Peer-Reviewed Publications
Naher, S., Amoah, D., Cartwright, K. et al. Impacts of the Affordable Care Act Medicaid Expansion on Health Insurance, Health Care Utilization, and Health Outcomes for Mexican Americans. J Econ Race Policy (2022). https://doi.org/10.1007/s41996-022-00100-0
Working Papers
Naher, Samsun. 2021. "Effects of Affordable Care Act (ACA) Marketplace Plans on Disability Claiming." FY2021 Research Projects: Extramural Mentored Fellowship Program. Retirement & Disability Research Center. https://cfsrdrc.wisc.edu/publications/working-paper/emf21-04
Working papers from Postdoc
Naher, S., Prusynski, R., Mroz, T. The Impact of Changes in Ownership on Quality of Home Health Agencies. Under Review
Abstract: In an effort to increase transparency about ownership of healthcare providers, the Centers for Medicare & Medicaid Services recently released detailed data on home health agency ownership. This data was used to examine the impact of ownership changes on two domains of home health agency quality: quality of care star ratings, which measure care processes and patient outcomes, and patient experience star ratings, which capture patient perspectives on the care they receive. Changes of ownership from 2015-2019 were associated with a 0.54-point (26 percent) increase in quality of care star ratings, but no change in patient experience star ratings. Findings suggest changes in ownership in home health agencies do not affect both domains of quality in the same way. Policymakers should consider both star ratings when monitoring quality and creating regulatory policies.
Keywords: home health care; home health agency; Medicare, ownership; quality of health care
Key points:
• Home health agencies that changed their ownership experienced an increase in quality of care star ratings compared to the agencies that did not change.
• Changes in ownership did not impact patient experience star ratings for home health agencies.
• Changes in ownership in home health agencies do not affect both domains of quality in the same way, so both star ratings should be considered for when monitoring quality and considering regulatory policies associated with changes in ownership.
Naher, S., Mroz, T., Molton, I.R., Delaney, K.E. Effects of COVID-19 Pandemic on the Prescribing of Medications Commonly Used By Medicare Beneficiaries with Physical Disabilities. In preparation for submission to the Archives of Physical Medicine and Rehabilitation
Abstract:
Research Objective: The COVID-19 pandemic disproportionately affected Medicare beneficiaries with disabilities compared to those without disabilities in terms of more COVID-19 cases and hospitalizations. People with physical disabilities commonly use prescription medications to manage pain and spasticity associated with their disability. It is unknown how the COVID-19 pandemic impacted access to these medications among Medicare beneficiaries with physical disabilities. The objective of this study was to examine how the COVID-19 pandemic affected prescribing practices for medications to treat pain and spasticity related to physical disability for Medicare fee-for-service beneficiaries.
Study Design: We used the Medicare Part D Prescription Drug Event Standard Analytic File from 2017 to 2021, which includes annual data on all prescription medications covered by Medicare Part D at the provider level (i.e., physician-drug-year). Our outcome was the prescription of drugs commonly used by Medicare beneficiaries with physical disabilities, including drugs used primarily to treat pain and spasticity related to physical disabilities and drugs used to manage conditions that commonly result in physical disabilities (e.g., multiple sclerosis, Parkinson's disease). First, we employed an event study methodology (ESM) to estimate how prescribing of these medications changed due to the COVID-19 shock. Second, we used a collapsed difference-in-differences (DID) model to estimate the average effect of the COVID-19 pandemic on prescribing of these medications. Finally, we estimated the heterogeneous effect of the COVID-19 pandemic on prescribing of these medications by physician specialty.
Population Studied: 126,030,606 physician-drug-year observations for medications commonly used by Medicare fee-for-service beneficiaries with physical disabilities.
Principal Findings: The event study results show a 1.29 decrease [95%CI: -2.51, -0.07] in prescription drugs commonly used by Medicare beneficiaries with physical disabilities in year 2021 compared to baseline. However, the collapsed DID model did not find a significant change in average total prescription drugs annually per physician [1.18, 95%CI: -2.42, 0.07]. The COVID-19 pandemic statistically significantly decreased the total prescription drugs annually per physician by 18.53 for neurologists [95%CI: -32.07, -4.99], but no change for physiatrists [10.94, 95%CI: -1.73, 23.60].
Conclusions: The pandemic decreased the overall prescribing of medications commonly used by Medicare beneficiaries with physical disabilities, but did not change among physiatrists, suggesting that being under the care of physical medicine and rehabilitation specialists may have preserved access to these medications during the pandemic for some Medicare beneficiaries with physical disabilities. Future study with beneficiary-level data is necessary to examine how access to prescriptions was affected for subgroups of Medicare beneficiaries with physical disabilities based on their sociodemographic and clinical characteristics, as well as provider type.
