About

I received my doctorate in economics from the University of California at Berkeley in 1984. Prior to joining UVA, in 2010, I held faculty positions at the University of North Carolina at Greensboro and Boston University, and was a Postdoctoral Research Fellow at Brandeis University. During the 1996-97 academic year I served as Senior Economist on President Clinton’s Council of Economic Advisers, where my main responsibilities were in the areas of health policy, aging and labor market issues. I am currently a Research Associate in the Economics of Health and Children’s Programs of the National Bureau of Economic Research and a Research Fellow at the Institute for the Study of Labor (IZA) in Germany.

Research topics

• Medicine
• Psychology
• Sociology
• Psychiatry
• Demography
• Economics
• Business
• Internal medicine
• Political Science
• Nursing
• Clinical psychology
• Demographic economics
• Environmental health
• Labour economics
• Law
• Economic growth

Selected publications

• Lingering Effects Of The COVID-19 Pandemic On Non-COVID-19 Death Rates In The US, 2020–24

  Health Affairs · 2026-04-01

  article1st authorCorresponding

  It is not currently understood whether the COVID-19 pandemic led to a lengthy period of elevated mortality rates or whether rates have returned to prepandemic trends. To examine this, I calculated age-adjusted excess mortality rates and percent excess mortality overall, by cause, and for population subgroups. COVID-19 death rates in the US fell 93 percent from 2021 to 2024, whereas excess non-COVID-19 death rates declined just 48 percent, with sustained excess mortality likely in the future, particularly for many natural causes. Suicide death rates did not rise, drug and homicide death rates jumped initially but declined relatively quickly, and transport death rates grew more moderately but showed greater persistence. Demographic-group differences were pronounced, with substantial lasting effects for females, American Indian/Alaska Native people, and seniors. This reflects heterogeneity in the prepandemic composition of deaths and in cause-specific percent excess mortality rates across groups. These results indicate important clinical and policy challenges, especially for natural causes of death and for groups facing relatively high cause-specific excess mortality rates.

  PublisherDOI

• The impact of state paid sick leave mandates on Medicaid-financed prescription medications

  American Journal of Health Economics · 2026-03-19

  articleSenior author
  PublisherDOI

• Pension Reforms and Personnel Decisions

  Labour · 2025-02-25

  articleSenior author

  ABSTRACT While the empirical literature on the effects of pension reform on workers is broad, less is known about the impact on employers. Yet reforms that create incentives to postpone retirement may affect employer labor demand and labor costs, especially in settings where there are strict legal protections against age discrimination in employment. We examine whether the differential impact of pension reform leads to differences in the incidence of workforce downsizing and hiring. When looking at hiring, we find that firms with larger shares of older workers decrease overall hiring. However, they have an increase in the shares of newly hired older workers. Results on downsizing are mixed, yet all are very small and statistically insignificant. This may be due to strong work protections in place in Germany.

  PublisherDOI

• Mental health and mortality trends in the United States

  Journal of Health Economics · 2025-06-03 · 3 citations

  article1st authorCorresponding
  PublisherDOI

• The Impact of State Paid Sick Leave Mandates on Medicaid-financed Prescription Medications

  National Bureau of Economic Research · 2025-11-01

  reportOpen access

  The United States lacks a federal paid sick leave policy.However, 18 states and the District of Columbia have adopted or announced paid sick leave employer mandates to increase access to this benefit, creating a quasi-experimental setting to study whether paid sick leave affects healthcare use.People enrolled in Medicaid are an important population to study in terms of state paid sick leave policies as the majority of non-disabled enrollees are employed, but frequently work in jobs without paid sick leave.Given enrollees' lower incomes, losing earnings to receive healthcare may be a significant barrier to care.In this study, we examine the effect of state paid sick leave policies on Medicaid-financed dispensed prescription medications.Using difference-in-differences methods that are robust to bias associated with a staggered treatment rollout, we show that Medicaid-financed dispensed prescription medications increase by 6.7% following adoption of a state paid sick leave policy.These findings suggest that state paid sick leave policies promote engagement with the healthcare system and use of healthcare services among financially constrained populations.

