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Report
Exploring causes of and responses to the opioid epidemic in New England
The opioid epidemic remains rampant in New England, where, from 2015 through 2017, more than 10,000 people died from opioid overdoses. In 2017, each of the six states experienced an overdose-death rate that was greater than the national average. Beyond causing a high number of deaths, the opioid epidemic is costing New England productive workers. People with the most severe problems stemming from opioid-use disorder tend to be in the 25?44 age group, but no one is immune. The epidemic affects people of every type?all ages and all races, men and women, residents of rural areas and of urban ...
Briefing
Declining access to health care in northern New England
Access to health care is a major concern across the northern New England states?Maine, New Hampshire, and Vermont?where rising operating costs and population loss threaten the stability of hospitals and other medical facilities that serve their surrounding rural communities. New analysis of financial data shows that many rural hospitals are operating at losses that are predictive of financial distress or even closure. Consequently, the communities served by these hospitals may be at risk of losing the benefits they provide to public health and the local economy. Addressing the financial ...
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 ...
Briefing
The COVID-19 Pandemic’s Impact on Public Transportation Ridership and Revenues across New England
In New England and elsewhere, public transportation was among the many sectors immediately impacted by the COVID-19 pandemic. Essential workers and members of the labor force with no teleworking options and no alternate means of transportation continued to rely on public transit following the onset of the pandemic. However, with business closures, event cancellations, and social distancing regulations in effect, ridership dropped sharply, hampering transit systems’ ability to generate revenue. As of June 2021, ridership remained depressed despite the relaxation of restrictions and a general ...
Briefing
Aging and declining populations in northern New England: is there a role for immigration?
In hundreds of communities across northern New England, the population is aging rapidly and becoming smaller. The entire country is aging, but northern New England stands out: Among the populations of all US states, those of Maine, New Hampshire, and Vermont have the top-three highest median ages, respectively. The situation is even more extreme in northern New England?s rural counties, where the populations of the smallest towns generally are substantially older than those of the rest of the region. These communities also have seen the slowest, or even negative, population growth over the ...
Report
The criminal population in New England: records, convictions, and barriers to employment
The portion of the U.S. population with a criminal record has been receiving mounting attention in recent years. While there is a significant amount of data about the criminal population under supervision, there is very limited linked data identifying how most individuals move through the criminal justice system. By analyzing multiple national and state data sources, this report aims to identify the size of the New England population with a criminal record and to describe the broad demographic characteristics of this population. The report illustrates that the size of the population in the ...
Briefing
Recent Trends in Infrastructure Investment and Capacity in New England
Households and businesses throughout New England rely on roads, bridges, dams, sewers, drinking water systems, and other elements of public infrastructure daily. However, the region’s states and municipalities have long been acknowledged as spending less than much of the rest of country on these public capital assets. The Infrastructure Investment and Jobs Act of 2021 (IIJA) represents a massive and historic opportunity that will fund billions of dollars’ worth of repairs and improvements to public infrastructure across the region. The $1.2 trillion package contains $550 billion in new ...
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 ...
Briefing
College Towns and COVID-19: The Impact on New England
The abrupt closing of college campuses this spring due to the spread of COVID-19 upended the lives of students and their families and disrupted the higher education sector. The impact of these closures and the questions of whether and how to reopen campuses this fall have been widely discussed. Less attention has been paid to the potential consequences for the local economies of the cities and towns that depend heavily on higher education. This issue is particularly important in New England, where in many communities, colleges and universities are among the largest employers and make an ...