Department of Economics
University of Notre Dame
3049 Jenkins Nanovic Halls
Notre Dame, IN 46556
NBER Program Affiliations:
NBER Affiliation: Faculty Research Fellow
Institutional Affiliation: University of Notre Dame
NBER Working Papers and Publications
|November 2019||Origins of the Opioid Crisis and Its Enduring Impacts|
with Abby E. Alpert, William N. Evans, David Powell: w26500
Overdose deaths involving opioids have increased dramatically since the mid-1990s, leading to the worst drug overdose epidemic in U.S. history, but there is limited empirical evidence on the initial causes. In this paper, we examine the role of the 1996 introduction and marketing of OxyContin as a potential leading cause of the opioid crisis. We leverage cross-state variation in exposure to OxyContin’s introduction due to a state policy that substantially limited OxyContin’s early entry and marketing in select states. Recently-unsealed court documents involving Purdue Pharma show that state-based triplicate prescription programs posed a major obstacle to sales of OxyContin and suggest that less marketing was targeted to states with these programs. We find that OxyContin distribution was a...
|April 2018||How the Reformulation of OxyContin Ignited the Heroin Epidemic|
with William N. Evans, Patrick Power: w24475
We attribute the recent quadrupling of heroin death rates to the August, 2010 reformulation of an oft-abused prescription opioid, OxyContin. The new abuse-deterrent formulation led many consumers to substitute to an inexpensive alternative, heroin. Using structural break techniques and variation in substitution risk, we find that opioid consumption stops rising in August, 2010, heroin deaths begin climbing the following month, and growth in heroin deaths was greater in areas with greater pre-reformulation access to heroin and opioids. The reformulation did not generate a reduction in combined heroin and opioid mortality—each prevented opioid death was replaced with a heroin death.
Published: William N. Evans & Ethan M. J. Lieber & Patrick Power, 2019. "How the Reformulation of OxyContin Ignited the Heroin Epidemic," The Review of Economics and Statistics, vol 101(1), pages 1-15. citation courtesy of
|January 2018||Targeting with In-kind Transfers: Evidence from Medicaid Home Care|
with Lee M. Lockwood: w24267
Making a transfer in kind reduces its value to recipients but can improve targeting. We develop an approach to quantifying this tradeoff and apply it to home care. Using randomized experiments by Medicaid, we find that in-kind provision significantly reduces the value of the transfer to recipients while targeting a small fraction of the eligible population that is sicker and has fewer informal caregivers than the average eligible. Under a wide range of assumptions within a standard model, the targeting benefit exceeds the distortion cost. This highlights an important cost of recent reforms toward more flexible benefits.
Published: Ethan M. J. Lieber & Lee M. Lockwood, 2019. "Targeting with In-Kind Transfers: Evidence from Medicaid Home Care," American Economic Review, vol 109(4), pages 1461-1485. citation courtesy of
|April 2017||Cost of Service Regulation in U.S. Health Care: Minimum Medical Loss Ratios|
with Steve Cicala, Victoria Marone: w23353
A health insurer's Medical Loss Ratio (MLR) is the share of premiums spent on medical claims. The Affordable Care Act introduced minimum MLR provisions for all health insurance sold in fully-insured commercial markets, thereby capping insurer profit margins, but not levels. While intended to reduce premiums, we show this rule creates incentives analogous to cost of service regulation. Using variation created by the rule's introduction as a natural experiment, we find claims costs rose nearly one-for-one with distance below the regulatory threshold: 7% in the individual market, and 2% in the group market. Premiums were unaffected.