Trends in Engagement with Opioid Use Disorder Treatment Among Medicaid Beneficiaries During the COVID-19 Pandemic (with Alyssa Tilhou, Laura Dague, Brendan Saloner, and Marguerite Burns)
Abstract: This paper examines trends in buprenorphine possession during the COVID-19 public health emergency in comparison with on-site services including urine drug testing and opioid treatment programs. We assess these outcomes using Wisconsin Medicaid administrative data containing detailed diagnostic information on all Medicaid-funded healthcare utilization. We find that among adult beneficiaries continuously enrolled from 12/2018 to 9/2020 with prior history of Opioid Use Disorder diagnosis, buprenorphine possession remained stable at the onset and for the first six months of the public health emergency. In contrast, completion of urine drug tests and receipt of opioid treatment program services declined with the start of the pandemic and recovered partially six months into the public health emergency. These findings suggest that patients in office-based settings were able to retain access to buprenorphine despite fewer on-site services like urine drug tests, while patients at opioid treatment programs experienced greater disruption in care.
Abstract: Wage offers are often bundled with non-wage amenities that are fixed at the firm level, which can lead to inefficient matching of offers to individual preferences. I develop a parsimonious search model of a frictional labor market with bundled wages and non-wage benefits, estimated using the most significant of these benefits in the United States: employer-sponsored health insurance (ESHI). I find that ESHI has a limited effect on job mobility and employment but inefficiently depresses wages, disproportionately impacting lower-wage workers. Counterfactual results suggest unbundling ESHI via universal healthcare provision would reduce wage inequality by three percentage points.
Abstract: This paper develops a simple structural model of the choice to work a second job. I examine the effects of non-wage job characteristics on this decision making in order to determine the extent to which individuals hold multiple jobs as a source of enjoyment, versus as a means of overcoming hours constraints in the primary job. To fit this model, I estimate a distribution of enjoyment parameters for individuals holding more than one job, and find that on average, individuals dislike their secondary jobs about 13.5% more than their primary jobs, but roughly 35% of these individuals enjoy their secondary jobs. Though this supports findings of hours constraints as the primary motivator of dual job holding, these results provide a framework for further study of the substantial portion of dual job holders that do prefer their second jobs.
Abstract: I examine the impact of the Covid-19 pandemic and its related income and employment shocks on the use of mental health resources in the Wisconsin Medicaid population. Using administrative Medicaid claims data from the Wisconsin Department of Health Services, I find a reduction in mental healthcare utilization during the public health emergency (PHE) that is similar to but significantly smaller than observed trends in overall outpatient visits. However, making use of the PHE declaration as an exogenous shock to employment, I find that this decline was 0.45 percentage points smaller for individuals who experienced a decrease in wages of 50% or more. This is largely driven by the subset of individuals with a pre-existing mental health diagnosis, as for this group I find the effect of an employment shock was a 1.3 percentage point smaller drop in mental health visit probability, a 4.35% difference relative to individuals who did not experience a reduction in wages. This suggests that individuals with pre-existing mental health conditions were more likely to continue care during the initial months of the pandemic if they were subjected to some form of job displacement.