Nathan Blascak
Peer Reviewed Publications
Hospital Billing Regulations and Financial Well-Being: Evidence from California’s Fair Pricing Law (with Yaa Akosa Antwi and Marion Aouad), Journal of Health Economics, 2026, Volume 109, 103173.
Working paper versions: NBER Working Paper 35080, Federal Reserve Bank of Philadelphia Working Paper 25-39 (Previous circulated as “I’ve Got 99 Problems But a Bill Ain’t One: Hospital Billing Caps and Financial Distress in California” in Federal Reserve Bank of Philadelphia Working Paper 23-20.)
Abstract:
We examine the financial consequences of the 2007 California Fair Pricing Law, which places a price ceiling on hospital bills for financially vulnerable individuals. Using cross-sectional variation in exposure to the law, proxied by county-level uninsured rates, we estimate its impact on individual financial outcomes. We find that the law reduces the likelihood of incurring non-medical debt in collections and the number of non-medical accounts in collections. In addition, we find evidence that credit scores increased and suggestive evidence that the number of delinquent accounts decreased for individuals in more exposed counties. Our results suggest hospital billing regulations can improve targeted individuals’ financial outcomes.“Gender Differences in Credit Card Limits: Evidence from Sole Mortgage Applicants” (with Anna Tranfaglia), Journal of Money, Credit, and Banking (Accepted)
Abstract:
Using linked mortgage application and credit bureau data, we document the existence of unconditional and conditional gender gaps in the distribution of total bankcard limits. We estimate that male borrowers have approximately $1,300 higher total bankcard limits than female borrowers. This gap is primarily driven by a large gender gap in the right tail of the limit distribution. At the median and in the left tail of the total limit distribution, women have larger limits than men. Results from a Kitagawa-Oaxaca-Blinder decomposition show that 87 percent of the gap is explained by differences in the *effect* of observed characteristics, while 10 percent of the difference is explained by differences in the levels of observed characteristics. The gap is persistent across geographies but has varied over time. Overall, these gender gaps are small in economic magnitude and have changed over time favoring women.“Missouri’s Medicaid Contraction and Consumer Financial Outcomes” (with James Bailey and Slava Mikhed), American Journal of Health Economics, 2025, 11(4): 529-564.
Abstract:
In July 2005, a set of cuts to Medicaid eligibility and coverage went into effect in the state of Missouri. These cuts resulted in the elimination of the Medical Assistance for Workers with Disabilities program, more stringent eligibility requirements, and less generous Medicaid coverage for those who retained their eligibility. Overall, these cuts removed about 100,000 Missourians from the program and reduced the value of the insurance for the remaining enrollees. Using data from the Medical Expenditure Panel Survey, we show how these cuts increased out-of-pocket medical spending for individuals living in Missouri. Using individual-level credit bureau data and employing a border discontinuity differences-in-differences empirical strategy, we show that the Medicaid reform led to increases in both credit card borrowing and debt in third-party collections. When comparing our results with the broader literature on Medicaid and consumer finance, which has generally measured the effects of Medicaid expansions rather than cuts, our results suggest there are important asymmetries in the financial effects of shrinking a public health insurance program when compared with a public health insurance expansion.-
##### Working paper version: [Federal Reserve Bank of Philadelphia Working Paper 20-42](https://www.philadelphiafed.org/-/media/frbp/assets/working-papers/2020/wp20-42.pdf)
##### Media Coverage: [KFF Health News](https://kffhealthnews.org/news/article/medicaid-expansion-state-constitutions-congress-gop-republican-cuts-missouri/), [KOAM (Joplin, MO Local News)](https://www.koamnewsnow.com/video/6am-newscast-july-14th/video_82d176d8-6ae0-515b-8d6c-085950f18631.html)
“Health Insurance and Young Adult Financial Distress” (with Slava Mikhed), Journal of Policy Analysis and Management, 2023, 42(2): 393-423.
Abstract:
We study how health insurance eligibility affects financial distress for young adults using the Affordable Care Act's (ACA) dependent coverage mandate-the part of the ACA that requires private health insurance plans to cover individuals up to their 26th birthday. We examine the effects of both gaining *and* losing eligibility by exploiting the mandate's implementation in 2010 and its automatic disenrollment mechanism at age 26. Our estimates show that increasing access to health insurance lowers young adults' out-of-pocket medical expenditures and debt in third-party collections. However, the reductions in financial distress are transitory, as they diminish after an individual loses access to parental insurance when they age out of the mandate at age 26.-
##### Working paper version: [Federal Reserve Bank of Philadelphia Working Paper 19-54](https://www.philadelphiafed.org/-/media/frbp/assets/working-papers/2019/wp19-54.pdf) (Previously circulated as ["Did the ACA's Dependent Coverage Mandate Reduce Financial Distress for Young Adults?"](https://www.philadelphiafed.org/-/media/frbp/assets/working-papers/2018/wp18-03.pdf) in Federal Reserve Bank of Philadelphia Working Paper 18-03.)
“The Effect of State Health Insurance Benefit Mandates on Premiums and Employee Contributions” (with James Bailey), Applied Economic Letters, 2016, 23(14): 1042-1046.
