Research

We review recent evidence on longer-term effects of Medicaid coverage during the prenatal period and in childhood and ask whether the benefits of these investments outweigh their costs. Included studies were published since 2015, follow cohorts for at least 10 years, and estimate the impacts of prenatal or childhood Medicaid eligibility on adult health, mortality, education, income, crime, and/or intergenerational outcomes. Reported effects are standardized to percent changes per additional year of eligibility and are incorporated into a Marginal Value of Public Funds (MVPF) framework to compare benefits with government costs.

Greater Medicaid eligibility in utero and during childhood is consistently associated with lower rates of adult disability, chronic disease, hospitalizations, and mortality. Benefits extend beyond health to higher educational attainment, improved employment and earnings in adulthood, and reduced criminal involvement. Emerging evidence also points to intergenerational gains, with improved birth outcomes in the next generation. The longer-term reductions in public spending attributable to the effects of Medicaid on improved health and economic outcomes exceed the direct cost of expanded eligibility. Hence, prenatal and childhood Medicaid “pays for itself” by generating additional benefits for individuals and society.

Overall, early-life Medicaid coverage generates durable improvements in longevity, health, human capital, and economic productivity while reducing crime and intergenerational disadvantage. These findings underscore Medicaid’s role as both a public health investment and a fiscal bargain. Planned Medicaid cutbacks risk reversing decades of progress and will likely impose significant financial and social costs.

How should payers balance fiscal sustainability with access to transformative medical technology? We study Louisiana’s 2019 Medicaid subscription model for hepatitis C (HCV), the first example of a U.S. state employing a two-part tariff to secure unlimited access to curative medicines. Using a differences-in-differences design comparing spending on beneficiaries with HCV to those with diabetes or HIV, we find that treatment volume tripled, medical spending fell, and new HCV diagnoses declined 23 percent. The state’s $37 million in incremental spending on antivirals generated $266 million in five-year savings. Innovative financing models can generate health benefits and near-term savings for payers.

Congestion pricing programs toll only a subset of roads and times, with theoretically ambiguous spillovers. We study New York City’s cordon-based congestion pricing using granular data from Google Maps and a generalized synthetic control design. The toll raised cordon-area speeds by 11%, with little effect on air quality, consumer spending, or foot traffic. Speeds also rose outside the cordon, especially on roads frequently traversed by cordon-bound drivers, making many unpriced trips faster. The magnitudes reflect steep congestion functions, where small volume reductions yield large speed gains. Because unpriced trips vastly outnumber priced ones, their small per-trip gains dominate aggregate driver welfare.