Effects of state hearing aid mandates on employment, wellbeing, and public benefit receipt

Nearly one quarter of Americans over the age of 12 are affected by hearing loss. (Goman & Lin, 2016). Untreated hearing loss is associated with adverse outcomes across the life course including delays in speech and language development and poorer academic performance in children (le Clercq et al., 2020; Tomblin et al., 2015), and social isolation , falls, and cognitive decline in older adults (Huang et al., 2024; Lin et al., 2011; Lin & Ferrucci, 2012). These outcomes can also negatively impact downstream human capital indicators, such as employment stability and timing of retirement (Helvik et al., 2013; Shan et al., 2020). Hearing loss has also been associated with an increased hazard of divorce, possibly due to hearing-related communication challenges between partners (Idstad et al., 2021). Hearing aids are an efficacious intervention that improve communicative function and general quality of life (Ferguson et al., 2017; Hori et al., 2025; Yeo et al., 2023). Previous randomized controlled trials of the effect of hearing aids largely focused on age-prevalent outcomes, demonstrating reduced cognitive decline and falls (Goman et al., 2025; Pike et al., 2025). However, little is known or understood about the impacts of hearing aid use on outcomes relevant to working-age adults, including employment, financial, and marriage stability. It is worth noting that there may be countervailing mechanisms linking hearing improvement to these downstream outcomes, making the net effect ambiguous a priori. For example, while hearing aids may reduce an individual’s need of public assistance due to improved employment outcomes, it may simultaneously increase another’s ability to successfully enroll in the program due to improvements in communication. In our current study, we propose to estimate downstream effects of hearing aid mandates for working-age adults on health, human capital, and public benefit receipt outcomes. To do so we rely on a natural experiment: variation in adoption and timing of private insurance and Medicaid mandates for hearing aid coverage. We will estimate a series of two-way fixed effects and event study models to compare outcomes among US adults ages 25–64 living in states with and without hearing aid coverage before and after the policy adoption. We hypothesize that the adoption of hearing aid coverage mandates at the state-level will improve self-reported health and downstream life satisfaction and economic security outcomes. (see "additional_refs.pdf" for full bibliographic information).