Date of Award

Summer 2023

Degree Type

Restricted to Claremont Colleges Dissertation

Degree Name

Economics, PhD


School of Social Science, Politics, and Evaluation

Advisor/Supervisor/Committee Chair

Deborah Freund

Dissertation or Thesis Committee Member

Thomas Kniesner

Dissertation or Thesis Committee Member

Qidi Peng

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Terms of Use for work posted in Scholarship@Claremont.

Rights Information

© 2023 Chengcheng Zhang

Subject Categories



My dissertation consists of three chapters. They are entitled “How do demand-side incentives relate to insurance transitioning behavior of public health insurance enrollees?”, “The Impact of Medicaid Expansion on Coverage Among Those Lacking Housing Basics, 2010-19” and “Health Insurance Coverage Changes under Affordable Care Act among High Housing Cost Households, 2010-19”. My first chapter conducts factor importance analysis on the insurance transitioning behavior of the public health insurance enrollees in the U.S. by using the data from the Medical Expenditure Panel Survey. Unlike traditional ranking scores, we use a voting ensemble approach, with four compeDDve base learners: forward and backward stepwise subset selections, LASSO and random forest. The selected top five driving factors of insurance transitioning are number of physician office visits, family size, chronic condition, age and family income. A predictive model based on the top-ranked factors is provided and the model validation result shows that it is compeDDve to other mainstream prediction methods. My second chapter estimates the relationship between housing quality, as measured by having certain basic necessities, and the likelihood of having health insurance coverage. Inadequate housing conditions can lead to respiratory problems, injuries, mental health issues, and exposure to lead or mold, resulting in a significant financial burden for those with lowerincomes. While the Affordable Care Act (ACA) aims to increase healthcare coverage for low-income individuals, Medicaid is designed to protect them from healthcare costs, making it particularly important for those living in substandard housing. This study examines disparities in health insurance coverage among individuals with various levels of housing quality, excluding those who are experiencing homelessness. Low-income households that do not qualify for housing voucher assistance face trade-offs between stable housing and healthcare needs. In the third chapter, we examine how the ACA's Medicaid expansion has impacted health insurance coverage among individuals with different levels of rent burden, shedding light on the effectiveness of the ACA in improving access to healthcare for those with limited financial resources. Our study indicates that the ACA Medicaid expansion provides a unique channel for low-income households and those with high housing costs to gain access to health insurance, alleviating their financial burdens and reducing the negative impact of health shocks.