Implications for Policy or Practice: The decrease in prescribing of medications commonly used by Medicare beneficiaries with physical disabilities during the COVID-19 pandemic highlights the importance of ensuring access to care during times of crisis. While telehealth and mail-order pharmacies provided alternatives to access medications, these solutions were not universally accessible, leading to disparities in medication adherence. Policies to support access to necessary medications for vulnerable populations should be considered when preparing for future public health emergencies.
Naher, S., Mroz, T., Molton, I.R. The Impact of Health Insurance Coverage on Medication Access in Persons with Long-Term Physical Disabilities (has been accepted for presentation at the 2025 APPAM Fall Research Conference to be held in Seattle, WA, November 13 - 15, 2025)
Abstract: Individuals with disabilities often encounter barriers to accessing healthcare, including essential medications that support health management and quality of life. While previous research has shown that health insurance reduces cost-related medication nonadherence, particularly among people with disabilities, this relationship has not been specifically examined in individuals with long-term physical disabilities (LTPDs). This study investigates how health insurance coverage influences medication access among people with LTPDs, including those with spinal cord injury, multiple sclerosis, muscular dystrophy, and post-polio syndrome. Using longitudinal survey data from waves five through seven (2014–2017), we analyze responses from 1,044 participants regarding six types of financial barriers to medication access, such as skipping doses or delaying prescription fills to save money. Overall, nearly a third of participants reported experiencing at least one medication access barrier in the past year. We conducted multiple logistic regression analyses to assess the association between health insurance status and medication access, controlling for age, sex, household income, marital status, race/ethnicity, education level, residence type, and diagnoses. Results show that individuals with private or government health insurance were significantly less likely to face medication access barriers compared to those who were uninsured. The findings suggest that expanding health insurance coverage could play a key role in reducing financial barriers to medication access among individuals with LTPDs.
Dissertation
Effects of Affordable Care Act (ACA) Marketplace Plans on Disability Claiming
Abstract: Health insurance marketplaces, a.k.a. “exchanges”, were established through the Affordable Care Act (ACA) to facilitate individual access to affordable health insurance following the implementation of the individual mandate. People with qualifying disabilities can alternatively obtain health insurance through Supplemental Security Income (SSI) and SSI for Children programs. This study examines the relationship between the pricing of the ACA marketplace plans and disability claiming. Specifically, I focus on the effect of state-level and Geographic Rating Area (GRA)-level changes in the prices of health plans for 30-year-olds with two children on the number of SSI and SSI child applications per 10,000 individuals at the state level and GRA-level using a linear fixed-effect model. I find no statistically significant effects from the changes in the health plan prices on the number of disability applications per 10, 000 individuals at the state level and GRA level in the primary analyses. However, I find evidence that certain subgroups are less likely to apply for SSI programs if the premium of a 30-year-old-with-two-children health plan increases, such as those living in states or GRAs with higher unemployment rates, poverty ratios, and high school graduation rates, as well as individuals living in states where a higher percentage report work limitations. I also find evidence that specific subgroup populations apply to SSI programs if the cost of the premium of a 30-year-old-with-two-children health plan increases, such as populations living in GRAs where there are higher percentages of non-Hispanic whites or individuals reporting difficulties with daily tasks or work limitations.
[Working paper can be found here and research brief here] [Permanent Link]
Effects of COVID-19 Pandemic on Prescription Drug Use for Anxiety and Depression among Medicaid Enrollees (Job Market Paper)
Abstract: The COVID-19 pandemic especially threatened Medicaid beneficiaries, who were already low-income, vulnerable populations and, therefore, more likely to be medically affected by health shocks and financially affected by shutdown policies. I use Medicaid State Drug Utilization Data at the state-quarter level from the first quarter of 2014 to the last quarter of 2021 to examine the impact of the pandemic on the utilization of prescription medications for anxiety and depression among Medicaid beneficiaries. The event study results indicate that the COVID-19 pandemic statistically significantly increased the percentage share of all prescription drugs use for anxiety and depression but decreased prescription drug use for anxiety and depression per Medicaid enrollee. Additionally, difference-in-differences (DID) results suggest a relative increase in prescription use for anxiety, depression, and all conditions in Medicaid expansion states compared to non-expansion states. The decline in drug utilization in this high-risk population is concerning. Lack of access to prescription drugs for anxiety and depression during times of stress can create long-term health consequences and increase costs for state Medicaid and other public assistance programs. These results indicate that the Affordable Care Act (ACA) Medicaid expansions continue to play an essential role in increasing healthcare utilization among Medicaid beneficiaries.
The updated version of the paper can be found here.
