This dissertation continues the tradition of identifying the unintended consequences of the US health insurance system. Its main contribution is to estimate the size of the distortions caused by the employer-based system and regulations intended to fix it, while using methods that are more novel and appropriate than those of previous work. Chapter 1 examines the effect of state-level health insurance mandates, which are regulations intended to expand access to health insurance. It finds that these regulations have the unintended consequence of increasing insurance premiums, and that these regulations have been responsible for 9-23% of premium increases since 1996. The main contribution of the chapter is that its results are more general than previous work, since it considers many more years of data, and it studies the employer-based plans that cover most Americans rather than the much less common individual plans. Whereas Chapter 1 estimates the effect of the average mandate on premiums, Chapter 2 focuses on a specific mandate, one that requires insurers to cover prostate cancer screenings. The focus on a single mandate allows a broader and more careful analysis that demonstrates how health policies spill over to affect the labor market. I find that the mandate has a significant negative effect on the labor market outcomes of the very group it was intended to help. The mandate expands the treatments health insurance covers for men over age 50, but by doing so it makes them more expensive to insure and employ. Employers respond to this added expense by lowering wages and hiring fewer men over age 50. According to the theoretical model put forward in the chapter, this suggests the mandate reduces total welfare. Chapter 3 shows that the employer-based health insurance system has deterred entrepreneurship. It takes advantage of the natural experiment provided by the Affordable Care Act's dependent coverage mandate, which de-linked insurance from employment for many 19-25 year olds. Difference-in-difference estimates show that the mandate increased self-employment among the treated group by 13-24%. Instrumental variables estimates show that those who actually received parental health insurance as a result of the mandate were drastically more likely to start their own business. This suggest that concerns over health insurance are a major barrier to entrepreneurship in the United States. / Economics

The road to energy-efficient housing is not without cracks and potholes. Many building stakeholders have pointed to the discrepancies that exist between simulated and measured efficiency results, where some have called it a post-occupancy gap, others have called it an energy efficiency information gap. The research presented in this thesis addresses that gap by detailing the results of two exploratory case studies of affordable housing projects in Virginia across three manuscripts. The data utilized in the first manuscript includes measured data collected at the second level through the NEXI energy monitoring and feedback device, wherein we used descriptive statistics to investigate the impact of temperature on energy use over different timeframes. We had anticipated our findings may not all be consistent with previously existing studies. We found this to be true in many cases, but we also discovered interesting contradictions to our assumptions. This study thereby investigates the gap in energy performance within net-zero buildings and contributes to the existing body of literature by presenting the findings of this unique study. The data utilized in Manuscript 2 and Manuscript 3 was utility data, which was reported as end-of-use monthly consumption values. We were able to investigate the impact of 3 different HVAC systems energy use by evaluating the energy and cost performance before and after the installation of newer, more efficient systems. We found that although all systems were performing below anticipated standards, the one-stage system outperformed in terms of efficiency, and the second-stage system outperformed in terms of cost. The findings in these studies emphasize the importance of energy education for residents to achieve greater efficiency gains. / Master of Science / Humans are complex beings; hence the buildings they inhabit are complex systems. While breakthroughs in simulating, designing, and constructing high-performance buildings as well as advanced energy use technologies have been promising, many have fallen short of their ambitious goals primarily due to the complexity of building occupant behavior. Achieving energy efficiency requires thorough research before design and construction, the use of advanced technologies, and the incorporation of behavior-driven energy use dynamics. Furthermore, with the breadth of literature to support the delivery of individualized energy information in real-time to residents comes the opportunity to investigate further the impact of advanced technologies in high performing buildings that have fallen short of their optimistic design goals. This thesis consists of three manuscripts, which describe two exploratory case studies of high-performance residential homes in Virginia's affordable housing sector. The first manuscript, a journal paper, investigates the individual HVAC energy use of six senior residents, wherein we explore the interplay between temperature, energy use, and age across different timeframes. We find that, across different timeframes, energy use for senior citizens remains relatively consistent in high-performance homes. The second and third manuscripts are conference papers, which have been presented on and published in the respective conference proceedings. We quantitively investigated the energy performance of energy-efficient HVAC systems and compared predicted results and measured results. In conclusion, we hope to contribute to the body of literature, which investigates shortcomings in achieving energy-efficiency within high-performance homes.