Abstract:
The average US state has 40 benefit mandates, laws requiring health insurance to cover particular conditions, treatments, providers or people. We investigate the extent to which these mandates increase the health insurance premiums paid by employers, and the extent to which these higher premiums are passed on to employees in the form of higher employee contributions. We use state-level data on premiums and employee contributions to health insurance from the insurance component of the 1996–2011 Medical Expenditure Panel Survey. Our main analysis is a fixed effects regression that controls for age, race, income, union membership and the presence of state mandate waivers. We find robust evidence that the average mandate increases premiums by approximately 0.6%, and that mandates lead to similar increases in employee contributions for single-coverage health insurance plans. Alternative specifications using an AR(1) error structure estimate a larger effect of mandates, while those using generalized estimating equations estimate smaller effects. We find that mandates requiring insurers to cover a specific benefit, as opposed to a specific type of provider or person, lead to the largest increases in employee contributions.Working Papers
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“Does Experience Matter? Past Fraud Exposure, Data Compromises, and Credit Market Behavior” (with Ying Lei Toh), Federal Reserve Bank of Philadelphia Working Paper 26-10.
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Abstract: We study how past experiences with fraud affect individuals’ likelihood of taking precautionary action in credit markets when faced with a new shock that raises their fraud risks. We focus on two kinds of past experiences with fraud: direct experience with fraud and a “near-miss” experience that increased fraud risk but did not directly lead to fraud. Using the 2017 Equifax data breach announcement, we show that individuals with either type of prior experience with fraud were more likely to take a precautionary action — freezing their credit report — than individuals with no prior experience with fraud. We also find that individuals with past direct experience with fraud were more likely to freeze their credit report than individuals who had a past near-miss experience. The individuals who froze their credit report had fewer total accounts and credit inquiries than those who did not, but this reduction in credit did not reduce their credit scores.
(Previously circulated as “Prior Fraud Exposure and Precautionary Credit Market Behavior” in Federal Reserve Bank of Philadelphia Working Paper 22-36.)
Media Coverage: Take on Payments Blog
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“Health Insurance as an Income Stabilizer” (with Emily A. Gallagher, Stephen Roll, and Michal Grinstein-Weiss), Federal Reserve Bank of Philadelphia Working Paper 20-05.
- Abstract: We evaluate the effect of health insurance on the incidence of negative income shocks using the tax data and survey responses of nearly 14,000 low income households. Using a regression discontinuity (RD) design and variation in the cost of nongroup private health insurance under the Affordable Care Act, we find that eligibility for subsidized Marketplace insurance is associated with a 16% and 9% decline in the rates of unexpected job loss and income loss, respectively. Effects are concentrated among households with past health costs and exist only for “unexpected” forms of earnings variation, suggesting a health-productivity link. Calculations based on our fuzzy RD estimate imply a $256 to $476 per year welfare benefit of health insurance in terms of reduced exposure to job loss.
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“Financial Fraud Through the Lens of Extended Fraud Alerts” (with Julia Cheney, Robert Hunt, Slava Mikhed, Dubravka Ritter, and Michael Vogan), Federal Reserve Bank of Philadelphia Working Paper 25-29. (Revise and Resubmit, Review of Corporate Finance Studies)
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Abstract: We use extended fraud alerts in anonymized credit reports to examine how identity theft, and subsequent clean-up, affects consumers’ credit outcomes. The immediate effects of fraud for these consumers are negative, relatively small, and transitory. After placing an alert, these consumers experience persistent declines in delinquencies and a 12-point increase in credit scores, and 11 percent of filers become prime consumers. Many of these consumers take advantage of their improved creditworthiness and obtain additional credit. Although alert filers have larger balances, their performance on loans is as good as better than before fraud, suggestive of a change in behavior following fraud.
(Previously circulated as “Financial Consequences of Severe Identity Theft in the U.S.” in Federal Reserve Bank of Philadelphia Working Paper 21-41 and “Identity Theft as a Teachable Moment” in Federal Reserve Bank of Philadelphia Working Paper 16-27.)
Media Coverage: American Banker
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“Hospital Market Structure and Medical Collections” (with Tom Hamami and Kejda Llana)
- Abstract: This paper studies how hospital market structure impacts medical collections in the U.S. We first formulate a stylized model of hospitals, insurers, and consumers to inform our empirical analysis. Then, using anonymized credit bureau data on medical collections and geographic data on hospital locations from 2007 to 2011, we examine the relationship between hospital market structure and medical collections empirically. We find that more concentrated hospital markets – counties with fewer hospitals – have a higher percentage of their population with medical collections compared to less concentrated hospital markets. An analysis of hospital mergers during this time period show that counties with hospitals involved in mergers have a higher percentage of individuals with medical collections.
Works In-progress
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“How do Cash Transfers affect Health?: Evidence from the Alaska Permanent Fund Dividend” (with Marion Aouad and Michael Fitzpatrick)
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“Trauma and Personal Finance: Evidence from Mass Shootings” (with Yaa Akosa Antwi
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“The Price of Treatment: Estimating the Effects of Substance Use Disorder Facilities on House Prices” (with Jonathan Cantor, Keyoung Lee, Brady Horn, Catherine Maclean, Alex Hollingsworth, and Kosali Simon)
Federal Reserve Notes, Reports, and Shorter Pieces
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“A Note on Gender Differences in Credit Card Limit Changes” (with Anna Tranfaglia), FEDS Note (2024)
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“Health Insurance and Individual Financial Outcomes” (with Slava Mikhed and James Bailey), CFI In Focus (2020)