• Associate Professor

  • O'Neill School of Public and Environmental Affairs

  • Indiana University

  • Research Associate

  • National Bureau of Economic Research

  • Co-editor

  • Journal of Policy Analysis and Management

  • Associate Editor

  • Journal of Health Economics

Interests: Health economics, environmental economics, regulation, substance abuse, access to care
Alex Hollingsworth is an associate professor at the O’Neill School of Public and Environmental Affairs at Indiana University. He is also a Research Associate at the National Bureau of Economic Research, a co-editor at the Journal of Policy Analysis and Management, and an associate editor at the Journal of Health Economics. Hollingsworth is an applied microeconomist who examines how regulations affect health with interests in environmental economics, population health, substance abuse, and access to care. His research has been published in outlets including American Economic Journal: Economic Policy, the Journal of Public Economics, and the Journal of Human Resources. His research has been covered by Scientific American, the Washington Post, CNBC, the Atlantic, VOX, and the Los Angeles Times. In 2018, Hollingsworth was recognized by the Association for Public Policy Analysis and Management with the 40 for 40 fellowship, honoring outstanding early career researchers. Hollingsworth teaches courses on program evaluation, statistics, health regulation, and an overview of the U.S. health care system. His commitment in the classroom was recognized in 2018 when he was awarded the Trustees Teaching Award. He also co-hosts a podcast, The Hidden Curriculum with Sebastian Tello-Trillo. The Hidden Curriculum aims to cover topics relevant to academic life with a focus on things that are not formally taught in graduate school.

    Working Papers

    • Excess emissions: Environmental impacts, health effects, and policy debate.

      Hollingsworth, Alex., David Konisky and Nikolaos Zirogiannis

      Forthcoming at the Review of Environmental Economics and Policy.

      [ungated link]
      NUMBER 10
    • A thousand cuts: Cumulative lead exposure and academic achievement.

      Hollingsworth, Alex., Mike Huang, Ivan Rudik, and Nick Sanders

      Journal of Human Resources.


      [ungated link] [NBER working paper]

      Media: [The Hill] [Tradeoffs] [the 74]

      NUMBER 16
    • Comparative effects of recreational and medical marijuana laws on drug use among adults and adolescents.

      Hollingsworth, Alex., Coady Wing, and Ashley Bradford

      Journal of Law and Economics.


      [ungated link] [Replication package] [code]

      Media: [The Hill]

      NUMBER 10
    • Simulated power analyses for observational studies: An application to the Affordable Care Act Medicaid expansion.

      Black, Bernard., Alex Hollingsworth, Leticia Nunes, and Kosali Simon

      Journal of Public Economics.


      [NBER working paper] [Replication package] [code] [Simulated power example with publicly available data link]
      NUMBER 7
    • The effect of leaded gasoline on elderly mortality: Evidence from regulatory exemptions.

      Hollingsworth, Alex., and Ivan Rudik

      American Economic Journal: Economic Policy.


      [ungated link] [code] [Non-technical summary]
      NUMBER 13
    • The health consequences of excess emissions: Evidence from Texas.

      Hollingsworth, Alex., David Konisky, and Nikos Zirogiannis

      Journal of Environmental Economics and Management.


      Media: [Wired]

      NUMBER 9
    • Can policy affect initiation of addictive substance use? Evidence from opioid prescribing.

      Sacks, Dan., Alex Hollingsworth, Thuy Nguyen, and Kosali Simon

      Journal of Health Economics.


      [NBER working paper]
      NUMBER 11
    • Estimating co-pollutant benefits from climate change policies in the electricity sector: An empirical approach.

      Zirogiannis, Nikos., Daniel Simon, and Alex Hollingsworth

      Energy Economics.


      NUMBER 12
    • Association of state marijuana legalization policies for medical and recreational use with vaping associated lung disease.

      Wing, Coady., Ashley Bradford, Aaron Carroll, and Alex Hollingsworth.

      JAMA: Network Open.


      [ungated link] [code]

      Media: [Medpage Today] [JNOLive] [The National Interest]

      NUMBER 16
    • Association between Medicaid expansion and rates of opioid-related hospital use.

      Wen, Hefei., Aparna Soni, Alex Hollingsworth, Seth Freedman, Joe Benitez, Kosali Simon, and Brendan Saloner

      JAMA: Internal Medicine.


