Changing the Price of Marriage: Evidence from Blood Test Requirements

Changing the Price of Marriage:Evidence from Blood Test Requirements
Kasey Buckles (Notre Dame) Melanie Guldi (Mt. Holyoke College) Joe Price (BYU & NBER)

Motivation Marriage is associated with many (usually) positive outcomes, including wages, productivity, health, early child cognitive outcomes, and happiness. Various public policies affect the marriage decision: Directly—age requirements, fees, waiting periods, divorce laws Minimum Age of Marriage (Dahl forthcoming; Blank, Charles, & Sallee 2009) Unilateral Divorce Laws (Rasul 2006; Stevenson and Wolfers 2007) Indirectly—tax and transfer policies Welfare Reform (Bitler, et al. 2004; Rosenzweig 1999) Income tax policy (Moffitt 1998) EITC (Dickert-Conlin and Houser 1998; Eissa and Hoynes 2000) Introduction Background Data and Methods Results Summary

Blood test requirements In this paper, we consider how blood test requirements for a marriage license affect: Where people marry Whether people marry Who is most sensitive to the laws? Commonly test for syphilis (VD) & rubella, less commonly for sickle-cell anemia and HIV. Most introduced as part of a public health campaign enacted in the late 1930s by Surgeon General Thomas Parran, Jr. Motivation for the laws: inform potential marriage partners of risk of contracting the disease (syphilis & VD) minimize risk of genetic disease or birth defects in the couple’s children (syphilis, VD, rubella, sickle-cell) We consider 33 repeals that occurred between 1980 and 2008. Introduction Background Data and Methods Results Summary

Why look at blood test laws? Allows us to study how people respond to small changes in the cost of marriage. Law changes occurring over a wide window of time. 19 repeals in 1980s, 7 in 1990s, 7 in 2000s. While effects may differ across people, the policy applied to all groups equally. Policy implication for Mississippi, and for states considering policies such as required premarital counseling, waiting periods, license fees. Ex: Twogether in Texas & similar, waiting periods in half of states Introduction Background Data and Methods Results Summary

Blood test requirements: Repeal Original motivation has diminished over time. Medical Technology: Vaccine for Rubella in 1969: Fewer than 1,000 cases of rubella reported each year and less than 10 cases of congenital rubella syndrome. Syphilis, VD can be treated with antibiotics: in NYC, cases of syphilis dropped 90% between 1946 and 1955, in 1976 only 39 cases found in 116,000 premarital tests Not the right population: In NYC’s first year, only 1.34% of applicants tested positive for syphilis Not the most at-risk group Other contributors: Most couples have sex before marriage Many births occur before marriage Privacy concerns Introduction Background Data and Methods Results Summary

Incidence of Syphilis and Rubella in the United States, 1941-2006 (Cases per 100,000) Source: CDC Introduction Background Data and Methods Results Summary

Source: MMWR 43(21);391,397-401 (CDC 1994) Introduction Background Data and Methods Results Summary

Congenital syphilis — Reported cases for infants <1 year of age and rates of primary and secondary syphilis among women: United States, 1970–1999 (Syphilis Surveillance Report 1999, CDC) Note: The surveillance case definition for congenital syphilis changed in 1988. Introduction Background Data and Methods Results Summary

Blood test requirements: Repeal Cost-benefit analysis: In California: “Of 300,000 persons tested in 1979, just 35 cases of syphilis (0.012 percent) were found--at a cost of $240,000 per case.” In New York City, cost per syphilis case was $60,000 in 1976; nationwide, $175,000 (Brandt 2005). In Massachusetts: “there are so few syphilis cases now among engaged couples that the test is outdated and an added economic burden . . . The test is also designed to detect rubella, but people are now vaccinated against that disease” (LeBlanc 2005). Introduction Background Data and Methods Results Summary

Years of Repeals for States with a BTR in 1980 * Illinois and Louisiana pass an HIV test requirement in 1988; IL repeals in 1989, LA repeals in 1988 Introduction Background Data and Methods Results Summary

Timing of Law Changes Introduction Background Data and Methods Results Summary

Variation in Law Changes Introduction Background Data and Methods Results Summary

