Academic Papers and Publications
Peer Reviewed Publications
- “Dynamic Price Competition for Low-Cost Silver Plans on Healthcare.Gov 2014–2021.” Medical Care Research and Review, July 2, 2023. https://doi.org/10.1177/10775587231183567. (with David M. Anderson)
- “Antitrust and Accountable Care Organizations: Observations for the Physician Market.” Medical Care Research and Review, January 2016, 1077558715627554. (with Samuel A. Kleiner and William D. White)
- “Environmental and health impacts from the introduction of improved wood stoves: evidence from a field experiment in Guatemala.” Environment, Development and Sustainability 13, no. 4 (2011): 657-676. (with Kent Moriarty, and Bruce Wydick)
More than 16 million people receive health care coverage through the Affordable Care Act’s (ACA) individual health insurance marketplaces. Many enrollees receive premium subsidies that are tied to the premium of the second least expensive silver plan available. This study investigates the consistency of the least expensive silver plan offered on Healthcare.gov from 2014 to 2021 and finds that on average, from one year to the next, the same insurer offered the least expensive silver plan in 63.1% of counties representing 54.7% of the population. However, even when the same insurer offers the least expensive plan, almost half the time, they introduce a new, less expensive plan in the next policy year. Consequently, ACA enrollees who previously purchased the least expensive silver plan may face incremental premium costs unless they spend time and effort to carefully reevaluate their choices each year. We estimate the potential premium cost of inattention and show how it varies over time and across states.
The creation of Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program has generated antitrust concerns. Utilizing a framework developed by the antitrust authorities for analyzing provider concentration for potential ACO participants, we examine the market for physician services, with a focus on the share of practices that could potentially be subject to antitrust scrutiny. Our findings suggest that while most physician practices would fall below the threshold that could raise anticompetitive concerns, this varies considerably by market and specialty. Furthermore, we find that the largest physician practice in most markets potentially remains at risk for antitrust review under the existing criteria.
Improved wood-burning stoves offer a possible solution that can simultaneously impact both problems of deforestation and problems of respiratory health in developing countries. We carried out a field experiment in which new fuel-efficient woodstoves were allocated in a Guatemalan village via the use of a lottery. A 2008 baseline survey was carried out on 2,148 individuals in 351 households, and then a follow-up survey was carried out in 2009, 4 months after households received the stoves. We found that households with the new stoves reduced wood consumption by an average of 59.1%. We also found indications of reductions in indoor air related health problems, where point estimates indicate a significant reduction in reported respiratory symptoms by 48.6% among women and 63.3% among children.
- The Efficiency Implications of Physician Integration: Behavioral vs Administrative (view current working paper)
- The Impact of ACO Formation on Physician Referrals (with Samuel Kleiner). Funded by a grant from Cornell’s Institute for the Social Sciences. Presented as a poster at ASHEcon 2019. (view current working paper).
- Physician Practice and MCO Negotiation: The Impact of Time Sensitive Supply and Demand. Presented as a poster at ASHEcon 2018. (view current working paper).
- Heterogeneous Impacts from the Release of Inpatient Care Reports in Texas (view current working paper)
- Identifying and Correcting Bias Driven by Market Boundaries in Willingness-to-Pay Estimates (view current working paper)
Works in Progress:
- Insurer Market Structure as a Determinate of Physician Practice Size (view current working paper)
- Who does what? An Analysis of the Relationship Between Physicians’ Specialties and Procedures (preview)
- Did Medicare Accountable Care Organizations Increase Integration? A Look at Patient Sharing Patterns