Economic Development, Unearned Income and Mortality: Evidence from Tribal Casinos

The relationship between income and health is not well understood. While descriptive studies have documented a strong positive gradient between income and health, research utilizing exogenous variations in income has found conflicting results. This work investigates the impact of economic expansions and unearned income transfers arising from tribal casino operations on the mortality of Native American and other residents of American Indian reservations. Using the universe of Native American records in Medicare for the period 1999-2018 and a random one-in-five selection of records from other races, we find that the casino operations reduce the probability of mortality for Native American men in our study by 7.4%. We also find that unearned cash transfers reduce overall mortality regardless of race or gender. However, there is an additional reduction in mortality for Native American women who receive the cash transfer that is not observed for Native American men. Opening a casino on tribal lands and disbursing unearned income to tribal members has positive effects on the longevity of Native Americans in Medicare residing on tribal lands.