Publications
Iowa's Healthcare Landscape
(with Ben Murrey and Andrzej Wieciorkowski at Common Sense Institute)
Iowa’s policymakers, providers, and insurers operate within a state comprised of an aging population and large rural areas. According to the Iowa Department of Justice, the state ranks 16th nationally for the number of residents 50-years-old and over. Approximately 18% of Iowa’s more-than-three-million residents are 65 years old and older while 23% are under 18 years old. The average life expectancy in Iowa is 78.12—21st highest in the country. In addition, the United States Department of Agriculture (USDA) considers 77 of the state’s 99 counties “rural” based on the amount of open countryside and rural towns. An astounding 22 of these rural counties have 100% of the population residing in a rural area. Other factors also help set the stage for the Iowa healthcare industry. Its diabetes prevalence of 8.5% puts the state at 28th highest in the country, and approximately 37% of the state’s population is obese, giving it the 13th highest obesity rate in the country, to name just two. While not directly caused by the healthcare system per se, these and other factors significantly influence Iowa’s particular healthcare needs and frame the backdrop for this report. Iowa needs a healthy population to thrive. To achieve that, Iowans must have access to quality healthcare. The ability of the state’s healthcare system to deliver that in the context of its unique demographics and characteristics depends on several factors. Access to quality care starts with the existence of providers and a workforce to support them. For patients to access providers’ services, they must possess means to pay. This depends largely on healthcare costs and the insurance market. And in the case of Iowa, to ensure access across the state the healthcare system must supply rural areas with sufficient healthcare resources. This report thus explores and presents data on Iowa’s healthcare business climate, healthcare expenditures, insurance, and rural healthcare. In doing so, it highlights Iowa’s unique healthcare landscape to help public- and private-sector decision makers understand the state’s challenges and identify where to focus solutions to improve the state’s healthcare system.
The Pass-Through of the Largest Tax on Sugar-Sweetened Beverages: The Case of Boulder, Colorado
(with John Cawley, David Frisvold, and David Jones)
This paper estimates the pass-through of the largest tax on sugar-sweetened beverages enacted in the U.S., which is two cents per ounce in Boulder, Colorado. A strength of the paper is that, to achieve as complete a perspective as possible, we estimate the pass-through of the tax not only to beverage prices in retail stores but also to those in restaurants, and we examine data for the treatment community of Boulder and a comparison community of Fort Collins, Colorado, from four sources: (a) hand-collected data on prices from stores; (b) Nielsen Retail Scanner Data of store prices; (c) hand-collected data on prices in restaurants; and (d) web-scraped data from online restaurant menus. Across the multiple datasets, we find consistent evidence that the tax was largely, but not completely, passed through to consumers. In both the hand-collected store data and restaurant data, pass-through is slightly less than 75%, whereas pass-through is just over 50% using the scanner data; consumers bear most, but not all, of the largest tax on sugar-sweetened beverages in the United States.
American Journal of Agricultural Economics, Volume 103, Issue 3, May 2021
Economics of Obesity
(with David Frisvold)
This chapter provides an overview of the levels, trends, causes, and consequences of obesity, related market failures, and the evidence of the impact of policies that could potentially address the market failures. More than 40% of adults in the United States are obese, and obesity-related healthcare accounts for over 20% of total annual medical expenditures. The decrease in the price of calorie-dense foods, which led to an increase in average calories consumed, is a primary cause of the rise in obesity since the 1970s. There are also significant market failures associated with obesity, including negative externalities due to pooled health insurance and asymmetric information between food producers and consumers. The presence of market failures provides support for government policies aimed at decreasing and preventing obesity. Public policy tactics to address this issue include price-based, information-based, and school-based policies. Of these, school-based policies may be the most effective as they help form healthy nutrition habits and prevent obesity in adulthood when healthcare costs are much higher. Overall, obesity rates remain high and continued government intervention is necessary to improve the market failures related to this epidemic.
Handbook of Labor, Human Resources and Population Economics, 2021
Working Papers
Metabolic Effects and Monetary Costs of Avoiding Ultra-Processed Foods in College Environments
Chronic diseases such as obesity, type 2 diabetes, and heart disease are closely linked to poor nutrition, particularly the consumption of ultra-processed foods (UPFs), which now make up nearly 70\% of the American diet. This study investigates whether avoiding UPFs improves metabolic health and whether such a dietary shift imposes financial costs, using a four-week within-subject design among college students. During the treatment period, participants significantly reduced UPF intake—from over five servings per day to less than one—and also consumed substantially fewer calories and carbohydrates, without increasing food costs or reducing protein intake. While the average Metabolic Flexibility Score (MFS) improved, this effect was not statistically significant after accounting for individual-level clustering, likely due to the study's small sample size and limited variability in outcomes. Still, the magnitude and consistency of dietary improvements suggest that reducing UPF consumption may positively impact metabolic health even in young, healthy populations. These findings support the potential for campus-level or policy-driven interventions—such as clearer food labeling regarding processing levels—to promote healthier eating and reduce long-term chronic disease risk.
