In this dissertation I examine the Child Tax Credit (CTC), who gets it and who doesn't, paying particular attention to children under the age of three, its legislative and political history, and how it could be improved. At $56.4 billion per year, the Child Tax Credit (CTC) is nearly the largest U.S. federal expenditure on children and families, second only to the Earned Income Tax Credit (EITC), at $59.5 billion (JCT, 2011). Created in 1997, it has been expanded seven times in just the last decade. Yet in spite of America's federal commitment of dollars and legislative commitment of reform, little has been written about the CTC. I examine the literature first to see if cash and cash assistance matter, finding on balance that there is strong evidence that it does, particularly for young children; second to show that the U.S. underinvests in this domain in young children relative both to what is needed and to what other advanced industrialized countries do; and third to lay out the case that changes to the refundable CTC offer one opportunity to address this underinvestment. I examine the legislative history of the CTC, as I believe both the policy analysis and history need to be understood to inform the policy responses. Next, I examine whether the portion of the new safety net that was fashioned as tax policy is working as child policy - specifically, whether it is reaching our youngest children, with initial evidence that it may not be in the case of the CTC (Burman and Wheaton, 2007) yet may be in the case of the EITC (Dowd and Horowitz, 2011). Using the 2011 Current Population March Supplement, I examine empirical evidence of the age distribution of federal tax credits for children, finding that 29% of children under the age of three are in families with too little earnings to get the full CTC, as opposed to 20% of older children. Nearly 13% of children under the age of three are in families with no earnings and as such get no CTC or EITC, as opposed to 8% of older children. While the EITC may disproportionately benefit young children, poor young children are more likely to be left out eligibility of the EITC than their older counterparts. Since infants may or may not be eligible for any CTC or EITC, depending on their birth month, I suggest that as some have found a marriage penalty in parts of the tax code, that there may also be a "baby penalty." I use micro-simulation to examine the costs and benefits of alternative CTC policies. Here I find that while full refundability may be the optimum CTC policy, that there are other possibilities, including those that increase the phase-in of eligibility, that are less costly, and also substantially lower child poverty among young children, including doubling the CTC for young children, increasing the phase in, and using a look back provision to allow families to use their previous year's earnings to calculate their refundable CTC and EITC. Yet, only moving to full refundability would do anything for the 12.67% of young children in families with no earnings. Finally, I propose policy responses that are rooted both in the science of increased cash investments in young children, and in the politics of working legislatively to get there, suggesting that policy makers consider the question of age equity when examining the distributional effects of tax policies. Implications for research and policy are discussed.

This dissertation explores the political development of Medicaid financing, specifically its federal-state cost sharing formula. This dissertation traverses a half-century of congressional policymaking and an original 30-year dataset of state-level Medicaid expenditure and enrollment figures to provide a positivist account of how the federal and state governments' shared financial responsibilities for Medicaid affect overall Medicaid expenditures and state budget priorities. This dissertation also considers the direct and indirect financial burden that Medicaid's costs impose on taxpayers--both in their capacity as Americans and as residents of individual states. This dissertation argues that the growth in Medicaid costs is attributed to the resiliency of a funding formula that subsidizes the states' policies and redistributes liability for Medicaid expenditures between the states and federal governments. By subsidizing the costs of a state's Medicaid program, a state's Federal Medical Assistance Percentage (FMAP) reduces the effective fiscal burden of its Medicaid policies, thereby incentivizing policymakers to expand Medicaid beyond what is warranted by the policy preference of the state's residents. As a result, state budgets are likely to reflect an intentionally inefficient, yet politically rational, allocation of public resources. Compounded over decades, and exasperated by more recent adjustments that reduce the states' direct fiscal responsibilities for their Medicaid policies, the fiscal imperative imposed by Medicaid's financing institution has compelled states to maintain a rate of growth in Medicaid expenditures that now threatens to overwhelm the states' ability to adequately fund its other public commitments.

Thesis (M.P.A.)--University of Hong Kong, 2003. / Includes bibliographical references. Also available in print.

