Project Summary/Abstract Research Project: Even with health insurance, many adults report cost-related barriers to care, possibly related to rising premiums, cost-sharing requirements, and other health care-associated expenses such as transportation. In the context of widening differences in health by social class alongside rising income equality, the goal of this research is to examine how changes in a policy intended to change the distribution of income – the minimum wage – affects access to health care, food insecurity, and mental health among people at the lower end of the income distribution. While the federal minimum wage remained unchanged since 2009, thirty states have increased their minimum wage since then. There is a robust economic and social literature looking at how the minimum wage affects earnings and employment; these studies generally show null to very modest effects on employment and positive effects on earnings, including a reduction in the racial earnings gap. Yet the impact of the minimum wage on access to health care and health has not been studied in as much detail. This proposal will examine three specific outcomes that could be affected most directly by increases in the minimum wage: barriers to health care, food insecurity, and psychological distress. Health care could mitigate some of the downstream health consequences of low income, but access to health care itself varies by income: in 2017, 29% of non-elderly adults in the lowest income group were unable to see a physician because of cost, versus 9% in the highest income group. Even for those able to access health care, the ability to follow a treatment plan and manage chronic illness can be hindered by food insecurity and poor mental health, which are also concentrated among low-income households. The proposed study will use national health survey data and quasi-experimental methods to accomplish two key aims. First, I will assess the effect of minimum wage laws on access to health care, food insecurity, and mental health among adults most likely to work in low-wage occupations. Second, I will examine the differential impact of minimum wage laws on health and access to health care by race, ethnicity, chronic disease status, and geography. Broadly, I seek to discover what interventions to address rising income inequality can reveal about the link between income inequality and access. The findings from this research will add novel evidence to current debates about minimum wage and related policies that seek to raise earnings at the lower end of the income distribution. Training Plan and Environment: My specific training goals include acquiring skills in advanced quantitative methods for policy evaluation and causal inference; developing an interdisciplinary expertise in how income and poverty can affect access to health care and health, including precise underlying mechanisms; and gaining expertise in survey design and survey-based measurement of both access and health outcomes. The vibrant, supportive, and interdisciplinary culture at Harvard University’s Department of Economics and Interfaculty Initiative in Health Policy provide an ideal environment for pursuing my training goals and research project.

Project Narrative Even with health insurance, many adults report cost-related barriers to care, possibly related to rising premiums, cost-sharing requirements, and other health care-associated expenses such as transportation. In the context of widening differences in health by social class alongside rising income equality, the goal of this research is to examine how a major policy intended to change the distribution of income – the minimum wage – affects access to health care, food insecurity, and mental health among adults most likely to work in low- wage occupations. The findings from this research will add novel evidence to current debates about minimum wage and related policies that seek to raise earnings at the lower end of the income distribution.