FV) purchases to low-income households, encouraging long-term participation and utilizing a community-supported enrollment model to engage non-English speaking households. Previous research demonstrated that Fresh Bucks participation reduced food insecurity and increased FV consumption; yet 46% of participating households chose to discontinue participation when requested to re-apply ~2 years post initial enrollment. We sought to identify factors that predict discontinuation of Fresh Bucks participation, particularly among non-English speakers
Do Unionized Firms Have Better Management Practice? Paper
(with Basu A)
Using restricted data from the World Management Survey (WMS), we examine the relationship between labor unions and management practices across private manufacturing firms in Latin America, North America, and Europe. While prior research shows that management quality is strongly correlated with firm performance, the role of unions in shaping managerial practices remains unclear. We find that unionized firms are significantly better managed overall. However, this aggregate relationship masks substantial heterogeneity across different management domains. Firms with higher union rate score lower on People Management practices, reflecting constraints on hiring, promotion, and dismissal, but score markedly higher on Operations, Monitoring, and Target-setting practices. These patterns suggest that unions are associated with the adoption of more structured performance systems while limiting managerial discretion in personnel management