Many developing countries are undergoing rapid urbanization which often outpaces affordable housing development, aggravating housing shortages. To address this, some governments initiate affordable housing schemes, aiming to provide low-income households with access to affordable housing. This thesis examines the impact of government affordable housing schemes on housing affordability in Rwanda, focusing on their distributional impact and their targeted households. Using a mixed-methods approach, this study analyses data from the fifth Integrated Living Conditions Survey (EICV5) to investigate income distribution, housing expenditure patterns, and expenditure-to-income ratios across different population segments and geographical regions. Complemented by a review of government policies and institutional frameworks, the study contextualises its findings within consumer theory, New Institutional Economics (NIE), and Housing Supply Value Chain frameworks. The analysis reveals significant disparities in income and expenditure-to-income ratios (EIR) among households across different deciles and geographical regions. These variations are shaped by factors such as household economic capacity, institutional frameworks, housing supply value chain, and regional population density. The study emphasizes the importance of strict eligibility criteria for beneficiaries of affordable housing units set by the government of Rwanda to maintain long-term affordability and prevent speculation in government-supported projects. However, variations in target beneficiaries, income requirements, and housing costs across the ongoing affordable housing projects highlight the complexity of defining and implementing affordable housing in Rwanda. Some projects target displaced households, while others target higher-income brackets, challenging the local definition of affordable housing. This master’s thesis sheds light on the distributional impact of government affordable housing schemes in Rwanda, highlighting the challenges and opportunities in ensuring housing affordability for low-income households amidst rapid urbanization and evolving housing dynamics.

Managed care plans purport to improve the health of their members with chronic diseases. How has the growing adoption of Medicare Advantage (MA), the managed care program for Medicare beneficiaries, affected the progression of chronic disease? The literature is rich with articles focusing on managed care organizations' impacts on quality of care, access, patient satisfaction, and costs. However, few studies have analyzed these impacts with respect to market penetration of Medicare managed care. The objective of this research has been to analyze the relationships between the market penetration of MA plans and the progression of chronic diseases among Medicare beneficiaries. The Chronic Disease Severity Index scale (CDSI) was constructed to represent beneficiaries' overall chronic disease states for survey or claims-based data, when more direct clinical measures of disease progression are not available. Using the CDSI on the MEPS survey dataset from AHRQ, we sought to assess the impacts of MA market penetration and other covariates on the overall chronic disease state of Medicare beneficiaries from 2004 through 2008. Though the model explains much of the variation in CDSI change, the author expected the multilevel model would show that MA penetration explains a significant level of variation in CDSI change. However, this hypothesis was not substantiated, and the findings suggest that unmeasured factors may be contributing to additional unexplained heterogeneity. Policymakers should explore opportunities to refine the current MA program. The MA program costs the federal government more than the Traditional Fee-for-Service Medicare program, and there is no definitive evidence that outcomes differ. Within both programs, there is opportunity to experiment with different models of payment, healthcare service delivery and care coordination. The Patient Protection and Affordable Care Act (ACA) contains provisions for innovative demonstration projects in delivery and payment. The effectiveness of these ACA initiatives must be monitored, both for impacts on health outcomes and for economic effects. This research can inform future approaches to outcomes assessment using the CDSI, and multilevel modeling methodologies similar to those employed here. Firms offering MA health plans would be prudent to proactively demonstrate their value to beneficiaries and taxpayers. They should explore means of better monitoring and reporting the longitudinal outcomes of their enrolled beneficiaries. Demonstrating that they can bring value in terms of improved health outcomes will help insure their long-term survival, both in the marketplace and in the political arena. / Graduation date: 2012

What is lobbying, properly understood, in the United States, and what strategies and tactics—including and especially those determined by contextual factors, as well as firm characteristics—are commonly employed by corporate lobbies as they operate in our American political environments? Considering this, what are the main strategies and tactics employed by the pharmaceutical lobby, with a particular focus on the Pharmaceutical Manufacturers and Researchers of America, or PhRMA? Finally, what roles did PhRMA play in the development and passage of the Obama administration’s Affordable Care Act, and what can this tell us about the lobbying strategies and tactics utilized by one of the most effective lobbies in modern times, as well as about how their strategies and tactics align, or not, with conventional conceptions of lobbying? Through effective use of key lobbying tactics such as direct lobbying and use of public awareness, PhRMA completed one of the more successful lobbying campaigns in recent history. When the White House came calling, they were first to the table, for they knew that with that seat came a position of leverage. From there, they were able to build both political and public support to complete a deal with the Obama administration that they positioned as necessary to keep the Affordable Care Act alive. This deal would ensure that the pharmaceutical industry would pay a flat rate of support for the act, and was therefore guaranteed protection from future government attempts to set or regulate the prices of their products and medicines. PhRMA played the long game, and they played it well.