      Media: [Kaiser Health News]

      NUMBER 16
    • Care management reduced infant mortality for Medicaid managed care enrollees in Ohio.

      Hollingsworth, Alex., Ashley Kranz, and Debbie Freund

      American Journal of Managed Care.


      [ungated link] [code]
      NUMBER 6
    • Association between the number of certified buprenorphine prescribers and the quantity of buprenorphine prescriptions: Evidence from 2015 to 2017.

      Lin, Lee-Kai., Kosali Simon, Alex Hollingsworth, and Brendan Saloner

      Journal of General Internal Medicine.


      [ungated link]
      Buprenorphine treatment capacity is limited because buprenorphine can only be prescribed by certified providers. To expand capacity, recent federal initiatives have increased the physician patient cap twice (from 30 to 100 patients and then to 275 patients) and have allowed nurse practitioners and physician assistants to obtain waivers. Previous research has shown that expanding buprenorphine prescribers for Medicaid populations leads to more buprenorphine prescriptions; however, it is unclear if this relationship holds across all payer groups. Our findings suggest that adding one more certified physician increases access for 3.6 patients, but we did not find a statistically significant effect for non-physician prescribers. The effects vary by the physician certification category: an additional provider with a 100-patient limit increases access for 8.71 patients; and an additional provider with a 275-patient limit increases access for 44.09 patients.
    • Gains in health insurance coverage explain variation in Democratic vote share in the 2008-2016 presidential elections.

      Hollingsworth, Alex., Aparna Soni, Aaron Carroll, John Cawley, and Kosali Simon

      PLoS ONE.


      In the last decade, health care reform has dominated U.S. public policy and political discourse. Double-digit rate increases in premiums in the Health Insurance Marketplaces established by the Affordable Care Act (ACA) in 2018 make this an ongoing issue that could affect future elections. A seminal event that changed the course of policy and politics around health care reform is the 2016 presidential election. The results of the 2016 presidential election departed considerably from polling forecasts. Given the prominence of the Affordable Care Act in the election, we test whether changes in health insurance coverage at the county-level correlate with changes in party vote share in the presidential elections from 2008 through 2016. We find that a one-percentage-point increase in county health insurance coverage was associated with a 0.25-percentage-point increase in the vote share for the Democratic presidential candidate. We further find that these gains on the part of the Democratic candidate came almost fully at the expense of the Republican (as opposed to third-party) presidential candidates. We also estimate models separately for states that did and did not expand Medicaid and find no differential effect of insurance gains on Democratic vote share for states that expanded Medicaid compared to those that did not. Our results are consistent with the hypothesis that outcomes in health insurance markets played a role in the outcome of the 2016 presidential election. The decisions made by the current administration, and how those decisions affect health insurance coverage and costs, may be important factors in future elections as well.
    • External impacts of local energy policy: The case of renewable portfolio standards.

      Hollingsworth, Alex., and Ivan Rudik

      Journal of the Association of Environmental and Resource Economists.


      [ungated link] [code]
      Renewable portfolio standards (RPSs) are state-level policies that require in-state electricity providers to procure a minimum percentage of electricity sales from renewable sources. Using theoretical and empirical models, we show how RPSs induce out-of-state emissions reductions through interstate trade of credits used for RPS compliance. When one state passes an RPS, it increases demand for credits sold by firms in other (potentially non-RPS) states. We find that increasing a state’s RPS decreases coal generation and increases wind generation in outside states through this tradable credit channel. We perform a welfare simulation to evaluate the aggregate avoided damage from RPS-induced reductions in local coal-fired pollutants. Our estimates suggest that a 1 percentage point increase in a state’s RPS results in up to $100 million in avoided damages over the United States from reduced pollution. We also find substantial heterogeneity in aggregate avoided damages caused by increases in different states’ RPSs.
    • Understanding excess emissions from industrial facilities: Evidence from Texas.

      Zirogiannis, Nikos., Alex Hollingsworth, and David Konisky

      Environmental Science & Technology.


