Chelsea Eats Guaranteed Income

As a form of pandemic relief, in September 2020 the city of Chelsea, Massachusetts conducted a randomized lottery to allocate unconditional cash transfers of up to $400/month for 9 months to low-income individuals. Lottery winners (N=1,746) comprised the treatment group and lottery losers (N=1,134) the control group.

The study found a statistically significant 27% reduction in emergency department visits (87 fewer visits per 1,000 persons) over the 9 months of program implementation - a primary study outcome. It also found a suggestive 10% increase in outpatient visits (424 more visits per 1,000 persons, not statistically significant, p=.13).

These shifts in healthcare utilization may be beneficial - e.g., by reducing overall healthcare costs (although the study didn't measure such costs). But the study goes further - saying that the reductions in emergency department use likely reflect a direct improvement in health:

However, the JAMA paper omits key countervailing evidence on this point. An earlier report on this RCT, presenting findings for the 60% of the sample who'd agreed (before randomization) to follow-up surveys, found no effect on self-reported physical or mental health - a primary study outcome.
Specifically, at the 5-6 month survey, 39% of both treatment and control group members self-reported poor physical or mental health (p. 46 of the earlier report). Also, the JAMA paper reports no discernible effects on health biomarkers (e.g., blood pressure, weight). Hence, our "quick take" above: no evidence of improved health.

Based on careful review, this was a high-quality RCT (e.g., baseline balance, negligible attrition in both healthcare records and survey outcomes).