Colleen Marie Carey
Associate Professor of Economics and Public Policy, Cornell University
Faculty Research Fellow, National Bureau of Economic Research
Co-Editor, American Journal of Health Economics
My research focuses on public policy for the health care industry, with special attention to federal regulation of health insurance markets. Previously, I was a Robert Wood Johnson Scholar in Health Policy Research at the University of Michigan, a Staff Economist at the Council of Economic Advisers, and a visiting researcher at Princeton University's Center for Health and Wellbeing.
In 2024-25, I am serving as a Fellow at the Centers for Medicare and Medicaid Services.
Working Papers
Why Does Disability Increase During Recessions? Evidence from Medicare, with Nolan Miller and David Molitor. (revision requested at Review of Economics and Statistics)
Social Security Disability Insurance (DI) awards rise in recessions, especially for older adults. Using Medicare data, we investigate how health and entry costs shape this pattern. We find that higher unemployment at application corresponds to increased DI entry, lower medical spending, and lower mortality among new entrants. We use age-based discontinuities in disability eligibility criteria as an instrument for DI entry to develop a model of the health of DI entrants at varying levels of unemployment. We find no shift in the health of marginal entrants as unemployment increases, indicating that health changes play little role in cyclical DI entry.
Coverage: Bulletin on Retirement and Disability
Partial Outsourcing of Public Programs: Evidence on Determinants of Choice in Medicare, with Marika Cabral and Jinyeong Son. (conditionally accepted at Review of Economics and Statistics)
Many public programs let individuals choose between publicly provided benefits and a subsidized private alternative. We investigate the determinants of health insurance choice in Medicare—a setting with vast geographic variation in the share of individuals selecting the public option versus private alternative. We analyze insurance decisions among individuals who move to quantify the relative importance of individual-specific factors (such as preferences or income) and place-specific factors (such as local health insurance options) on insurance decisions. We find roughly 40\% of the geographic variation in the share selecting private coverage is due to place-based factors, while the remainder is explained by individuals. Our findings highlight the importance of individual factors in these decisions and may inform discussions about the use of policy to address geographic disparities.
Nothing for Something: Marketing Cancer Drugs to Physicians Increases Prescribing Without Improving Mortality, with Michael Daly and Jing Li. (revision requested at Journal of Public Economics)
Physicians commonly receive marketing-related transfers from drug firms. We examine the impact of these relationships on the prescribing of physician-administered cancer drugs in Medicare. We find that prescribing of the associated drug increases 4% in the twelve months after a payment is received, with the increase beginning sharply in the month of payment and fading out within a year. A marketing payment also leads physicians to begin treating cancer patients with lower expected mortality. While payments result in greater expenditure on cancer drugs, there are no associated improvements in patient mortality.
Recent Court Ruling Could Increase the Size and Administrative Complexity of the 340B Program, with Sayeh Nikpay and John P. Bruno. (forthcoming at Health Affairs Scholar)
Racial and Ethnic Disparities in SSDI Entry and Health, with Nolan Miller and David Molitor.
Racial disparities in the Social Security Disability Insurance (DI) program have long been a concern, yet little is known about how the health and entry patterns of DI recipients vary by race and ethnicity. In this paper, we examine trends in the racial/ethnic composition of DI recipients and show how the health of DI entrants and the responsiveness of DI entry to economic conditions and program rules differ across race and ethnicity. Our analysis uses the racial/ethnic categorization in Medicare administrative data, which we first validate against U.S. Census self-reports. We then document the race and ethnicity of all DI recipients since 1992. In examining entry patterns, we find that per capita DI entry is highest among Blacks and lowest among Asians, while illness burden, as measured by medical expenditure and mortality, is lowest among Asians and Hispanics and highest among Blacks and Natives. Additionally, we analyze the effects of poor economic conditions on DI entry for different racial and ethnic subgroups. Finally, we show racial/ethnic variation in the effect of an age-based change in the program’s eligibility rules, finding that the impact of relaxing the eligibility rules at ages 50 and 55 is largest among Natives and smallest among Asians.