No description available.

The purpose of this study was to conduct a formal program evaluation of the New York State newborn screening for Krabbe disease (KD), a rare neurological disease with variable onset of symptoms to assess 1) the perceptions of stakeholders 2) KD test characteristics, and 3) actual program costs. Using the CDC Framework for Program Evaluation in Public Health, integration of qualitative and quantitative techniques was used to provide a comprehensive evaluation. Stakeholder input was elicited using semi-structured interviews of medical professionals and parents and content analysis of the interview transcripts identified five themes: Legislative/Political, Unintended Consequences, Knowledge and Science, Communication, and Moral Issues. Finally, cost and charge data were used to calculate the cost of the KD screening program from the perspective of the State. Triangulation of the results provided the conclusions for practice and policy recommendations. Using the data from the State annual reports of 9 positive KD screening results, sensitivity was calculated at 100%, specificity was 99%, positive predictive value was 5%, negative predictive value was 100% and prevalence was 1/100,000 births. However, the State reports did not include the 19 infants with low enzyme activity and mutations that could develop into later onset forms of KD. When these 19 infants were included, sensitivity, specificity, and negative predictive value remained unchanged; however, positive predictive value rose to 15%, and prevalence increased to 3/100,000 births. The total annual cost of the program from the perspective of the State was calculated at $750,652. For parents, the cost calculated from initial newborn screen to neurodiagnostic testing was $2669/family. Since 2006, there have been more than 1,000,000 infants screened for KD in New York State. While the screening has identified four infants with the early infantile form of the disease, there have been 24 others identified with low enzyme activity and mutations that may cause later onset forms of the disease, which are poorly understood. This unexpected finding suggests that newborns may be diagnosed with a disease that may not present symptomatically until adulthood. Unfortunately, the current confirmatory enzyme test and neurodiagnostic tests cannot predict onset of disease or severity of symptoms. In addition, the only available treatment, a cord blood transplant, is irreversible, has a high risk of morbidity and mortality, and long term outcomes have not been studied. While the cost of the program from the perspective of the state is not excessive, cost-effectiveness studies are needed to determine the cost of KD screening from the societal perspective, and should include treatment and follow up costs.

In many of today's education debates, "teacher voice" is invoked as a remedy to, or the cause of, the problems facing public schools. Advocates argue that teachers don't have a sufficient voice in setting educational policy and decision-making while critics maintain that teachers have too strong an influence. This study aims to bring some clarity to the contested and often ill-defined notion of "teacher voice." I begin with an original analytical framework to establish a working definition of teacher voice and a means by which to study teachers' educational, employment, and policy voice, as expressed individually and collectively, to their colleagues, supervisors, and policymakers. I then use this framework in Part I of my paper which is a historical review of the development and expression of teacher voice over five major periods in the history of public education in the United States, dating from the colonial era through today. Based on this historical interpretation and recent empirical research, I estimate the impact of teacher voice on two outcomes of interest: student achievement and teacher working conditions. In Part II of the paper, I conduct an original quantitative study of teacher voice, designed along the lines of my analytical framework, with particular attention to the relationship between teacher voice and teacher turnover, or "exit." As presented in Parts I and II and summarized in my Conclusion, teacher voice requires an enabling context. For much of the history of public education in the United States, a number of social and political factors presented conditions that inhibited teacher voice. As the state acquired more responsibility for the delivery of schooling, the required institutional context took shape allowing for the emergence of teacher voice in its various forms. Collective bargaining laws established formal procedures for the expression of teacher collective voice, originally on matters of employment but quickly spreading to issues of education and policy. Over the past thirty years, just as teacher voice gained strength at the negotiating table and in the corridors of power, the evolving institutional context has privileged choice, or "exit," over voice; a concurrent centralization of authority has made decision making less susceptible to voice efforts. At present, and despite mechanisms that promote teacher voice such as unionization and collective bargaining, teachers feel as if they do not have much of a voice in educational, employment, or policy decisions. Context matters, though, for when teachers are satisfied with their place of work, when represented by an effective union, and when the issues they raise are implemented or addressed, voice levels are at their highest. My findings also indicate that the right working conditions are associated with higher levels of teacher voice even among those educators who are inclined to leave their school. This finding suggests, and additional research is required to confirm, that promoting teacher voice can reduce unwanted turnover in schools. I conclude with thoughts on the future prospects of teacher voice. New technologies, social media, and other forms of connectivity are providing teachers with new opportunities to voice ideas amongst themselves and with supervisors and policymakers. Although it is too early to tell, there is reason to believe that these new voice pathways will serve as an effective medium for teachers to influence decisions and policies and expand the enabling context for teacher, and public, voice in education.

