Effect of Increasing Healthcare Costs on Small Firms: Evidence from Private Equity Acquisitions of Hospitals (Job Market Paper)

Abstract: The U.S. is experiencing concurrent trends of rising healthcare costs and declining small business employment and startup rates; however, the link between these aggregate trends has not yet been established. I use private equity (PE) acquisitions of hospitals during the period 2002-2017 as a shock to local healthcare prices in order to study the effect of increasing healthcare costs on the composition of firms in local economies using a difference-in-differences framework. I use confidential Census Bureau data to show first that PE acquisitions of hospitals indeed affect the health insurance premiums charged by insurers to local employers. Turning to the economic implications, I show that smaller firms face both increased barriers to entry and decreased firm resilience following a PE-induced increase in health insurance premiums; firms with 20 or fewer employees are less likely to enter the market, while firms with between 11 and 50 employees who do still enter face a higher probability of exit.

The Financial Impacts of Decreased Access to Abortion

Abstract: In this paper, I exploit variation in changes in access to abortion resulting from Planned Parenthood clinic openings and closings during the period 2010-2019 to study the relationship between access to abortion and financial health (delinquencies). I find that auto loan delinquencies are negatively related to access to abortion, a relationship which is unique when compared to other types of loans (i.e., credit cards, mortgages, and student loans). I show that this effect is driven by changes in access in low-income areas, shedding light on the mechanism as well as the significance of auto loans, as low-income individuals disproportionately hold auto loans (e.g., compared to mortgages). I provide further evidence of the causality of the relationship between access to abortion and auto loan delinquencies by exploiting a 2013 legislative change in Texas. Finally, I use these estimates to calculate the impact of the overturning of Roe v. Wade in June 2022 on financial health.