La notion de chez-soi est porteuse d’un imaginaire foisonnant et génère un grand intérêt dans notre culture et société. Bien qu’elle soit une considération importante pour la plupart d’entre nous, l’architecte occupe une position privilégiée qui lui permette d’agir sur le chez-soi de manière significative et tangible. La présente recherche explore le concept du chez-soi tel qu’étudié par les architectes et non-architectes de manière à comprendre son impact sur la création du lieu et sur la construction des environnements domestiques en Amérique du nord. Un regard porté sur les connotations entre espace et lieu, à travers la temporalité, les comportements et les perspectives sociales, supporte l’épistémologie du chez-soi comme un élément important des théories et pratiques de design contemporain. Le démantèlement hypothétique d’un espace en ses composantes suppose que les dispositifs architecturaux peuvent être modelés de manière à ce qu’ils opèrent un transfert depuis la maison, en tant qu’élément physique, vers le domaine psychologique du chez-soi. Afin d’élargir la maniabilité des éléments constitutifs du bâtiment et de son environnement, six thèmes sont appliqués à trois champs de données. Les six thèmes, qui incluent l’entre-deux, la limite, la voie, le nœud, le détail et la représentation, illustrent des moments architecturaux déterminants, potentiellement présents à l’intérieur et à l’extérieur du projet domestique et qui transforment les comportements physiques et psychiques. Depuis la pratique normalisée du logement social et abordable au Canada, une analyse de photographies de maisons abordables existantes, du discours critique sur cette typologie et de projets de recherche-création conduits par des étudiants en architecture, révèle le caractère opérationnel de la notion de chez-soi et consolide les valeurs de communauté et de frontière. L’objectif premier de la recherche est d’avancer la production de connaissances en architecture par l’exploration de la notion de chez­soi dans l’enseignement, la recherche et le design. L’approche fonctionnaliste vis-à-vis le < penser > en design, place l’usager au centre de l’environnement domestique, soutient la proposition que le chez­soi donne sens et utilité au logement, et renforce la responsabilité éthique de l’architecte à faire de cette notion une partie intégrante de la réalité quotidienne. / The notion of home is a powerful generator of ideas and imagination in our culture and society. Few can have as significant an impact on the idea of home as an architect. This research thesis explores the concept of home as studied by architects and non-architects alike, in order to further understand its impact on placemaking and the construction of North American domestic environments. A look at the connotations of space and place, from temporal, behavioural, and social perspectives, further establishes the epistemology of home as an impactful element of contemporary design theory and practice. The hypothetical breaking down of space into its component pieces drives the supposition that architectural devices can be manipulated to shift a physical house into the psychological realm of a home. Unpacking the maneuverability of the various parts of a building and its surroundings, six themes are applied to three fields of data. The six themes ̶ In-Between, Border, Pathway, Node, Details, and Representation ̶ exemplify key architectural moments, potentially occurring within the domestic project, that alter corporal and mental behaviour. Within the constrained disciplines of social and affordable housing in Canada, a tripartite examination of photographs of existing low-cost homes, critical writing on this typology, and student-generated research-creation projects, elicits an operational notion of home, and reinforces the value of community and boundary. The intent of this project is to advance knowledge in architecture by exploring the topic of home within teaching, research, and design. This functional approach to thinking about design places the user at the heart of the domestic environment and emphasizes the belief that home gives meaning and purpose, while reinforcing the ethical responsibility of the architect to make this an everyday reality.

. Latin@ immigrants face many obstacles to affordable healthcare that push them to disproportionately rely on the primary safety-net for their healthcare needs. This system is mostly funded with public monies that will be significantly reduced when Affordable Care Act is fully implemented. Since undocumented Latin@ immigrants are prohibited from accessing federally funded healthcare, they will be left out of the health care reform. This thesis examines two community-based clinics in the Greater New Orleans area that serve this population, and have developed linguistically and culturally appropriate programs that address its needs. The New Orleans Faith Health Alliance and Common-Ground Health Clinic are cases used to explore the impact that the Affordable Care Act will have in the already unstable safety-net in New Orleans. Through the analysis of other models around the nation, this thesis presents viable recommendations to both clinics and the City of New Orleans Health Department.

