Publications
- 2015. “Do ‘Cheeseburger Bills’ Work? Effect of Tort Reform for Fast Food” with Kitt Carpenter. Journal of Law and Economics. NBER Working Paper 21170. Replication Kit
- 2019. “Public Spillovers from Private Insurance Contracting: Physician Responses to Managed Care” with Michael Richards. American Economic Journal: Economic Policy
- 2019. “The Impact of Obesity on Wages: The Role of Personal Interactions” with Andrea Moro and Tommaso Tempesti. LABOUR. Lead Article.
- 2020. “Losing Public Health Insurance: TennCare Disenrollment and Personal Financial Distress” with Laura Argys, Andrew Friedson, and Melinda Pitts. Journal of Public Economics.
- 2020. Regional disparities in Qualified Health Plans’ Prior Authorization Requirements for HIV Pre-exposure Prophylaxis in the United States with Kathleen McManus, Sam Powers, Elizabeth Rogawski, and Amy Killelea. JAMA Network Open
- 2021. Connecting Medicaid and Child Support: Evidence from Disenrollment with Lindsey Bullinger. Review of Economic of the Household
- 2021. Private Coverage Mandates, Business Cycles, and Provider Treatment Intensity with Michael Richards. Health Economics
- 2021. Losing Public Health Insurance on Preventative Care, Health, and Emergency Department Use: Evidence from the TennCare Disenrollment. Southern Economic Journal. (Replication kit)
- 2018 John Heinz Dissertation Award from the National Academy of Social Insurance
- APPAM Ph.D. Dissertation award – Honorable Mention
- 1st place in APPAM poster competition
- Previously known as: Effects of Losing Public Health Insurance on Healthcare Access, Utilization, and Health Outcomes: Evidence from the TennCare Disenrollment
- 2022. Losing insurance and behavioral health inpatient care: Evidence from a large-scale Medicaid disenrollment” with Catherine Maclean and Douglas Webber. NBER Working Paper 25936. Journal of Economic Behavior and Organization
After highly publicized lawsuits against McDonald’s in 2002, 26 states adopted commonsense consumption acts (CCAs)—also known as cheeseburger bills—that greatly limit fast-food companies’ liability for weight-related harms. We provide the first evidence of the effects of CCAs using plausibly exogenous variation in the timing of CCA adoption across states. In two-way fixed-effects models, we find that CCAs significantly increased self-reports of attempts to lose weight and consumption of fruits and vegetables among heavy individuals. We also find some evidence that CCAs increased employment in the fast-food industry. Finally, we find that CCAs significantly increased the number of company-owned McDonald’s restaurants and decreased the number of franchisee-owned McDonald’s restaurants in a state. Overall, our results provide novel evidence supporting a key prediction of tort reform—that it should induce individuals to take more care—and show that industry-specific tort reforms can have meaningful effects on market outcomes
Managed care is rebounding as more emphasis is placed on cost containment. These efforts may benefit consumers but challenge providers; however, empirical evidence on how supply-side managed care influences physicians is incomplete. We leverage a quasi-experiment in which a commercial insurer imposed a new contract regime on behavioral health providers in response to recent policy shifts. We demonstrate spillovers in the form of negative effects on local physician supply and positive effects on Medicare and Medicaid participation in areas where the insurer has market power. Commercially insured patients are also not obviously harmed but receive less intense services in some settings.
We estimate the effects of obesity on wages accounting for the workers' sorting into jobs requiring different levels of personal interactions in the workplace. Using data from the National Longitudinal Survey of Youth 1979 combined with detailed information about jobs from O*Net, we find a wage penalty for obese white women. This penalty is higher in jobs that require a high level of personal interactions. Accounting for job selection does not significantly change the estimated wage penalty.
A primary goal of health insurance is smoothing the financial risk associated with health shocks. We estimate the effect of exposure to health-insurance reform on individual-level financial well-being. Utilizing a plausibly exogenous shock to health insurance status resulting from a sudden disenrollment from Tennessee's Medicaid program in 2005, we find that the reform resulted in a 2.78 point decline in credit risk score for an individual in the median county in Tennessee. This study is the first examining the impact of losing any form of public assistance on personal financial well-being and our results inform ongoing discussions around Medicaid reform.