Paper 1: Missing at Random? An Analysis of the Effect of Sample Selection on Intergenerational Earnings Elasticities by Race Utilizing the Panel Study of Income Dynamics, I assess the effect of sample selection bias on estimates of intergenerational earnings elasticities for white and black father-son pairs, regressing log child earnings on log parent earnings. Estimating four increasingly less selected models, I assess the robustness of estimates to alternative methods of handling sons who are missing data due to periods of unemployment or part-time employment. The results indicate that the assumption of exogenous selection into full-time employment significantly biases the estimates for blacks, although it does not have a large impact on estimates for whites. As a consequence, selection bias will understate the magnitude of the black-white mobility gap. The results also indicate that two methods substantially mitigate this selection bias: having a long panel, or imputing data in a short panel. Paper 2: Measuring the Black-White Mobility Gap: A Comparison of Datasets and Methods Chapter 3 utilizes both the National Longitudinal Survey of Youth (NLSY) and the Panel Study of Income Dynamics (PSID) to analyze the magnitude and nature of black-white gaps in intergenerational earnings and income mobility in the United States. This chapter finds that relying on different datasets or measures will lead to different conclusions about the relative magnitudes of black versus white elasticities and correlations, but using directional mobility matrices consistently reveals a sizable mobility gap between black and white families, with low-income black families disproportionately trapped at the bottom of the income distribution and more advantaged black children more likely to lose that advantage in adulthood than similarly situated white children. I find the family income analyses to be most consistent and estimate the upward mobility gap as between 19.1 and 20.3 percentage points and the downward gap between -20.9 and -21.0. Additionally, I find that racial disparities are much greater among sons than daughters and that incarceration and being raised in a female-headed household have much larger impacts on the mobility prospects of blacks than whites. Paper 3: Can Parental Wealth Explain the Black-White Mobility Gap? Utilizing longitudinal data from the Panel Study of Income Dynamics (PSID), this chapter examines the relationship between parental wealth and intergenerational income mobility for black and white families. I find that total parental wealth promotes upward mobility for low-income white families, but does not protect against downward mobility for white families from the top half of the income distribution. Conversely, I find that total parental wealth does not assist low-income black families while home ownership may have negative associations with the likelihood of upward mobility for these families. However, for black families from the top half of the income distribution home equity is protective against downward mobility suggesting a heterogeneous relationship between home ownership and mobility for black families.

This study examines the engagement of the life insurance industry with the emerging field of public health during the Progressive era. By conducting research, promoting hygiene, and providing the services of visiting nurses, firms such as Metropolitan Life and the Prudential transferred their ideologies and methodologies into the wider medical arena. Thus, the collaborations conducted during this period had significant ramifications for the future shape of American public health, which drew methods of risk assessment and a statistical approach to medicine from the alliance. This dissertation asks why the partnerships occurred. Public health and life insurance are not automatic allies, and their cooperation took place in a wider context of economic growth, social upheaval, and changing attitudes toward the management of risk. The study notes the power of life insurance firms as cultural institutions, which derived their commercial success from their ability to harness the social preoccupations of the buying public; the most profitable companies had a history of adjusting their sales rhetoric to anticipate, match, and manipulate public perceptions about which risks were salient and what the best ways to manage them might be. The passage of social insurance legislation in Europe provided a powerful example to reformers, whose structural approach to social betterment favored poverty prevention and legislative change. To prevent such measures from becoming law in the United States, insurance firms engaged in a strategy of political capitalism that included activities promoting public health. By positioning themselves as guardians of the nation's physical vitality (and, by extension, its prosperity), they protected the dominance of the private sector, strongly influenced the nascent field of public health, and created a point of significant methodological transmission to the medical arena.