Cup of Joe and Knowledge Flow: Coffee Shops and Invention (with Michael Andrews)
We estimate how the availability of informal gathering places can facilitate knowledge spillovers that lead to innovation. More specifically, we estimate how the spread of coffee shops increases local inventive activity. To account for endogeneity in the number of coffee shops in an area, we use an instrumental variables approach based on the geographic and temporal patterns of the opening of Starbucks coffee establishments.As Starbucks opened new establishments, these establishments tended to spread out-ward from the location of the first Starbucks establishments in Seattle. Using this strategy, we find that 10% faster growth in the number of new Starbucks stores in a county increases patent filings in that county by about 4-6%. A faster growth rate of Starbucks increases citations to local patents, suggesting that increasing localized knowledge flow shifts the direction of invention towards local ideas. Collaborative patenting and patenting by firms both increase, and does collaboration across firms, providing suggestive evidence that coffee shops are especially conducive for cross-firm business meetings
Academic and Behavioral Impacts of After School Program Participation (with Drew Westberg)
Kids on Course (KOC) is a non-profit organization that provides tutoring, enrichment, parent engagement, summer learning and long-term mentoring to students in the Cedar Rapids, Iowa community. The program begins with students in elementary schools and follows them throughout their educational career. Previous research has illustrated the value of before and after school programs such as school breakfast programs and after school extracurricular activities. There is limited evidence, however, on the effectiveness of a comprehensive program that targets academics through tutoring, includes family engagement, promotes extracurricular enrichment, and provides resources to minimize barriers to academic success. Using data from the universe of the Cedar Rapids School district which contains demographic, academic, and behavioral data from all students over three academic years, we evaluate the effectiveness of participation in KOC on student academic achievement and behavior. Since students are recommended for the program based on academic performance and family background, a simple comparison of students enrolled in KOC to those not enrolled does little to describe the effectiveness of the program. Using propensity scores derived from demographic information, we identify students that are similar to those enrolled in KOC but who did not participate. This allows us to construct a more reliable control group of students.
Using doubly robust propensity score estimation, we find that participation in KOC did not significantly improve standardized test scores in most cases. There were significant gains in math scores from the beginning of the year to the middle of the year for the KOC participants in middle school, but these midterm gains were washed out by the end of the year. We find no academic effects of KOC participation for 2-5th graders. We do, however, find significant impacts of participation in KOC on behavior events for all grades. KOC participants, in contrast to our constructed control group, have approximately 0.3 fewer behavior event per year. KOC participants also had fewer suspensions and suspension days and missed significantly less school. Together, these results suggest that participation in such a comprehensive after school program may further educational attainment primarily through improved classroom behavior and attendance.
Price and Quality Responses of the Restaurant Industry to Increases in the Minimum Wage [pdf]
Using a novel dataset comprised of online menu item and restaurant quality information from thousands of primarily non-chain establishments across three states, I estimate the price and quality responses to varying levels of minimum wage increases enacted at the start of 2017. I find that prices rise 0.3% to 0.8% in response to a 10% increase in the minimum wage. These results are consistent with previous estimates in the literature, as well as what is predicted by the textbook model of competitive factor markets and monopolistically competitive firms. Building on this, I then extend the literature to more broadly understand the price pass-through as well as provide the first estimates of responses on quality. I find heterogeneity in pass through across restaurant characteristics, with higher pass-through among small firms, and lower pass-through for restaurants near the border of a minimum wage policy region. At the menu item level, pass-through is higher for sides and sandwiches, and options with organic or gluten-free ingredients. I find no evidence of higher pass-through for popular items. Finally, I find significant changes in restaurant quality due to an increase in the minimum wage. Specifically, I find that for low quality restaurants, quality decreases after an increase in the minimum wage, but that quality increases for high quality restaurants.
Works In Progress
Labor Market Effects of a Health Shock on the Aging Population: Evidence from Trans Fat Bans
The Impact of School Year Calendar Structure on Childhood Weight Gain