Yin on Risks of ‘Buy Now, Pay Later’ Plans

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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.”

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Public Policy Students Take On the Health Care Digital Divide Effort to widen access to telemedicine is one of 15 immersive projects aimed at developing policy solutions for real-world clients

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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.

Applied Policy Projects 2022

Yin on Policy Changes to Reduce Medical Debt

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Associate Professor of Public Policy Wesley Yin was cited in a Health Care Journalism article about the burden of medical debt in the United States. Yin said that medical debt, totaling at least $140 billion, is the single largest source of consumer debt in the United States. To address this issue, the White House announced four steps to ease the burden of medical debt on health care consumers, including holding medical providers and debt collectors accountable for harmful practices and forgiving debt for low-income veterans. “Just shining a light on that type of behavior might lead to reducing the most egregious practices from providers,” Yin said. He expressed hope that the “White House’s actions to shine a light on charity care practices will have a positive effect for low-income individuals.” The policy changes may also “nudge providers to be stronger advocates for increased subsidies for health insurance and Medicaid expansion,” he said.

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Yin on Burden on U.S. Medical Debt

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Associate Professor of Public Policy Wesley Yin’s research into the soaring cost of medical debt in the United States was featured in the UCLA Anderson Review. A study co-authored by Yin and published in the Journal of the American Medical Association found that medical bills sent to collection agencies totaled an estimated $140 billion as of June 2020. That sum, which is bigger than all other sources of debt in collection combined, was tallied even before the pandemic saddled COVID-19 sufferers with unpaid doctor and hospital bills. Medical debt is concentrated in low-income neighborhoods, in the South and in states that refused to expand Medicaid coverage under the Affordable Care Act. “Communities that had been most burdened by medical debt have become even worse off, in absolute and relative terms, due to their leaders choosing not to expand Medicaid,” Yin said. “The results are important because they indicate that these problems are within the control of public policy.”

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Yin on National Burden of Medical Debt

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Associate Professor of Public Policy Wesley Yin spoke to Verywell Health about the results of his research on the burden of medical debt in the United States. “Medical debt has become the largest source of debt and collections than all other sources combined,” Yin said, referring to recent research he co-authored that found 17.8% of individuals in the U.S. had medical debt in collections as of June 2020. “It just speaks to how important the expansion of Medicaid has been towards financial security, financial well-being, as well as reducing disparities in these communities,” he said. When medical bills are left unpaid, it can negatively impact an individual’s credit score and make it more difficult to qualify for loans. In order to curb medical debt, Yin recommended extending subsidies that would allow patients to purchase more affordable insurance plans with a smaller deductible. He also suggested expanding Medicaid, an approach that has been shown to reduce state spending.

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Study Measures Americans’ Growing Medical Debt

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Over the last decade, medical bills have become the largest source of debt that Americans owe collection agencies, according to new research co-authored by Associate Professor of Public Policy Wesley Yin. The $140 billion in unpaid health care bills, held by about 18% of Americans, now exceeds all other debt in collections combined, according to the paper just published in the Journal of the American Medical Association (JAMA). Only debts referred to collection agencies were measured; other unpaid bills owed to health-care providers would push the total amount of debt even higher. Yin and co-authors Raymond Kluender of Harvard Business School, Neale Mahoney of Stanford University and Francis Wong of the National Bureau of Economic Research examined records from the credit rating agency TransUnion from January 2009 to June 2020, reflecting medical care delivered prior to the COVID-19 pandemic. Their comprehensive look at the evolution of medical debt reveals that, while Americans’ household finances largely recovered after the Great Recession, medical debt continued to grow. Yin said the debt was most concentrated in low-income communities and in the South. He added that, in 12 states that chose not to expand Medicaid coverage, significant disparities grew even worse during the period studied. “Addressing the problem of medical debt in the U.S. health care system must be a high priority,” said the authors of a JAMA editorial accompanying the study. “In addition to the potential consequences for health and health care use, the economic and social ramifications of medical debt are likely equally consequential, if not more so.”

 

A Spotlight on Yin’s Research on Health Insurance Literacy

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The podcast Tradeoffs featured Public Policy Associate Professor Wesley Yin’s research into low enrollment rates in public health insurance plans, even when government subsidies are available. The study, which will be published in American Economics Review, noted that 60% of people who are uninsured and eligible for either Medicaid or Affordable Care Act premium tax subsidies choose to remain uninsured. In a randomized field experiment, researchers sent five types of letters to a group of uninsured, subsidy-eligible people in California. The letters contained escalating amounts of information, from merely announcing the start of open enrollment to specifying how much subsidy an individual could receive. Enrollment rates in this group increased about 16%, suggesting that this low-cost intervention increased their health insurance literacy and comfort level in navigating the system. In addition, the new enrollees were healthier, on average, than those already in the system, creating a more stable risk pool. Yin’s study is discussed in the second half of the podcast.

