The purpose of this thesis is to examine the Affordable Care Act through an analysis of the United States Supreme Court's holding in The National Federation of Independent Business v. Sebelius. In order to better understand the Supreme Court's reasoning in that case, this paper will first examine the history and the function of the Supreme Court, which will demonstrate the Court's power to either augment or diminish the power of the states in relation to the federal government. This paper will then discuss the background of the Affordable Care Act, the procedural history of the case, and the majority's analysis supporting its decision. The concurring and dissenting opinions of the other justices will be discussed to present the various viewpoints regarding the proper role of the federal government and the implications this case may have on federal/state conflict. The Supreme Court ruled in favor of the Department of Health and Human Services. The 5-4 decision was extremely close and the opinions given by each Justice highlighted the various flaws and benefits of the Act it was looking to uphold. Further research of Supreme Court cases in our country's history reveal the trend of augmenting and diminishing state's rights. This thesis will examine the constitutionality of the aforementioned decision, the effects it will have on each of the states within the United States, and the impact the citizens will experience.

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This dissertation studies the impact of Medicaid expansion on the liability insurance industry. Within the three chapters, the first two chapters focus on the medical liability insurance industry, and the third chapter focuses on the auto insurance industry. Chapter 1, “Medicaid Expansion and Medical Liability Costs”, examines the impact of health insurance expansion on medical liability costs using the case of the Affordable Care Act’s (ACA) Medicaid expansion. Medicaid expansion has increased the demand for medical services, but in doing so it may also have increased physicians’ liability in medical practice. By studying malpractice costs to insurers, medical practitioners, and hospitals in the U.S. for the period 2010–2018, we find insurers operating in states with Medicaid expansion experienced significantly higher medical liability costs than those in non-expansion states. While insurers in expansion states did increase premiums, the increase was not enough to fully offset rising costs. Moreover, we find that tort reforms did not mitigate ACA-induced malpractice liability costs. We show this is because Medicaid expansion increased malpractice costs mainly by increasing claim frequency while tort reforms generally focus on reducing claim severity. We further find little evidence that hospitals paid higher malpractice insurance premiums, self-insurance, or incurred higher out-of-pocket medical liability losses after Medicaid expansion. Taken together, our results imply that it is medical practitioners and malpractice insurers who bear the rising medical liability costs. Chapter 2, “Medicaid Expansion and Medical Liability Insurance Prices” extends the first chapter to study the impact of Medicaid expansion on medical liability insurance prices for three specialties, internal medicine, general surgery, and obstetrics-gynecology (OB-GYN). As Medicaid expansion increased medical liability costs to insurers, they may react by increasing medical malpractice insurance prices. By studying counties in expansion states and non-expansion states and bordering counties with different Medicaid expansion status over the years from 2010-2018, we find that Medicaid expansion leads to significantly higher medical liability insurance prices two years after the expansion on average and the impact is strongest for internal medicine and general medicine but less so for OB-GYN. Our finding suggests that the expansion of health insurance could increase liability costs to medical practitioners. Auto insurance provides coverage of healthcare for injured drivers even for those without traditional health insurance coverage. The expansion of public health insurance provides low-income injured drivers with an additional source of coverage for medical bills. This may change drivers’ incentives for using auto insurance and the ultimate payments made by auto insurers. In Chapter 3, “Public Health Insurance Expansion and Auto Insurance: The Case of Medicaid Expansion”, we first use a simple theoretical model to illustrate how obtaining public health insurance mitigates the incentive of insured drivers to engage in claims buildup. We then empirically test how the Affordable Care Act (ACA)’s Medicaid expansion changed the medical costs covered by auto insurance. By studying private passenger auto insurers in expansion states and non-expansion states between 2010 and 2018, we find that Medicaid expansion led to significantly lower auto insurance losses and premiums. We further show that the results were driven by the decreasing losses and premiums for third-party liability insurers but not in the states with no-fault insurance. / Business Administration/Risk Management and Insurance