Inserindo-se nos debates sobre pobreza e cidade no Brasil, a pesquisa aborda os nexos entre deslocamentos habitacionais, mobilidades socioespaciais, dinâmicas familiares e políticas urbanas nos processos recentes de produção do espaço urbano. A tese parte do argumento de que, em um contexto de reconfiguração do mundo social e ressignificação das categorias fundadoras dos territórios periféricos, em curso no país nas últimas décadas, também o espaço urbano se reconfigura: nesse sentido, direciona-se a refletir, de modo articulado, sobre as dimensões sociais e territoriais dessas mudanças e permanências. Tomando como base a realização de uma pesquisa de campo de caráter etnográfico na cidade de São Carlos - SP, são investigadas trajetórias urbanas de moradores de periferias que, nas últimas décadas, transitaram pela cidade em busca de moradia, bem como os cruzamentos, tangenciamentos ou desencontros com as políticas urbanas e habitacionais empreendidas nesse mesmo período. Tais trajetórias são encaradas como uma entrada privilegiada para o estudo das dinâmicas socioespaciais envolvidas em processos situados de produção, apropriação e significação das periferias urbanas, ao permitir apreender tais processos nas injunções entre espaço e sociedade. A tese delineia uma cartografia espaço-temporal de territorialidades e experiências urbanas ditas marginais ou periféricas, revelando cidades outras: cidades feitas de desenraizamentos, vulnerabilidades e ajustes, mas também de relações, simbolizações e projetos, cuja multiplicidade de dimensões históricas, concepções em ato ou devires possíveis somente se dão a apreender a partir das práticas e narrativas dos sujeitos. Estabelece, assim, um diálogo sobre as dobras que configuram, simultaneamente, territórios, subjetividades e sensibilidades; percursos, narrativas e espaços; pobreza, experiência urbana e cidades; produção de conhecimento e produção do espaço. / Being inserted in debates about poverty and cities in Brazil, the research deals with the links among housing displacements, socio-spatial mobility, family dynamics and urban policies in recent processes of urban space production. The dissertation starts from the argument that, in the context of reconfiguration of the social world and re-signification of the founding categories of surrounding territories, in progress in the country in recent decades, the urban space is also reconfigured: in this sense, it is directed to reflect, in an articulated way, about social and territorial dimensions of these changes and continuities. Based on the completion of an ethnographic field research in the city of São Carlos - SP, it investigates urban trajectories of residents of surrounding areas who, over the last decades, passed through the city in search of housing, as well as the crossings, tangents or divergences with the urban and housing policies undertaken during the same period. Such trajectories are faced as a prime input for the study of socio-spatial dynamics involved in situated processes of production, appropriation and significance of urban surrounding areas, while allowing for apprehending such processes in the injunctions between space and society. The dissertation outlines a spatio-temporal cartography of urban territorialities and experiences considered marginal or peripheral, revealing other cities: cities made out of uprooting, vulnerabilities and adjustments, but also of relationships, symbolizations and projects, whose multiplicity of historical dimensions, conceptions in act or possible future ones, take place just to be apprehended as from the practices and narratives of the subjects. A dialogue is thus established on the folds that simultaneously shape territories, subjectivities and sensibilities; pathways, narratives and spaces; poverty, urban experience and cities; production of knowledge and production of space.

Como mudam os instrumentos de política pública? A pergunta que intitula este trabalho pode ser respondida através de uma característica principal: gradualismo. Parte dos modelos explicativos que visam compreender transformações em políticas públicas partem de uma análise de fatores e processos exógenos. Estas abordagens constantemente privilegiam a ótica de um dos atores que participam do jogo da distribuição de recursos da política, sejam estes o governo, a sociedade civil, os capitais, ou quaisquer outros atores imersos nestas disputas. Ainda que o olhar para as atuações dos atores seja fundamental, há dois riscos intrínsecos a esta estratégia, são eles: a formação de um viés explicativo de acordo com as premissas dos atores onde se estabelece o enfoque analítico e o abandono dos fatores e processos causais que ocorrem de forma endógena à política. Este trabalho visa oferecer um enfoque analítico que se dá por dentro da política pública, através da análise dos seus instrumentos. Em paralelo à formação de conjunturas críticas externas abruptas, que fogem ao controle dos atores imersos ao jogo, há um processo gradual de mudanças que só é possível captar através deste tipo de abordagem. A análise do instrumento das Operações Urbanas em São Paulo permite compreender como estas alterações internas ocorrem de maneira paulatina e gradual através de um processo de layering - ao passo que conjunturas mais abruptas acontecem de maneira exógena ao instrumento. A combinação destes processos é o que viabiliza transformações mais amplas no instrumento, que são, por fim, institucionalizadas. / How does a public policy instrument change? The question that entitles this dissertation may be answered through a mains characteristic: gradualism. Some of the explanatory models which aim to understand transformations in public policies choose the analysis of external factors and processes. These frameworks constantly privilege the focus on one of the actors whose are embedded on the distributional policy game, being them the government, civil society, private companies or any other actors. Even if the look at these actors remains important, there are two intrinsic risks in this strategy: the existence of an explanatory bias, according to the specific premises of the actors chosen as the analytical focuses and the neglect of the causal factors and processes that happen inside the policy. This or offers an analytical emphasis that occurs endogenously to the policy, through the analysis of its instruments. Simultaneously to the formation of external abrupt critical junctures, there is a gradual changing process which is only able to comprehend through this endogenous look into the policy and its instruments. The analysis of the Urban Operations instrument in São Paulo aims to explicit how this changes happens in a gradual way through a layering process whereas critical junctures emerge in the external environment. The combination of these to processes is what enable broader transformations in the policy instrument, which are ultimately, institutionalized.

