Research
Publications
Employed in a SNAP? The Impact of Work Requirements on Program Participation and Labor Supply (with Colin Gray, Adam Leive, Kelsey Pukelis, and Mary Zaki) [download]
AEJ: Economic Policy, 2023, 15(1): 306-341.
Work requirements are common in US safety net programs. Evidence remains limited, however, on the extent to which work requirements increase economic self-sufficiency or screen out vulnerable individuals. Using linked administrative data on food stamps (SNAP) and earnings with a regression discontinuity design, we find robust evidence that work requirements increase program exits by 23 percentage points (64 percent) among incumbent participants. Overall program participation among adults who are subject to work requirements is reduced by 53 percent. Homeless adults are disproportionately screened out. We find no effects on employment and suggestive evidence of increased earnings in some specifications.
Coverage: NPR's The Indicator, NPR Here & Now, NPR Marketplace (1, 2), Time, Vox's The Weeds, The Messenger, Newsweek, Kellogg Insight
Policy impact: cited in Congressional testimony (1, 2, 3, 4), CMS decision letters (1, 2)
Employer Consolidation and Wages: Evidence from Hospitals (with Matt Schmitt) [download]
American Economic Review, 2021, 111(2): 397-427.
We test whether wage growth slows following employer consolidation by examining hospital mergers. We find evidence of reduced wage growth in cases where both (i) the increase in concentration induced by the merger is large and (ii) workers’ skills are industry-specific. In all other cases, we fail to reject zero wage effects. We consider alternative explanations and find that the observed patterns are unlikely to be explained by merger-related changes besides labor market power. Wage growth slowdowns are attenuated in markets with strong labor unions, and wage growth does not decline after out-of-market mergers that leave local employer concentration unchanged.
Coverage: New York Times, Freakonomics, Modern Healthcare, Healthcare Dive, Kellogg Insight
Policy impact: FTC statements (1, 2), CEA post (explains Executive Order), Treasury report, cited in Congressional testimony (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12) and White House report
Health Care Demand Under Simple Prices: Evidence From Tiered Hospital Networks [download]
AEJ: Applied Economics, 2020, 12(4): 196-223.
This paper shows that consumers respond to prices for complex health care when they can easily assess out-of-pocket prices. Health care cost containment efforts increasingly incentivize price-shopping, despite a dearth of evidence that this steers consumers toward lower-priced care for major medical services. I show that consumers shift toward lower-priced hospitals in the highly simplified price information environment of insurance plans with tiered hospital networks. Consumers observe a single predictable, well-defined price that applies to a broad range of services within each of at most three hospital tiers. Within three years, expected partial-equilibrium savings reach 8–17 percent of baseline spending.
Coverage: Kellogg Insight
Policy impact: CMS rule, CBO model
Working Papers
Regulating Out-of-Network Hospital Payments: Disagreement Payoffs, Negotiated Prices, and Access (with Nicholas Tilipman) [download]
Recent policy proposals seek to regulate the prices that hospitals can levy for care delivered outside of a patient's insurance network. In this paper, we study the potential effects of such regulations on equilibrium in-network prices and access. We first describe how out-of-network reimbursements affect negotiations over in-network prices and network status. We then conduct a series of counterfactuals to empirically evaluate current policy proposals that would cap out-of-network reimbursements. To do so, we estimate a model of insurer-hospital bargaining that explicitly allows for transactions in the absence of a contract. We operationalize the model using a novel, data-driven measure of out-of-network prices paid by insurers to hospitals. Our results suggest that reducing out-of-network reimbursements would have the intended effect of lowering negotiated prices with in-network hospitals. Aggressive regulation, however, would reduce access to care as a result of narrower networks and some outright service line closures.
In Progress
Impact of Increasing Hospital Price Transparency: Collusion, Search, and Equilibrium Price (with Maryam Saeedi and Robert Town)
Peer Learning in College Applications (with Ana Gazmuri)
Labor Market Collusion through Common Leadership (with Alejandro Herrera-Caicedo and Jessica Jeffers)
Papers in Health Policy
Tiered Physician Network Plans and Patient Choices of Specialist Physicians (with Vilsa Curto, Alexa Magyari, Marema Gaye, and Anna Sinaiko) [download]. JAMA Network Open, 2023, 6(11):e2341836.
Tiered Network Health Plans and Changes in Physician Practice Intensity (with Anna Sinaiko). Forthcoming at Health Services Research.
Hospitals Are Paid Their Chargemaster Prices by Some Health Insurers (with Nicholas Tilipman). Working paper.