With starting point in current housing policy debates in Sweden, where the deregulated rental market in Finland is used as an example of a better functioning housing market, this thesis aims to investigate if this image is shared by the Finnish experts in rental housing related questions. Based on eight semi-structured interviews, the precarious living conditions on the Finnish rental housing market are revealed and discussed in relation to the theoretical framework of housing inequality. Finland’s market liberal approach to housing provision has created good conditions for investing in housing that is reflected on the supply of rental housing on the private sector. Rental apartments on this sector are small, referred to as ‘tube studios’ and ‘suicide studios’, unaffordable for many, and the legal framework provides little security for the tenants causing uncertainty about the future. Furthermore, a number of reforms are currently being carried out to decrease state support in providing affordable housing and access to social housing, referred to as ARA-housing, is to be limited for the worst-off population. In light of these results this thesis aims to provide an alternative image to the market dominated discourse and argues that behind the numbers of constructed units and vacancy rates, a wide range of precarious housing conditions exist. This precarity affects first and foremost residents on private sector and is expected to become a bigger issue and impact a greater number of people in the future when the political reforms currently under way are rolled out.

The Department of Housing and Urban Development is the primary public agency responsible for providing housing subsidies to low-income households. The Home Choice Voucher Program (HCVP) is currently the most significant housing subsidy. The voucher can be transferred to any location where the landlord is registered with the local housing agency to participate in the program. The mobility of the voucher is designed to decrease concentrations of low-income households in areas that lack economic, educational, and social opportunities. The results of the study found that race and income have a strong negative impact on the percentage of subsidized households and rental units. The findings also show that median area rents have a negative impact on subsidized households, while home values have a negative impact on subsidized rental units. There are more subsidized households and rental units in highly populated with many households living in areas with more transit stops. finally, the data showed that jobs paying under $3,333 per month had a negative impact on the percentage of subsidized housing units. These outcomes can provide insight for HUD and public housing agencies to assist in the utilization of subsidies and encourage more landlord participation to add units to the current housing supply. The geographical selection of subsidized households and units can help promote better housing options for voucher recipients.

This dissertation analyzes contemporary transformations in urban policy and space production in Brazil; in particular, those associated with state efforts to attract the private sector to participate in the design, finance, development and long-term management of infrastructure and housing provision systems. While the study's focus is on adoption of the public-private partnership (PPP) mechanism in the affordable housing sector, empirical research is based on the case study analysis of Casa Paulista Program, the first PPP for affordable housing delivery in the country, sponsored by the State Government of São Paulo and implemented in the central districts of the city of São Paulo, the state's capital. Specific questions driving the research are twofold: in the first, I ask what were the characteristics of the Casa Paulista PPP model, and in the second, how public and private agents, including social groups, affected the evolution of the model. Permeating this analysis is the concern as to how housing provision through PPPs may affect the ability of local populations to access adequate housing and fully participate in city living, as demanded by social housing movements and urban reform advocates and predicted in Brazil's Federal Constitution, and rights-based urban policy at national and local levels. Findings indicate that the Casa Paulista model, while neither leveraging private capital nor scaling up housing production, facilitates rearrangements in the private local housing market, urban policy, and social relationships around housing provision. These efforts are successful only with support of the development and finance industries operating beyond the local scale. I argue that these new rearrangements support a publicly funded, privately managed model to support predominantly residential real estate development projects of large scale and which are debt financed through long term agreements. This dynamic generates risk to society's ability to control urban transformation in the central city area and support preservation of a stock of public and private land where affordable housing development is currently prioritized, an outcome I describe as 'privatizing planning and socializing risk'. / PHD / This dissertation analyzes contemporary transformations in urban policy and space production in Brazil. While the study’s focus is on adoption of the public-private partnership (PPP) mechanism in the affordable housing sector, empirical research is based on the case study analysis of Casa Paulista Program, the first PPP for affordable housing delivery in the country, sponsored by the State Government of São Paulo and implemented in the central districts of the city of São Paulo, the state’s capital. Specific questions driving the research are twofold: in the first, I ask what were the characteristics of the Casa Paulista PPP model, and in the second, how public and private agents, including social groups, affected the evolution of the Casa Paulista model. Findings indicate that the model, while neither leveraging private capital nor substantially increasing housing production, facilitates rearrangements in the private local housing market, urban policy, and social relationships around housing provision. I argue that these new rearrangements support a publicly funded, privately managed model to support predominantly residential real estate development projects of large scale and financed through long term debt agreements. This dynamic generates risk to society’s ability to control urban transformation in the central city area and support preservation of a stock of public and private land where affordable housing development is currently prioritized.