      [ungated link]

      Media: [U.S. News] [Houston Chronicle]

      We analyze excess emissions from industrial facilities in Texas using data from the Texas Commission on Environmental Quality. Emissions are characterized as excess if they are beyond a facility’s permitted levels and if they occur during startups, shutdowns, or malfunctions. We provide summary data on both the pollutants most often emitted as excess emissions and the industrial sectors and facilities responsible for those emissions. Excess emissions often represent a substantial share of a facility’s routine (or permitted) emissions. We find that while excess emissions events are frequent, the majority of excess emissions are emitted by the largest events. That is, the sum of emissions in the 96–100th percentile is often several orders of magnitude larger than the remaining excess emissions (i.e., the sum of emissions below the 95th percentile). Thus, the majority of events emit a small amount of pollution relative to the total amount emitted. In addition, a small group of high emitting facilities in the most polluting industrial sectors are responsible for the vast majority of excess emissions. Using an integrated assessment model, we estimate that the health damages in Texas from excess emissions are approximately $150 million annually
    • Macroeconomic conditions and opioid abuse.

      Hollingsworth, Alex., Chris Ruhm, and Kosali Simon

      Journal of Health Economics.


      [NBER working paper] [code]

      Media: [Scientific American] [Washington Post] [The Atlantic] [CNBC] [Vox] [Breitbart] [Axios] [U.S. News] [National Affairs] [Bloomberg] [Marginal Revolution]

      We examine how deaths and emergency department (ED) visits related to use of opioid analgesics (opioids) and other drugs vary with macroeconomic conditions. As the county unemployment rate increases by one percentage point, the opioid death rate per 100,000 rises by 0.19 (3.6%) and the opioid overdose ED visit rate per 100,000 increases by 0.95 (7.0%). Macroeconomic shocks also increase the overall drug death rate, but this increase is driven by rising opioid deaths. Our findings hold when performing a state-level analysis, rather than county-level; are primarily driven by adverse events among whites; and are stable across time periods.
    • Opposition to Obamacare: A closer look.

      Gordon, Paul., Laurel Gray, Alex Hollingsworth, Eve Shapiro, and James Dalen

      Academic Medicine.


      Media: [Los Angeles Times] [Arizona Daily Star] [Medical Economics] [Association of American Medical Colleges]

      Prior telephone surveys have reported two main reasons for opposition to the Affordable Care Act (ACA): distrust of government and opposition to the universal coverage mandate. The authors set out to elucidate the reasons for this opposition. This article describes how the authors used qualitative methods with semistructured interviewing as a principal investigative method to gather information from people they met while bicycling across the United States from April through July 2016. During this time, the authors conducted open-ended, semistructured conversations with people they met as they rode their bicycles from Washington, DC, to Seattle, Washington. Informants were chosen as a convenience sample. One hundred sixteen individuals participated as informants. The majority of comments were negative toward the ACA. Conversations were categorized into four themes, which included the following: (1) The ACA has increased the cost of health insurance; (2) government should not tell people what to do; (3) responsibility for ACA problems is diffuse; and (4) the ACA should not pay for other people’s problems. These face-to-face conversations indicated that opposition to the ACA may be due to the fact that many Americans have experienced an increase in the cost of insurance either through increased premiums or greatly increased deductibles. They blame this increase in cost on the ACA, President Obama, the government or insurance companies, and the inclusion of “others” in insurance plans. The authors discuss how these findings can influence medical education curricula to better prepare future physicians to discuss health policy issues with patients.

    Work in Progress
    • Cognitive performance and air pollution: Evidence from India.

      Patrick Carlin, Alex Hollingsworth, and Jamie Mullins.

      NUMBER 15
    • Public insurance expansions, HIV and risky behavior: The role of PrEP.

      Ben Harrell, Alex Hollingsworth, Sam Mann, Shyam Raman, and Katherine Wen.

      NUMBER 17

    • Indiana University

      • SPEA-H 124: Overview of the U.S. health care system

        , 2015-

      • SPEA-H 455: Health industry regulation

        , 2022-

      • SPEA-H 524: Health industry regulation

        , 2017-

      • SPEA-V 506: Statistical analysis for effective decision making

        , 2018-

      • SPEA-P 764: Seminar in policy analysis

        , 2021-

      University of Arizona

      • Economics 323: The economics of sports

        , 2014

      • Economics 371: Economic development

        , 2013

      • Economics 330: Macroeconomic and global institutions and policy

        , 2012