Did Medicaid Fuel the Early Opioid Epidemic? An Investigation Using State Policies
Abstract: I examine the role of Medicaid in fueling the early opioid epidemic, between 1996 and 2010. To do so, I construct a novel database of Medicaid policy reforms in the late 1990s and 2000s, a period marked by substantial changes to program eligibility, and I link these reforms to a range of data on opioid sales, abuse treatment, and use-related mortality. To address endogeneity of program eligibility, my empirical strategy uses two simulated instrumental variables that isolate quasi-exogenous variation in eligibility within and across states. Regression estimates indicate that Medicaid expansions contributed to significantly higher opioid sales, though effect sizes are relatively small and explain only a fraction of the documented rise in sales over this period. I then show that these expansions also resulted in a significant increase in opioid abuse treatments, an effect I argue is more consistent with greater abuse than improved treatment access. Estimates of program impacts are smaller in states that more tightly regulated prescription access. Perhaps surprisingly, these policy reforms do not seem to have significantly increased opioid-related mortality. These findings provide novel evidence on the causal drivers of the opioid epidemic, and they offer insights for the broader debate about tradeoffs in the design of health insurance policy.
The Role of Pre-ACA Medicaid Expansions in Access to Substance Use Disorder Treatments
Abstract: I explore the role of Medicaid expansions in the provision of substance use disorder (SUD) treatment services between 1996 and 2010, using a novel set of income thresholds for Medicaid eligibility. I find that while increasing access to Medicaid led to a dramatic increase in SUD treatment episodes, there was no increase in numbers of SUD treatment facilities or client loads (as given on a specific reference date) at those facilities. This discrepancy is explained by a sharp increase in client loads at hospital facilities, especially for relatively rapid detoxification services, which appear to have led the average SUD treatment episode to shorten dramatically. Comparing my results to past research focusing on Medicaid expansions that occurred after the 2010 Affordable Care Act (ACA) is insightful, as it has been found that those expansions actually had the largest effects on clients' utilization of outpatient rehabilitation services, which might be thought to be more effective for long-term health improvements. I propose that these considerably different sets of results can be explained by major changes in Medicaid coverage of SUD treatment after the ACA, although further research is needed to confirm this.
The Impact of COVID-19 on Emerging Markets Economies' Financial Conditions
Abstract: We explore the role of COVID-19 indicators in changing financial variables among Emerging Market Economies (EMEs). Using panel regressions, we find that lockdown stringency has the effects of depreciating currencies, widening credit spreads, and pushing down equity prices in a sample of 22 EMEs. These results underscore the broader dangers posed by the COVID-19 pandemic to already vulnerable countries.