UCLA Luskin Public Policy Professor Wesley Yin spoke to the Los Angeles Times about a proposal by the L.A. County Board of Supervisors to purchase and forgive more than $2 billion in medical debt owed by constituents. A growing number of local and state governments have launched similar efforts to purchase such debt at a steep discount, relieving patients and their families of a heavy burden. Yin, who has researched the impact of these programs, said they are particularly beneficial if they erase debt early on, when patients are still working to pay it off. If L.A. County focuses on purchasing the cheapest debt, the kind of years-old medical bills that most people have long forgotten about, “it might not impact people’s financial situations that much anymore,” he said. In addition to debt forgiveness programs, solutions such as hospital financial assistance programs and health insurance expansions would help ensure that bills are paid more quickly, Yin said.
Wesley “Wes” Yin is a Professor of Economics at the UCLA Luskin School of Public Affairs, and the Anderson School of Management. He is also a Research Associate at the National Bureau of Economic Research, and a Faculty Affiliate at the Jameel Poverty Action Lab at MIT. He is currently on leave during the 2023-2024 year, serving as Chief Economist of the White House Office of Management and Budget.
Yin’s research focuses on health care, consumer finance, and economic inequality. His recent work studies competition and market power in health care, and the links between health care financing and consumer financial health and well-being.
His work has been published in leading economics and policy outlets such as the Quarterly Journal of Economics, the American Economic Review, the Review of Economics and Statistics, JAMA, Health Affairs, and the Hamilton Project at the Brookings Institution, and has been featured in or he has written for media outlets such as the New York Times, Washington Post, New Yorker, Vox, and others.
From 2012 to 2014, Yin served in the Obama Administration as Acting Chief Economist and Deputy Assistant Secretary for Microeconomic Policy at the U.S. Department of the Treasury, and in the White House Council of Economic Advisers, advancing policing on health care quality, insurance affordability, higher education finance, and housing market stability. Since 2014, Yin has advised the state of California on health care reforms, including the design of state subsidies for marketplace insurance.
Previously, he was an assistant professor at the University of Chicago and Boston University, and a Robert Wood Johnson Scholar in Health Policy at Harvard University. He received his PhD in economics from Princeton University.
The Impact of Financial Assistance Programs on Health Care Utilization. 2022. (with Alyce Adams, Ray Kluender, Neale Mahoney, Jinglin Wang, and Francis Wong). Forthcoming at American Economic Review: Insights.
Personalized Telephone Outreach Increased Health Insurance Take-Up for Hard-to Reach Populations. 2022. (w/ Rebecca Myerson, Nicholas Tilipman, Andrew Fehrer, Honglin Li, and Isaac Menashe) Health Affairs 41(1): 129–137.
Medical Debt in the United States, 2009-2020. 2021. (with Ray Kluender, Neale Mahoney and Francis Wong) Journal of the American Medical Association 326(3). Media Coverage: NY Times, Washington Post, Vox, Marketwatch, CBS Evening News, Marketplace. JAMA editorial.
The Role of Behavioral Frictions in Health Insurance Marketplace Enrollment and Risk: Evidence from a Field Experiment. 2021. (with Richard Domurat and Isaac Menashe) American Economic Review 111(5): 1549–1574. [Online Appendix] Media Coverage: Tradeoffs Podcast
The Market for High-Quality Medicine: Retail Chain Entry and Drug Quality in India. 2019. (with Daniel Bennett) Review of Economics and Statistics 101(1) p.76-90 [Appendix]
Insurers’ Negotiating Leverage and the External Effect of Medicare Part D. 2015. (with Darius Lakdawalla), Review of Economics and Statistics 97:2 p.314-331 (an earlier version appears as NBER working paper no. 16251). Media coverage: New Yorker
R&D Policy, Agency Costs and Innovation in Personalized Medicine. 2009. Journal of Health Economics 28(5): 950-962.
Market Incentives and Pharmaceutical Innovation. 2008. Journal of Health Economics 27(4):1060-1077.
Female Empowerment: Impact of a Commitment Savings Product in the Philippines. 2010. (with Nava Ashraf and Dean Karlan) World Development 38(3): 333-344.