My goal in this dissertation is to examine whether the political ideology of the federal courts, as well as the ideology of political principals in Congress and the executive branch, affect the decision making and behavior of an independent U.S. agency. The agency's decision making pertains specifically to the application of its powers both directly through its politically appointed leadership and bureaucrats, and indirectly through a private litigation regime, in a policy area - civil enforcement - that should normatively be mostly free from politics. As a foundation for the study, I analyze the public civil enforcement program and related policy and procedural components of the United States Securities and Exchange Commission (SEC) to determine whether political ideology - and other factors - influence the agency's strategic decision making and behavior relating to its direct bureaucratic powers of civil prosecution. I generally focus the analysis on the SEC's selection of forum in enforcement cases. My research examines whether the agency is less likely to utilize the forum of federal court for civil enforcement actions, and will opt instead for an administrative forum, when the ideology of the court that will likely hear a case is conservative, and whether the agency is more likely to utilize the federal court system when the ideology of the court that will likely hear a case is liberal. My analysis supports a conclusion that although the characteristics of individual civil enforcement cases play a prominent role in the SEC's strategic decision making, the impact of political ideology is significant and comparable in magnitude. The data analysis reveals that the ideology of the lower federal courts at the district level is a material factor in the strategic decision making of the SEC in its enforcement program. It also shows that the politics of some of the agency's political principals -congressional committees responsible for the oversight and annual budget of the SEC - significantly affect the agency's strategic enforcement behavior. This element of my research extends a line of political science literature that analyzes who controls the federal bureaucracy. I then use a different research perspective to broaden my analysis of the SEC's enforcement behavior by examining its measured role in private securities litigation as a strategic extension of its public civil enforcement program, and explain how the agency carefully leverages the private regime to help achieve its enforcement mission. In this part of the dissertation, I conclude that the SEC actively and directly participates in the private enforcement regime through a strategic program of filing amicus curiae briefs, and participates indirectly through the fruits of its public civil enforcement litigation. This component of the dissertation rounds out my analysis by revealing an unexpected strategic dimension the agency leverages to achieve its mission.

At the heart of debates about the effects of globalization and the service economy on the welfare state is the notion of employment insecurity. It is considered a key causal mechanism through which cross-border movements of capital, goods and services (globalization) and employment shifts from manufacturing to services (deindustrialization) affect social policy. However, empirical research on such a causal linkage has been markedly lacking. In many cases, employment insecurity has been simply assumed to be the causal mechanism at work behind the observed relationship between economic globalization or deindustrialization and governments' commitment to social protection. This dissertation brings the hidden causal mechanism to the fore by using employment protection both as an explanatory and a dependent variable. Employment protection, which refers to regulatory frameworks that govern hiring and firing, has a direct bearing on workers' job security and can capture the politics of labor market risks. This dissertation consists of two projects. First, it examines how globalization and the service economy affect employment protection. Second, it analyzes how employment protection influences institutions of social protection. Focusing on the preferences and political strength of skilled workers, I argue that the effects of international trade and the service economy on employment protection depend on the relative scarcity of skilled labor and on the patterns of employment shifts between industries. I also contend that whether employment insecurity leads to expanded social protection depends on the social policy preference of skilled workers, which in turn, is shaped by the skill distribution in the economy and by pre-existing social protection institutions. This study finds that employment protection is both a political response to external and internal economic changes and a driving force for social policy change. Moreover, it highlights different causal processes for developed and developing economies. It offers statistical evidence based on two extensive cross-national time-series datasets of employment protection in the OECD and Latin America, and uses a case study of South Korea as qualitative evidence to elucidate the underlying dynamics of its quantitative findings.