Were the costs of the blood tests great enough to deter marriage?: The Sniff Test Time costs: Cost of going to doctor/clinic Cost of waiting 3-5 days for results (confirmed with calls to DC and MS). This may be especially important for spur-of-the-moment marriages. Over 10% of marriages 1980-1988 were civil ceremonies occurring Mon-Thurs. Financial costs of the test: We have found per-couple costs of the tests that range from $10 to $200. Add in the cost of the doctor’s visit, and tests “can cost couples hundreds of dollars” (Leblanc 2005). Calls to DC and Mississippi confirm that tests from a clinic cost $26 (MS) and $40 (DC) per couple; from a doctor’s office can cost $200 per couple. Mississippi reports that Medicaid does not cover Psychic costs: Bowman, 1977: “the mandatory testing for carriers of genetically determined diseases at the time of marriage application can result in serious psychological trauma, for the decision has already been made to marry” May not want to know disease status, or may not want partner to know Disutility of doctor’s visit, blood draw Introduction Background Data and Methods Results Summary

Empirical Approach Data are at state-year level, in most cases y is a marriage outcome bloodtest=1 if state had a BTR for entire year, 0 otherwise Includes state and year effects, and a quadratic state-specific time trend. Standard errors clustered at the state level, observations are weighted by population or cell size. Time trends and fixed effects should help alleviate any remaining concerns about endogenous repeals. Introduction Background Data and Methods Results Summary

Data: Four Sources Annual state marriage rates from CDC Vital Statistics data (1980-2006) Number of marriage licenses issued per 1,000 state residents. Do not observe state of residence Information not available by race or education. Marriage Detail Files from vital statistics (1981-1995) Reports state of residence and state where marriage occurs. Individual-level data, but not all states report. Vital Statistics Natality data (1980-2002) Observe marital status at the time of birth We focus on young first-time mothers Includes information on race, education, age Current Population Survey (1980-2006) Mothers 19-24 Includes poverty status Notes: In most regressions, NV, HI, CA omitted. Introduction Background Data and Methods Results Summary

Marriages per 1,000 Residents (CDC Data) Introduction Background Data and Methods Results Summary

Table 1: Effect of Blood Test Requirement on Number of Marriage Licenses Issued by the State (CDC Data) Introduction Background Data and Methods Results Summary

Table 4: Effect of Blood Test Laws on Number of MARRIAGESper 1,000 State Residents (Vital Statistics Marriage License Records) Introduction Background Data and Methods Results Summary

Table 3: Effect of Marriage License Policies on Number of Marriage Licenses Issued by the State, per 1,000 State Residents Introduction Background Data and Methods Results Summary

Table 1. Estimated Probit Models for the Repeal of a Blood Test Requirement Source: CDC State Marriage Rates, 1975-2006. Regressions also include a quadratic time trend. Std. errors are clustered at the state level and are in parenthesis. Changes in probabilities are in brackets. Introduction Background Data and Methods Results Summary

Appendix Table 7: Effect of Blood Test Requirement on Number of Marriage Licenses Issued by the State, with Placebos Introduction Background Data and Methods Results Summary

Table 5: Effect of Blood Test Laws on Where Marriage License is Obtained(Vital Statistics Marriage License Records) Introduction Background Data and Methods Results Summary

Marriage Among Mothers in the Natality and Current Population Survey Data Measure of whether the mother is married when the baby is born (natality) or currently (CPS) Focus on first time mothers in birth certificate data, young mothers in CPS (point at which marriage policies may become more important). Past research (Eissa and Hoynes 2000) suggest that less likely to detect an effect for couples with children. They were looking at responses to EITC marriage penalties. Introduction Background Data and Methods Results Summary

Table 6. Effects of Blood Test Laws on Likelihood of First-Time Mothers Ages 19+ Being Married at Time of Birth (Birth Certificates) Introduction Background Data and Methods Results Summary

Table 7. Effect of Blood Test Laws on Marital Status of Mothers Age 19-24(Current Population Survey, 1980-2008) Introduction Background Data and Methods Results Summary

Summary & Discussion Substantial evidence that repealing blood test requirements increased the number of marriage licenses issued in a state (about 6.1%). About one-third of this decrease can be attributed to couples marrying in another state, with the remainder attributable to deterred marriages. The marriage deterrent effect seems largest for low-SES groups Young mothers are less likely to be married in states with a BTR What do you think is the goal of policies that require waiting periods, premarital counseling, etc.? Does the evidence in this paper suggest that those policies would accomplish those goals? What else would we need to know? Introduction Background Data and Methods Results Summary

Changing the Price of Marriage: Evidence from Blood Test Requirements