The Effect of the Medicare Part D Prescription Benefit on Drug Utilization and Expenditures (with Anirban Basu, James Zhang, Atonu Rabbani, David Meltzer, Caleb Alexander) Lead article at Annals of Internal Medicine 148(3): 169-177. Annals’ Summary for Patients.
Designing Targeting Schemes with Poverty Maps: Does Disaggregation Help?. 2007. (with Berk Özler, Chris Elbers, Tomoki Fujii, Peter Lanjouw) Journal of Development Economics 83(1).
Tying Odysseus to the Mast: Evidence from a Commitment Savings Product in the Philippines. 2006. (with Nava Ashraf and Dean Karlan) Quarterly Journal of Economics 121(2). Winner of TIAA-CREF 2006 Certificate of Excellence.
Deposit Collectors (with Nava Ashraf and Dean Karlan). 2006. Advances in Economic Analysis & Policy 6(2), Article 5.
Provider Market Power and Adverse Selection in Health Insurance Markets (with Nicholas Tilipman)
The Burden of Medical Debt and the Impact of Debt Forgiveness (with Ray Kluender, Neale Mahoney and Francis Wong). J-PAL Summary. AEA Pre-registration 1 (Old Debt). AEA Pre-registration 2 (Young Debt).
Trends in Medical Debt During the COVID Pandemic (with Raymond Kluender, Benedict Guttman-Kenney, Neale Mahoney, Francis Wong, and Xuyang Xia)
Other Publications and Policy Articles
“Trends in Medical Debt During the COVID-19 Pandemic” (with Benedict Guttman-Kenney, Raymond Kluender, Neale Mahoney, Francis Wong, and Xuyang Xia) JAMA Health Forum. 2022, 3(5), 2022.
“Options To Improve Affordability In California’s Individual Health Insurance Market,” (with Peter Lee, Katie Ravel and Nicholas Tilipman), a Covered California report for Gov. Newsom, California State Senate and State Assembly pursuant to AB1810, February, 2019
“How retail drug markets in poor countries develop” (with Dan Bennett) VoxDev.org, August, 13th, 2018.
“Potential Impacts of Graham-Cassidy-Heller-Johnson on Californians and the Individual Health Insurance Market” (with John Bertko) Covered California Report, September 25, 2017
“Evaluating the Potential Consequences of Terminating Direct Federal Cost-Sharing Reduction (CSR) Funding” (with Richard Domurat) Covered California Report, January 26, 2017 [Appendix]
“Trump’s “populist” economic proposals come with massive catches. Here’s what to watch for.” Vox, November 18, 2016
Strengthening Risk Protection through Private Long-Term Care Insurance. Brookings Institution, Hamilton Project Discussion Paper 2015-06, June 2015. Policy Brief.
Value of Survival Gains in Chronic Myeloid Leukemia (with John Penrod, J. Ross Maclean, Darius Lakdawalla and Tomas Philipson) American Journal of Managed Care 2012 Nov;18(11 Suppl):S257-64
The impact of Medicare Part D on Medicare-Medicaid Dual-eligible Beneficiaries’ Prescription Utilization and Expenditures (with Caleb Alexander and Anirban Basu), Health Services Research, February 2010, 45(1), pp. 133-151
Valuing health technologies at NICE: Recommendations for Improved Incorporation of Treatment Value in HTA (with Dana Goldman, Darius Lakdawalla and Tomas Philipson) Health Economics October 2010, 10(11) pp. 1109-1116
Solutions and Challenges to Curing Global Health Inequality Innovations 2(4), October 2007, 2(4), pp. 72-80
Testing Savings Product Innovations Using an Experimental Methodology (with Nava Ashraf and Dean Karlan), Asian Development Bank, Economics and Research Department Technical Paper No. 8. November, 2003
A Review of Commitment Savings Products in Developing Countries (with Nava Ashraf, Nathalie Gons, Dean Karlan) ERD Working Paper, July 2003.
