Increasing Vaccination Rates: Does Pharmacy Access Matter?
Examining the Obesity Gap: A Cohort Analysis (with Marcus Dillender)
Contraception Use, Abortions, and Births: the Effect of Insurance Mandates (forthcoming, Demography) [PDF]
(previously titled Contraception and fertility: the role of insurance mandates)
Beginning August 2012, the Patient Protection and Affordable Care Act (ACA) required new private health insurance plans to cover contraceptive methods and counseling without a copay. The ACA represents the first instance of federally mandated contraception insurance coverage. Prior to the ACA, 30 states effectively mandated contraceptive insurance coverage through state-level legislation. This study utilizes variation in mandated insurance coverage of contraception across states and over time to determine the causal impact of insurance coverage of contraception on contraception use, abortions, and births. Analysis using the Behavioral Risk Factor Surveillance System finds that mandates increase the likelihood of contraception use by 2.1 percentage points. Additionally, results from state-level abortion and birth data indicate that mandates decrease the abortion rate by 3% and have an insignificant impact on the birth rate. The results imply a lower bound estimate that the ACA will result in approximately 25,000 fewer abortions.
Access to emergency contraception and its impact on fertility and sexual behavior, forthcoming, Health Economics [PDF]
Half of all pregnancies in the USA are unintended, suggesting a high incidence of either improper or nonuse of contraceptives. Emergency birth control (EBC) provides individuals with additional insurance against unplanned pregnancy in the presence of contraception failure. This study is the ﬁrst to estimate the impact of switching EBC from prescription to nonprescription status in the USA on abortions and risky sexual behavior as measured by STD rates. Utilizing state-level variation in access to EBC, we ﬁnd that providing individuals with over-the-counter access to EBC leads to increase STD rates and has no effect on abortion rates. Moreover, individual-level analysis using the National Longitudinal Survey of Youth indicates that risky sexual behavior such as engaging in unprotected sex and number of sexual encounters increases as a result of over-the-counter access to EBC, which is consistent with the state-level STD ﬁndings.
The Effect of Medicare Eligibility on Spousal Insurance Coverage (with Marcus Dillender; forthcoming, Health Economics) [PDF]
A majority of married couples in the United States take advantage of the fact that employers often provide health insurance coverage to spouses. When the older spouses become eligible for Medicare, however, many of them can no longer provide their younger spouses with coverage. In this paper, we study how spousal eligibility for Medicare affects the health insurance and health care access of younger spouses. We ﬁnd spousal eligibility for Medicare results in younger spouses being more likely to have insurance privately purchased through the individual market, which tends to provide fewer beneﬁts at a higher cost. As a result, younger spouses are less likely to have comprehensive coverage and use fewer health care services as a result of their older spouses becoming eligible for Medicare. Most of these changes in coverage appear to be driven by employer practices and not retirement decisions made by couples.
Effectiveness of state-level vaccination mandates: evidence from the varicella vaccine (with Jason Abrevaya, Journal of Health Economics (2011)) [PDF]
This paper utilizes longitudinal data on varicella (chickenpox) immunizations in order to estimate the causal effects of state-level school-entry and daycare-entry immunization mandates within the United States. We find significant causal effects of mandates upon vaccination rates among preschool children (aged 19-35months); these effects appear in the year of mandate adoption, peak two years after adoption, and disappear (minimal difference from aggregate trend) about four years after adoption. For a daycare-entry mandate enacted in 2000, the model and estimates imply that 22% of the increase in state-level immunization rates were caused by the mandate introduction.
Working Papers/Works in Progress
Economic Conditions and Vaccination Rates (with Rob Garman and Mark Owens)