Inserindo-se nos debates sobre pobreza e cidade no Brasil, a pesquisa aborda os nexos entre deslocamentos habitacionais, mobilidades socioespaciais, dinâmicas familiares e políticas urbanas nos processos recentes de produção do espaço urbano. A tese parte do argumento de que, em um contexto de reconfiguração do mundo social e ressignificação das categorias fundadoras dos territórios periféricos, em curso no país nas últimas décadas, também o espaço urbano se reconfigura: nesse sentido, direciona-se a refletir, de modo articulado, sobre as dimensões sociais e territoriais dessas mudanças e permanências. Tomando como base a realização de uma pesquisa de campo de caráter etnográfico na cidade de São Carlos - SP, são investigadas trajetórias urbanas de moradores de periferias que, nas últimas décadas, transitaram pela cidade em busca de moradia, bem como os cruzamentos, tangenciamentos ou desencontros com as políticas urbanas e habitacionais empreendidas nesse mesmo período. Tais trajetórias são encaradas como uma entrada privilegiada para o estudo das dinâmicas socioespaciais envolvidas em processos situados de produção, apropriação e significação das periferias urbanas, ao permitir apreender tais processos nas injunções entre espaço e sociedade. A tese delineia uma cartografia espaço-temporal de territorialidades e experiências urbanas ditas marginais ou periféricas, revelando cidades outras: cidades feitas de desenraizamentos, vulnerabilidades e ajustes, mas também de relações, simbolizações e projetos, cuja multiplicidade de dimensões históricas, concepções em ato ou devires possíveis somente se dão a apreender a partir das práticas e narrativas dos sujeitos. Estabelece, assim, um diálogo sobre as dobras que configuram, simultaneamente, territórios, subjetividades e sensibilidades; percursos, narrativas e espaços; pobreza, experiência urbana e cidades; produção de conhecimento e produção do espaço. / Being inserted in debates about poverty and cities in Brazil, the research deals with the links among housing displacements, socio-spatial mobility, family dynamics and urban policies in recent processes of urban space production. The dissertation starts from the argument that, in the context of reconfiguration of the social world and re-signification of the founding categories of surrounding territories, in progress in the country in recent decades, the urban space is also reconfigured: in this sense, it is directed to reflect, in an articulated way, about social and territorial dimensions of these changes and continuities. Based on the completion of an ethnographic field research in the city of São Carlos - SP, it investigates urban trajectories of residents of surrounding areas who, over the last decades, passed through the city in search of housing, as well as the crossings, tangents or divergences with the urban and housing policies undertaken during the same period. Such trajectories are faced as a prime input for the study of socio-spatial dynamics involved in situated processes of production, appropriation and significance of urban surrounding areas, while allowing for apprehending such processes in the injunctions between space and society. The dissertation outlines a spatio-temporal cartography of urban territorialities and experiences considered marginal or peripheral, revealing other cities: cities made out of uprooting, vulnerabilities and adjustments, but also of relationships, symbolizations and projects, whose multiplicity of historical dimensions, conceptions in act or possible future ones, take place just to be apprehended as from the practices and narratives of the subjects. A dialogue is thus established on the folds that simultaneously shape territories, subjectivities and sensibilities; pathways, narratives and spaces; poverty, urban experience and cities; production of knowledge and production of space.