Public Finance and the Economics of Inequality (Econ 415)
Health Care Finance and Management (MBA and MPP elective) (MGMT298 & PP290)
Econometrics for Policy Analysis (MPP Core) (PP208)
Applied Policy Project (APP) Capstone Advisor (PP298A-D)
Wesley Yin, associate professor of public policy at UCLA Luskin, spoke to LAist about the burdens of medical debt. In Los Angeles County, 1 in 10 adults are currently in debt due to medical care. Yin’s research shows that when hospitals wipe out patients’ debt and temporarily reduce how much they pay in co-pays, they are more likely to fill prescriptions and utilize health care resources. Yet within six months, even those whose debt was forgiven had returned to getting less care due to high costs. “Getting rid of medical debt may help in the short term, but a one-time cancellation doesn’t impact the future debts they may incur,” Yin said. He added that medical credit cards and other loans for medical bills can have high interest rates that deepen debt and threaten patients’ financial security.
Wesley Yin, associate professor of public policy and management at UCLA Luskin, spoke to the New York Times about new options for paying off medical debt that can ultimately be more costly than using regular credit cards. Medical debt is a burden that has plagued many Americans throughout the years, with about 23 million adults owing more than $250 in health care debt. Yin said some financing plans for repaying this debt have alarming consequences. Some lenders provide small loans at a zero-percent interest rate if it is paid over the course of a few weeks. If the debt cannot be repaid by the deadline, however, high interest will be charged retroactively from the start of the loan. Other financing plans charge extremely high interest rates, with the annual percentage rate of a typical medical credit card being 27%.
Wesley Yin, associate professor of public policy and management, was cited in an article by NOLA News about an initiative in New Orleans to erase $130 million in medical debt held by the city’s residents. The New Orleans City Council voted last year to allocate funds to a New York-based nonprofit that purchases medical debt on secondary markets, then forgives it. Yin, who is working with the nonprofit to observe the effects of debt forgiveness, said that eliminating newer debt is potentially more impactful than eliminating older debt. He also said there are limits to what providers can do to curb the effects of patient debt. “The problem of debt is something that’s beyond what a hospital really controls, and a much larger problem about inequality and financing in health care systems,” Yin said. “The best place to do this is prevention, and just have more generous health insurance to begin with.”
Wesley Yin, associate professor of public policy and economics, spoke to the New York Times about local governments’ efforts to address the high cost of health care by canceling their constituents’ medical debts. People with medical debt are less likely to seek needed care, and carrying a sizable debt load can damage credit and make it difficult to find employment, research shows. So across the United States, city and county officials are using funds from President Joe Biden’s American Rescue Plan to provide medical debt relief to eligible residents. Erasing this debt could be a “game changer” for some people, said Yin, who is studying the impact of medical debt relief programs on people’s livelihoods. He added, however, that governments should also address the root causes of medical debt, including high costs and limited access to good health insurance.
Wesley Yin, associate professor of public policy and management, spoke to the podcast Tradeoffs about how Americans can reduce their medical debt. Currently, about 100 million Americans have amassed more than $140 billion in medical debt. Yin explained that simply forgiving a person’s medical bills is a short-term solution to the greater problem of accumulating medical debt. When a hospital erases debt and temporarily reduces service costs, patients became more likely to receive care; however, within six months, they are likely to go back to getting less care as their debt again piles up, a study by Yin has found. Yin and his colleagues also published a paper in JAMA showing that states with Medicaid had far less medical debt than those without it. “In the states that expanded Medicaid, the amount of debt basically was halved. And in places that didn’t, it was essentially unchanged,” he told the podcast in a segment beginning at minute 10.
Wesley Yin, associate professor of public policy and economics, spoke to USA Today about the rapid growth in “buy now, pay later” credit, which has come under the scrutiny of the Consumer Financial Protection Bureau. The loans are especially appealing to young shoppers and people with low income or poor credit, and the federal agency found that borrowers may be unaware of late fees and other consumer risks. Yin drew a parallel to the easy credit of the pre-2008 mortgage industry, which helped trigger the Great Recession, but said the macroeconomic implications of the “buy now, pay later” programs are less worrisome. He noted that the growing popularity of this form of credit may be a symptom of a deeper problem in the economy. “Is it a luxury to want an iPhone, or is it a luxury to want a new sofa?” he said. “The fact that people can’t pay for it, I think, is the issue.”
