PROJECT OVERVIEW
Burden Reduction in Social Safety Net Programs Reduces Mortality
Highlights
While there is robust evidence that social welfare policies improve health, we know less about how the administration of those policies affects health.
BGL examined the mortality consequences of receiving Supplemental Security Income (SSI) after a reduction in administrative burden generated by sending informational letters to older adults likely eligible, but not enrolled in SSI. Using data from a large-scale randomized controlled trial (N=4,016,461), we estimate the mortality effects of older adults’ subsequent enrollment in SSI. The intervention increased SSI awards by more than triple baseline rates. Among those who enrolled in SSI, we estimate that their risk of death declined by approximately 40% compared to those that were SSI eligible but did not enroll.
Burden reduction that increases access to social welfare programs like SSI in the short-term can generate significant health benefits, in this case through reduced mortality.
Overview
The goal of this project is to analyze data from a prior randomized control trial that evaluated mailed letters’ effect on SSI enrollment to test the effect that letter–induced SSI benefit receipt had on mortality among older adults. We hypothesize that receipt of letter-induced SSI benefits will decrease mortality.
Approach
We used random assignment as an instrumental variable to estimate the mortality effect of reduced learning costs among older adults induced to enroll in SSI through the mailed letter. Mortality was measured after a 52 month (4.33 years) follow-up period.
Given this instrument, we use two primary approaches to test the effect of SSI on mortality.
1) Covariate-Adjusted Cox Proportional Hazards Model with a Control Function
2) Covariate-Adjusted Two-Stage Least Squares (OLS LATE) Model
We estimated these two primary models instrumenting for SSI application instead of successful SSI application. We expect that in these models, we should find that the effect of SSI application on mortality is slightly smaller than the effect of SSI enrollment on mortality. This is a more conservative approach than our primary models because not everyone who applies for SSI is approved for the benefits.
Sending letters led SSI uptake to increase by an estimated 1.8 percentage points or a 340 percent increase from a baseline enrollment rate of 0.5 percent. The mortality rate was 12.25% for the control group over the follow-up period and 12.16% for the mailed-letter group for a difference that is statistically significant at the 10% level.
Using the prespecified, covariate-adjusted Cox model we estimate a statistically significant reduction in mortality (Hazard Ratio=0.6101, 95% CI=0.5127 - 0.7075) for those induced to enroll in SSI by the mailed letter. We also found that as age increases, the size of the mortality effect rose and the mortality effect is robust to changes in how long a mortality follow-up period is used, including restricting data to before the COVID-19 pandemic.
Funder: Social Security Administration Retirement and Disability Research Consortium, Arnold Ventures