Coverage: Bulletin on Retirement and Disability
Publications
Cabral, Marika, Colleen Carey, and Sarah Miller. (forthcoming). "The Impact of Provider Reimbursement on Health Care Utilization of Low-Income Individuals: Evidence from Medicare and Medicaid." American Economic Journal: Economic Policy
Coverage: NBER Digest
Hyland, Megan and Colleen Carey. 2023. "Biosimilars Engage in Low Levels of Direct-to-Physician Marketing Relative to Reference Biologics." Health Affairs Scholar. 1(6).
Gaddis, S. Michael, Colleen M. Carey, and Nicholas V. DiRago. 2023. "Changes over Time in COVID-19 Vaccination Inequalities in Eight Large U.S. Cities." Socius. 9.
Gaddis, S. Michael, Nicholas V. DiRago, Meiying Li, Thalia Tom, Will Schupmann, Yvonne Carrillo, and Colleen Carey. 2022. “COVID-19 Vaccine Rollouts and the Reproduction of Urban Spatial Inequality: Disparities Within Large U.S. Cities in March and April 2021 by Racial/Ethnic and Socioeconomic Composition.” Journal of Urban Health.
Carey, Colleen. 2021. "Sharing the Burden of Subsidization: Evidence on Pass-Through from a Subsidy Revision in Medicare Part D." Journal of Public Economics. 198. (ungated)
Carey, Colleen, Ethan M. J. Lieber, and Sarah M. Miller. 2021. "Drug Firms' Payments and Physicians' Prescribing Behavior in Medicare Part D," Journal of Public Economics. 197. (ungated )
Coverage: Cornell Chronicle
Finalist for National Institute for Health Care Management Foundation’s 27th Annual Health Care Research Award
Carey, Colleen, Giacomo Meille, and Thomas Buchmueller. 2021. "Provider Compliance With Kentucky’s Prescription Drug Monitoring Program’s Mandate To Query Patient Opioid History" Health Affairs. 40(3).
Carey, Colleen, Sarah M. Miller, and Laura Wherry. 2020. "The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare." American Economic Journal: Applied Economics. 12(4): 288-318. (ungated)
Buchmueller, Thomas, Colleen Carey, and Giacomo Meille. 2020. "How Well Do Doctors Know Their Patients? Evidence from a Mandatory Access Prescription Drug Monitoring Program." Health Economics. 29 (9): 957-974. (ungated)
Buchmueller, Thomas and Colleen Carey. 2018. "The Effect of Prescription Drug Monitoring Programs on Opioid Utilization in Medicare." American Economic Journal: Economic Policy. 10(1).
Carey, Colleen, Anupam B. Jena, and Michael L. Barnett. 2018. "Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes in Medicare, 2008-2012." Annals of Internal Medicine. doi: 10.7326/M17-3065.
Carey, Colleen. 2017. "Technological Change and Risk Adjustment: Benefit Design Incentives in Medicare Part D." American Economic Journal: Economic Policy. 9(1).
Finalist for National Institute for Health Care Management Foundation’s 24th Annual Health Care Research Award
Carey, Colleen and Stephen Shore. 2013. "From the Peaks to the Valleys: Cross-State Evidence on Income Volatility Over the Business Cycle." Review of Economics and Statistics. 95(2): 549-562.
Buchmueller, Thomas, Colleen Carey, and Helen Levy. 2013. "Will Employers Drop Health Insurance Coverage Because of the Affordable Care Act?" Health Affairs. 32(9): 1522-1530.
Sommers, Benjamin D., Thomas Buchmueller, Sandra L. Decker, Colleen Carey, and Richard Kronick. 2013. "The Affordable Care Act Has Led To Significant Gains In Health Insurance And Access To Care For Young Adults." Health Affairs. 32(1).