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Report
Did the Medicaid Expansion Crowd Out Other Payment Sources for Medications for Opioid Use Disorder? Evidence from Rhode Island
Using information from the all-payer claims database for Rhode Island covering more than three-quarters of health insurance enrollees in the state from April 2011 through May 2019, this paper offers new measures of the association between the Medicaid expansion and the rate of receipt of buprenorphine and methadone for opioid use disorder (OUD). These robust measures adjust for the extent to which new Medicaid payments for these medications that started in 2014 crowded out payments from either non-Medicaid insurance or from non-insurance subsidies for the treatment of opioid abuse. We find ...
Journal Article
Comments on 2000 benchmark revisions to regional employment data
Working Paper
Did the Affordable Care Act Affect Access to Medications for Opioid Use Disorder among the Already Insured? Evidence from the Rhode Island All-payer Claims Database
Previous research suggests that state Medicaid expansions implemented under the Patient Protection and Affordable Care Act (ACA) helped large numbers of patients suffering from opioid use disorder (OUD) gain access to life-saving medications, including buprenorphine. However, Medicaid expansions could have impeded access to care among individuals already enrolled in Medicaid, as new enrollees would have placed added demands on a limited supply of buprenorphine providers. Using a panel data set of medical claims from Rhode Island, we estimate the causal effects of the state’s January 2014 ...
Report
The Medicaid Expansion and the Uptake of Medication-assisted Treatment for Opioid Use Disorder: Evidence from the Rhode Island All-payer Claims Database, 2012–2018
This article uses the all-payer claims database for the state of Rhode Island to assess recent progress in the state toward the goal of expanding access to medication-assisted treatment (MAT) for opioid use disorder (OUD). The analysis highlights the role played by the Affordable Care Act (ACA) and the associated Medicaid expansion in furthering that goal. Using measures that account for changes in health insurance enrollment, we find that the MAT rate per 100,000 enrollees in Rhode Island effectively doubled between 2012 and 2018, while the prevalence of OUD in the sample also doubled over ...
Working Paper
Who Gets Medication-assisted Treatment for Opioid Use Disorder, and Does It Reduce Overdose Risk? Evidence from the Rhode Island All-payer Claims Database
This paper uses the all-payer claims database (APCD) for Rhode Island to study three questions about the use of medication-assisted treatment (MAT) for opioid use disorder (OUD): (1) Does MAT reduce the risk of opioid overdose; (2) are there systematic differences in the uptake of MAT by observable patient-level characteristics; and (3) how successful were federal policy changes implemented in 2016 that sought to promote increased use of buprenorphine, one of three medication options within MAT? Regarding the first question, we find that MAT as practiced in Rhode Island is associated with a ...
Working Paper
Employment Trajectories among Individuals with Opioid Use Disorder: Can Evidence-Based Treatment Improve Outcomes?
Using administrative records of Medicaid enrollees in Rhode Island that link their health-care information with their payroll employment records, this paper produces new stylized facts concerning the association between opioid use disorder (OUD) and employment and inquires as to whether treatment with FDA-approved medications might boost the job-finding rates of OUD patients. We find that individuals diagnosed with OUD are less likely to be employed compared with other Medicaid enrollees, that their employment tends to be more intermittent, and that they face increased job-separation risk ...
Journal Article
Art's economic power in New England
Journal Article
Lessons from the Rhode Island banking crisis
The failure of the Rhode Island Share and Deposit Indemnity Corporation (RISDIC), a private insurance fund, and the closure of its 45 remaining member institutions froze the accounts of 300,000 individuals and 10 percent of all deposits in the state. While the closure of two institutions triggered RISDICs demise, flaws in both design and management had set the stage for failure and are the focus of this article. The authors group RISDICs problems into three categories: risk concentrations, control of the insurance fund by those it insured, and RISDICs inadequate regulatory oversight of ...