Author ORCID Identifier

https://orcid.org/0000-0002-5814-5478

Year of Publication

2021

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Business and Economics

Department/School/Program

Economics

First Advisor

Dr. Charles Courtemanche

Abstract

This dissertation explores the role of policy on health outcomes and behaviors that relate to major public health concerns. Essay 1 and Essay 2 investigate the effects of Medicaid expansions on substance-use outcomes. Essay 3 examines the impacts of school reopenings in Texas on COVID-19 and mobility outcomes.

Essay 1 studies the effect of the Affordable Care Act Medicaid expansion. Using State Drug Utilization Data 2011-2017, I find that the Medicaid expansion is associated with an increase of 40-60 Medicaid-paid opioid prescriptions per 1,000 people aged 19–64. However, the results suggest that post-expansion prescriptions are, on average, shorter or prescribed in lower doses. Analyses of commonly misused opioids show that hydrocodone is the most affected substance, which makes up more than 50 percent of all Medicaid-paid opioid prescriptions. I do not find evidence that the Medicaid expansion is associated with the fentanyl epidemic.

Essay 2 studies the impact of Medicaid expansions on discharge outcomes of substance-use-disorder treatment and racial disparities in treatment completion. Using data from the Substance Abuse and Mental Health Services Administration 2008-2018 and event-study analysis, I do not find evidence that Medicaid expansions affect treatment completion rate in public-funded specialty treatment facilities. Analyses on racial subsamples, however, show some evidence of a negative effect on treatment completion among Black patients, while there is little effect among White and Hispanic patients.

Essay 3 examines the effect of fall 2020 school reopenings in Texas on county-level COVID-19 cases and fatalities. Analyses from hand-collected data imply that school reopenings led to at least 43,000 additional COVID-19 cases and 800 additional fatalities within the first two months. Results on mobility, using Safegraph data to provide evidence that spillovers to adults’ behaviors contributed to these large effects. Median time spent outside the home on a typical weekday increased substantially in neighborhoods with large numbers of school-age children, suggesting a return to in-person work or increased outside-of-home leisure activities among parents.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2021.353

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