Decomposing the impact of the COVID-19 pandemic on prescription drug use for anxiety and depression among Medicaid Enrollees
Abstract: Prior research has shown that Medicaid prescription drug use declined during COVID, including for anxiety and depression (Naher, 2023). This paper decomposes the effects of COVID-19 policies, health insurance coverage, the pre-existing prevalence of mental health conditions, state-level demographics, and state-level policies in explaining these documented changes in anxiety and depression prescription during the COVID-19 pandemic. Using the Medicaid State Drug Utilization Data at the state-quarter level between the first quarter of 2014 and the last quarter of 2021 and a Blinder-Oaxaca decomposition approach, this study examined how different characteristics were associated with the changes in prescription drug use for anxiety and depression among Medicaid enrollees during pandemic. This study conducted the analyses in two steps. First, it decomposed prescription use differences due to the COVID-19 pandemic. Second, it examined how equalizing the covariates would close the differences in prescription use in the pre- and post-COVID period. The difference in prescription drug use for anxiety, depression, and all conditions between the pre-COVID period and post-COVID period is driven by the COVID-19 policies, such as stay-at-home orders, mask mandates, and school closure mandates; the prevalence of mental health conditions; and quarter and state fixed effects. Lockdown mandates, school closure mandates, and state-fixed effects contribute to the decrease in overall prescription drug use. In contrast, mask mandates, the prevalence of mental health conditions, and quarter-fixed effects contribute to increased prescription drug use during the pandemic. This work highlights the breakdown in access to healthcare during the pandemic. Expanding telehealth and other remote care methods could help ensure continuity of care even when in-person care is not an option.
The updated version of the paper can be found here.
Works in Progress
Naher S., Stith, S.S. Treating Anxiety and Depression During COVID: The Role of Cannabis & Prescription Drugs.
Sattar, A., Naher S. The Association Between Tobacco Use and Receiving Antenatal Healthcare Among Women in Bangladesh.
Naher S., Horn, P.B., Li, X. Impacts of the Affordable Care Act Dependent Coverage Mandate on Insurance Coverage, Access to Care, and Self-Reported Health Status of Undocumented Young Adults Compared to Documented Whites and Hispanic Young Adults.
Blankenship, J. C., Leung, E., Naher, S., Santos, R. Social Determinants of CPR Recipients in Out-of-Hospital Cardiac Arrest.
Naher S., Rahman M.A. Relationship between GDP, Life Expectancy and Public Health Expenditure in Bangladesh: A Vector Autoregressive (VAR) Model.
Rahman M.A., Naher S. The Impact of natural disasters on child health and investments in Bangladesh.
Rahman M.A., Naher S. The Effects of Air Pollution on Housing Values in the Southwest of US: A Hedonic Price Approach.
Rahman M.A., Naher S. The Role of Air Pollution and Economic Growth in the determination of Health Expenditure in SAARC countries.
Naher S. Optimal Environmental Policy for a Uranium Mine Under Polluting Wastes.
Abstract: Five legacy uranium mining operations are located in the Grants Mining District, New Mexico. Within these five mining sites, the Homestake Mining Company (HMC) site is one of the large extraction firms which leaves dangerous chemicals after extraction. The Nuclear Regulatory Commission (NRC), in coordination with the Environmental Protection Agency (EPA) and New Mexico Environment Department (NMED), currently regulates ongoing remedial activities at the Homestake Mining site for cleaning up the soil, rock, and groundwater. This study analyzes two socially optimal environmental policies 2010 Five Year Plan and the 2015 Five Year Plan for the Homestake Mining site with a model that takes into account waste or waste rock production of the mine. I develop a model in which the mine produces an externality related to the waste rocks, such as uranium acid mine drainage. I find that the extraction rate tends to be lower with higher waste production, and the optimal taxes on the waste production is strictly increasing over time.
Naher S. Did public health insurance for Mexican Americans crowd out private health insurance? (has been accepted for presentation at the Southern Economic Association® (SEA) 95th Annual Meeting, scheduled for November 22-24, 2025 (Saturday through Monday) at the Tampa Marriott Water Street in Tampa, FL)
Graduate Research Assistant: Department of Economics, University of New Mexico, USA
Project: "Social Determinants of CPR Recipients in Out-of-Hospital Cardiac Arrests" - with Dr. Richard Santos Aug 2022 - Dec 2023
Project: "Chronic Kidney Disease and Community Health Workers" - with Dr. David van der Goes Aug 2018 - Jan 2021
Project: "Effects of SNAP-Associated Work Requirements on Disability Claiming" - with Dr. Sarah Stith Jan 2020 - May 2020
Project: "Effects of recreational cannabis legalization and dispensary access on product
availability among medical cannabis users" - with Dr. Sarah Stith Jan 2020 - May 2020
Project: "Chronic Kidney Disease and Community Health Workers" - with Dr. David van der Goes Aug 2018 - May 2019
Graduate Research Assistant: Advance at UNM, University of New Mexico, USA
Project: "Mexican American and Health Utilization under ACA" - with Dr. Kate Cartwright Summer 2021
Project: "History of translation of the Huarochiri Manuscript" - with Dr. Angelica Serna Jeri Summer 2021
Book Chapters
Naher, S. Economic and Government Programs: Their impact on Baby Boomer Generation. In “The Baby Boomers Come of Age: Implications for Research, Policy, and Practice”. Book chapter. American Psychological Association Books. Invited to contribute. Currently Under Review