  PublisherDOI

• US State Restrictions and Excess COVID-19 Pandemic Deaths

  JAMA Health Forum · 2024-07-26 · 18 citations

  articleOpen access1st authorCorresponding

  Importance: Despite considerable prior research, it remains unclear whether and by how much state COVID-19-related restrictions affected the number of pandemic deaths in the US. Objective: To determine how state restrictions were associated with excess COVID-19 deaths over a 2-year analysis period. Design, Setting, and Participants: This was a cross-sectional study using state-level mortality and population data from the US Centers for Disease Control and Prevention for 2020 to 2022 compared with baseline data for 2017 to 2019. Data included the total US population, with separate estimates for younger than 45 years, 45 to 64 years, 65 to 84 years, and 85 years or older used to construct age-standardized measures. Age-standardized excess mortality rates and ratios for July 2020 to June 2022 were calculated and compared with prepandemic baseline rates. Excess death rates and ratios were then regressed on single or multiple restrictions, while controlling for excess death rates or ratios, from March 2020 to June 2020. Estimated values of the dependent variables were calculated for packages of weak vs strong state restrictions. Behavioral changes were investigated as a potential mechanism for the overall effects. Data analyses were performed from October 1, 2023, to June 13, 2024. Exposures: Age and cause of death. Main Outcomes: Excess deaths, age-standardized excess death rates per 100 000, and excess death ratios. Results: Mask requirements and vaccine mandates were negatively associated with excess deaths, prohibitions on vaccine or mask mandates were positively associated with death rates, and activity limitations were mostly not associated with death rates. If all states had imposed restrictions similar to those used in the 10 most restrictive states, excess deaths would have been an estimated 10% to 21% lower than the 1.18 million that actually occurred during the 2-year analysis period; conversely, the estimates suggest counterfactual increases of 13% to 17% if all states had restrictions similar to those in the 10 least-restrictive states. The estimated strong vs weak state restriction difference was 271 000 to 447 000 deaths, with behavior changes associated with 49% to 79% of the overall disparity. Conclusions and Relevance: This cross-sectional study indicates that stringent COVID-19 restrictions, as a group, were associated with substantial decreases in pandemic mortality, with behavior changes plausibly serving as an important explanatory mechanism. These findings do not support the views that COVID-19 restrictions were ineffective. However, not all restrictions were equally effective; some, such as school closings, likely provided minimal benefit while imposing substantial cost.

  PublisherOA PDFDOI

• "Despair" and Death in the United States

  National Bureau of Economic Research · 2024-09-01 · 3 citations

  reportOpen access1st authorCorresponding

  Increases in “deaths of despair” have been hypothesized to provide an important source of the adverse mortality experiences of some groups at the beginning of the 21st century. This study examines this possibility and uncovers the following primary findings. First, mental health deteriorated between 1993 and 2019 for all population subgroups examined. Second, these declines raised death rates and contributed to the adverse mortality trends experienced by prime-age non-Hispanic Whites and, to a lesser extent, Blacks from 1999-2019. However, worsening mental health is not the predominant explanation for them. Third, to extent these relationships support the general idea of “deaths of despair”, the specific causes comprising it should be both broader and different than previously recognized: still including drug mortality and possibly alcohol deaths but replacing suicides with fatalities from heart disease, lower respiratory causes, homicides, and conceivably cancer. Fourth, heterogeneity in the consequences of a given increase of poor mental health are generally more important than the sizes of the changes in poor mental health in explaining Black-White differences in the overall effects of mental health on mortality.

  PublisherDOI

• "Despair" and Death in the United States

  SSRN Electronic Journal · 2024-01-01

  articleOpen access1st authorCorresponding
  PublisherDOI

• Marijuana legalization and opioid deaths

  Journal of Health Economics · 2023-01-05 · 35 citations

  articleOpen accessSenior authorCorresponding

  Many states have legalized marijuana over the last two decades, initially for medical purposes and more recently for recreational consumption. Despite prior research, it remains unclear how these policies are related to rates of opioid-involved overdose deaths, which have trended rapidly upwards over time. We examine this question in two ways. First, we replicate and extend previous investigations to show that the prior empirical results are frequently fragile to the choice of specifications and time periods, and probably provide an overly optimistic assessment of the effects of marijuana legalization on opioid deaths. Second, we present new estimates suggesting that legal medical marijuana, particularly when available through retail dispensaries, is associated with higher opioid mortality. The results for recreational marijuana, while less reliable, also indicate that retail sales may be correlated with greater death rates relative to the counterfactual of no legal cannabis. A likely mechanism for these effects is the emergence of illicit fentanyl, which has increased the riskiness of even small positive effects of cannabis legalization on the consumption of opioids.

  PublisherDOI

• Estimating Drug Involvement in Fatal Overdoses With Incomplete Information

  American Journal of Preventive Medicine · 2023-07-05 · 10 citations

  articleOpen accessSenior authorCorresponding
  PublisherOA PDFDOI

Recent grants

• NIH Grant R01AA012309

  NIH · $245k · 2003

• NIH Grant R01AA009268

  NIH · $156k · 1996

• NIH Grant R01HD038521

  NIH · $393k · 2005

Frequent coauthors

• Jane Waldfogel

  Columbia University

  198 shared

• Charles Courtemanche

  103 shared

• Maya Rossin‐Slater

  Stanford University

  96 shared

• Ann P. Bartel

  Columbia University

  96 shared

• Garth Heutel

  72 shared

• George L. Wehby

  Iowa City VA Health Care System

  71 shared

• Joshua C. Pinkston

  University of Kentucky

  69 shared

• Albert N. Link

  University of North Carolina at Greensboro

  64 shared

Education

• Ph.D., Economics

  University of California, Berkeley

  1995

• M.A., Economics

  University of California, Berkeley

  1992

• B.A., Economics

  University of California, Santa Barbara

  1989

Awards & honors

• Time Out With Baby: The Case for Paid Parental Leave (publis…
• Turbulence in the American Workplace (published by Oxford Un…