By Mary Braswell
When Sophia Li decided to apply to graduate school to pursue her interest in health policy, she could not have known that the field would soon be upended by a protracted global health emergency.
Along with most of her peers in the UCLA Luskin School of Public Affairs’ master of public policy program, Li began her studies in September 2020, when COVID-19 had already taken more than 1 million lives worldwide and the arrival of vaccines was still months away.
When the time came to embark on the public policy program’s exacting capstone project, Li chose to focus on an inequity brought into sharp focus by the pandemic: As they isolated in their homes, more people turned to telemedicine for their health care needs — but that option was not available to people who lacked computers, smart phones and internet service.
“The pandemic really did shine a light on the possibilities that telemedicine brings,” Li said, “but it also showed that, while the upper half are benefiting from this, what does this mean for the lower half that have these barriers to access?”
Li was part of a team that explored this question on behalf of their client, the nonprofit Community Clinic Association of Los Angeles County. On an evening in May, Li and teammates Stacy Songco, who is earning a master of public policy and a doctorate in medicine, Xinyuan Qi, Ziyi Wei and Yixuan Yu boiled down a year’s worth of policy research and analysis into a 20-minute summary.
They were among nearly 70 second-year students to complete 15 applied policy projects this year, a rite of passage before receiving their UCLA master of public policy degrees. The capstone projects challenge students to find solutions to real-life policy dilemmas on behalf of clients in Los Angeles, across the state and nation, and around the world.
Networking with UCLA Luskin alumni had connected Li with the Community Clinic Association, which supports 65 neighborhood clinics in underserved areas. At the time, the nonprofit was “just dipping their toes into the digital divide issue,” she said.
The team spent months speaking with medical staff, local policymakers, internet service providers and, of course, the patients themselves. The conversations took place via Zoom because of COVID restrictions, but also in person, to make sure those without the means to gather virtually would be heard.
By year’s end, the team had developed more than a dozen recommendations, including the creation of a new role of digital navigator — a clinic staff member trained to guide individuals through the often-confounding world of broadband access, as well as benefits they may be entitled to, which change from ZIP code to ZIP code.
The students proposed a mechanism to receive federal funds for this new position. They stressed that information should be provided in multiple languages, and not just online but in printable formats, for those unable to access the internet. And they quickly determined that unlocking digital doors would open up a world of services and opportunities beyond telemedicine.
One of their focus groups spoke of their experiences with the California Lifeline program, which provides discounted landline and cell phone services to low-income households. While some found it confusing, “we had one unhoused individual who said, ‘Actually, you know what? I can walk you through all the paperwork, I can talk to you about how to use this,’” Li said.
“If people from the community could tap their experiences to guide others and receive compensation as a digital navigator, imagine the possibilities.”
The project culminated in a full published report for the Community Clinic Association and a formal presentation before Luskin faculty, staff and students, including the team’s advisor, Public Policy chair Martin Gilens.
Other capstone projects completed by the class of 2022 dealt with how to protect the rights of car wash workers, whether to expand the number of seats on the Los Angeles City Council, how to balance public health and humane treatment of asylum seekers at the border, as well as homelessness, mass transit, criminal justice and more.
“It’s an immersive experience. The students value that, and the marketplace also values that,” said Wesley Yin, an associate professor of public policy and economics who has served as coordinator and advisor in the applied policy projects program.
“There’s a professionalism that makes it much more than a class project,” Yin said. “It equips students with the rich experience and knowledge to seamlessly integrate into an organization.”
Li said her team emerged with unexpected areas of expertise. “The digital divide is a really complicated issue that has everything from some little niche funding source that you need to know about, to complex infrastructure issues and these really technical things that you need to understand,” she said.
As she looks toward graduation, Li reflects on the turns in her education that brought her to this point.
She transferred from Chaffey College to UC Merced, where she earned a bachelor’s degree in public health, then managed the rigors of earning her master of public policy at a time of pandemic. Selected as a Presidential Management Fellow, Li will spend the next two years in a program that helps train young scholars to become the next generation of leaders in federal government.
“It’s been a lot of these 90-degree turns that keep putting me on the right path,” Li said. “So let’s go explore new things.”
View photos of this year’s applied policy project presentations on Flickr.
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