In 2005, Tennessee disenrolled about 170,000 adults from its Medicaid program. This health insurance reform has been shown to decrease access to care and worsen financial well-being. Those affected by the disenrollment greatly overlaps with the population responsible for paying child support. We examine whether the contraction of public health insurance eligibility in Tennessee affected child support receipt. We find that after TennCare disenrollment, parents with custody of children in Tennessee were 7.2 percentage points (16 percent) less likely to receive child support income. Child support income also decreased by $204 (20 percent). We document heterogenous effects, with the largest effect among custodial parents who are non-white, under age 40, and above the poverty line.
The Affordable Care Act (ACA) is the source of multiple large-scale health insurance expansions affecting various segments of the US population. Although much has been done to quantify the first-order effects of these policies, less empirical investigation has been devoted to the effects on the supply-side of health care. We focus on a well-known ACA initiative (the young adult dependent coverage mandate) to offer novel evidence on two fronts: the policy's heterogeneous effect across different labor markets and the potential for the policy-induced shift in payer mix to influence provider treatment decisions. First, we show that the federal mandate's direct effect on young adult private insurance take-up is strongly mitigated by the Great Recession. Second, we demonstrate that providers do not treat young adults more aggressively when more of them hold private coverage. Policymakers should keep these broader considerations and more diffuse risk protection implications in mind when contemplating changes to the law.
This paper studies the effect of losing public health insurance eligibility on preventative care, self-reported health, and emergency department use. I exploit the 2005 TennCare disenrollment in which 190,000 residents–mainly non-elderly childless adults–lost public health insurance eligibility due to budget cuts. I use two surveys, the Behavioral Factor Surveillance System and the National Health Interview Survey, in a difference-in-difference methodology to study the effects of the reform. I find that the reform lead to a 4%–5% reduction in reporting having mammograms and breast exams. An increase of 20% in number of days with health incapacitation and no strong evidence of changes of emergency department visits (nor number of visits). I document margins of heterogeneity of the effects across demographic characteristics. Finally, I explore the margins of symmetry between gaining and losing public insurance by comparing estimates to those from the Affordable Care Act Medicaid Expansions.
We study the effect of losing insurance on psychiatric – mental health disorder (MHD) and substance use disorder (SUD) – hospital-based care. Psychiatric disorders cost the U.S. over $1T each year and hospitalizations provide important and valuable care for patients with these disorders. We use variation in public insurance coverage (Medicaid) eligibility offered by a large-scale and unexpected disenrollment in the state of Tennessee in 2005 that lead to 190,000 individuals losing their insurance. Medicaid enrollees are at elevated risk for psychiatric disorders. Following the disenrollment, hospitalizations for SUDs declined by 15.4%. Findings suggest that MHD hospitalizations declined by 4.2%, but the coefficient estimate is imprecise. The expected financing of hospital care received also changed, with the probability that Medicaid was listed as the expected payer for MHD and SUD hospitalizations declining by 27.5% and 30.8% respectively post-disenrollment. We provide suggestive evidence that psychiatric health declined post-disenrollment.
Working Papers
- "Health Insurance for Whom? The ‘Spill-up’ Effects of Children’s Health Insurance on Mothers" with Daniel Grossman and Barton Willage. NBER Working Paper 29661. Submitted
- “Under the same umbrella: Public health insurance expansions and the uniformity of insurance for families” with Sarah Hamersma and Daniel Grossman. NBER Working Paper 31491 Submitted
- “The introduction of PrEP on HIV: Incidence, Mortality and Heterogeneity” with Dr. Kathleen McManus.
- “Losing Medicaid: What happens to hospitalizations?” with Ausmita Ghosh, Johanna Catherine Maclean, and Kosali Simon.
- “Gestión de calidad y la productividad laboral de las Empresas formales en el Perú: un diseño no experimental y técnicas de Machine learning causal” with Mario Tello
What else am I working on? (Updated on December, 2022)
Currently future work spans on topics of HIV, Medicaid policies and racial disparities, measuring mental health, effects of licensing of therapist on labor outcomes and mental health outcomes, and school upgrades on health. This means that I’m working on these areas, may have some results but don’t have a shareable draft. However, if you work on these areas and would like to collaborate or are looking for these topics for creating panels, let me know!
Public Engagement
If you are interested in seeing my public engagement, please check out my media appearances, or check out my podcast “The Hidden Curriculum”, I have also produced articles for the ASHEcon Newsletter, and help out with the non-profit EconThaki.