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Super Tuesday, Luskin-Style

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As Super Tuesday drew to a close after 72 hours of campaign twists and turns, Public Policy students and faculty flocked to a watch party at the Luskin School for pizza and political talk. The contest for the Democratic presidential nomination as a two-man race came into focus as returns came in from across the country. In addition to weighing the merits of Sen. Bernie Sanders and former Vice President Joe Biden, students talked about state and local races and the new voting centers rolled out by Los Angeles County for the March 3 primary. Many in the room wore “I Voted” stickers after casting their ballots at Ackerman Union. The crowd also included half a dozen international students who were fascinated by the political process unfolding before them. Professors Martin Gilens and Mark Peterson provided context and commentary as hosts of the event. They were joined by Associate Professor Wesley Yin and Visiting Professor Michael Dukakis, the former Massachusetts governor and 1988 Democratic nominee. Dukakis and his wife, Kitty, shared their own unique perspectives with students at the watch party.

View more photos on Flickr.

 

Super Tuesday Watch Party

Improving India’s Mom-and-Pop Pharmacies

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UCLA Report Provides Strategies for Making Covered California More Affordable Public Policy's Wes Yin helps develop policy options to keep insurance costs down

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By Mary Braswell

With California taking steps to revamp its health care system, research by the UCLA Luskin School of Public Affairs is guiding the conversation.

The report, published Feb. 1, details strategies to improve the affordability of Covered California, the state’s health insurance marketplace. It was co-authored by economist Wes Yin, associate professor of public policy at UCLA Luskin.

Affordability is “the top challenge for individuals who are insured as well as those who remain uninsured,” according to the report (PDF), which lays out a wide array of proposals to meet that challenge, including:

  • capping out-of-pocket premiums for all eligible Californians;
  • offering expanded cost-sharing benefits, which would lower deductibles and the cost of office visits; and
  • creating a California-only penalty for those who opt out of coverage, to replace the penalty that was phased out by the federal government.

“This will help push the conversation forward, now with policy options that we know will improve affordability and market stability,” said Yin, who wrote the report with economist Nicholas Tilipman of the University of Illinois, Chicago, and Covered California’s policy and research division.

Commissioned under a state law, the report was presented to the governor’s office and state Legislature. It was developed amid a shifting landscape for health care in California.

On Jan. 30, Covered California reported mixed figures for 2019 enrollment. Although the number of Californians held steady from 2018 to 2019, the number of new enrollees dropped by 23.7 percent. In addition, on the first day of his term, Gov. Gavin Newsom unveiled his own far-reaching health care plan, calling for increased premium subsidies and Medicaid coverage for undocumented youths up to age 26, among other reforms.

“Our analysis gives policymakers a sense for how different approaches benefit Californians and at what cost,” Yin said. “So this report bolsters the governor’s effort to improve health care access.”

The dialogue, he said, will include a debate over the state’s funding priorities.

“From a wider lens, it’s helpful to think about how we can best spend that next public dollar,” Yin said. “It could be health care, it could be pre-K programs, it could be public education or parental leave benefits. These are all important. And there is a strong argument for improving the affordability of health care coverage and reducing cost-sharing burdens. Coverage improves health — especially mental health — it improves chronic disease management and it drastically reduces the risk of catastrophic spending and debt incurred by consumers.”

The report includes proposals to address the divisive issue of penalties for Californians who choose not to buy health insurance. Covered California attributes the decline in new enrollments to removal of the federal individual mandate penalty beginning this year. A statewide penalty would create a fresh incentive to opt in.

“The penalty appears to be quite impactful,” Yin said. “What we’re seeing in Covered California the past year shows that, and our modeling also shows that. Zeroing out the penalty has directly caused premiums to increase and enrollment to drop. Including a penalty while making plans more affordable can be both an effective and fair way of expanding coverage and lowering premiums.”

The report also notes that premium costs can vary widely for consumers based on their age and geographic location. “For consumers nearing retirement age living in high-cost regions, premium costs can exceed 30 percent of income for the most common benefit package,” it said.

To make health insurance more affordable for those consumers, California could use subsidies to cap all premium payments at 15 percent of annual income. Currently, subsidies are offered only to people who earn up to 400 percent of the federal poverty level, or $103,000 for a family of four. Consumers who earn just over the 400 percent threshold would not qualify for federal premium subsidies, Yin said. A 15 percent cap would also eliminate this so-called tax-credit cliff.

The report’s policy options are based on a model developed by Yin and Tilipman that shows the potential effects that various policy proposals would have on health care enrollment, consumer health spending and public spending.

As elected officials and consumers debate competing visions of health care reform — from repealing the federal Affordable Care Act to moving to a state-run single-payer system — Yin said the proposals are aimed at expanding coverage and increasing affordability as much as possible.

“Let’s find ways to build on the successes of the Affordable Care Act and make it work better,” Yin said. “These are models for improvement.”