Premium
State earned income tax credits and general health indicators: A quasi‐experimental national study 1993‐2016
Author(s) -
Morgan Erin R.,
Hill Heather D.,
Mooney Stephen J.,
Rivara Frederick P.,
RowhaniRahbar Ali
Publication year - 2020
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.13307
Subject(s) - generosity , medicaid , earned income tax credit , behavioral risk factor surveillance system , mental health , demography , poverty , poisson regression , percentage point , wage , demographic economics , medicine , psychology , economics , environmental health , health care , population , labour economics , psychiatry , political science , economic growth , sociology , law , finance
Objective To assess the relationship between the presence and generosity of state‐level Earned Income Tax Credits (EITC) and multiple self‐reported measures of general health. Data Sources Data on state‐level tax credits and covariates were obtained from the National Bureau of Economic Research and University of Kentucky Center for Poverty Research, respectively. These data were merged with Behavioral Risk Factor Surveillance System survey records from 1993‐2016. Study Design Using difference‐in‐differences approaches and survey‐weighted Poisson regression that accounted for clustering of observations and included state and year fixed‐effects, we assessed relationships between EITC and self‐reported overall health, frequent mental distress, and frequent poor physical health in the prior 30 days. Covariates included state minimum wage, state GDP, and adoption of Medicaid expansion. Sensitivity analyses revealed that parallel trends were plausible; there were no significant lead and lag effects. Data Extraction Methods Analyses were restricted to respondents with no more than a high school diploma or equivalent because less‐educated adults are more likely to be low‐wage earners and therefore qualify for EITC. Principal Findings Among adults with no education beyond high school ( n = 2 884 790), each additional 10‐percentage‐point increase in the generosity of state EITC—relative to the federal credit—was associated with fewer reports of frequent mental distress (−97.3 per 100 000; 95% CI: −237.2, 42.6) and frequent poor physical health (−149.6 per 100 000; 95% CI: −284.4, −14.9). When restricted to individuals interviewed during the three months when tax rebates are commonly disbursed, the magnitude of the association between EITC and prevalence of reported frequent mental distress was greater (−329.7 per 100 000; 95% CI: −636.0, −23.5). Conclusions The generosity of state EITC policies is positively associated with significant reductions in frequent mental distress and poor physical health, especially during months when the credit is received. Interventions to reduce poverty may positively impact health by reducing material hardship and stress.