• Assistant Professor

  • O'Neill School of Public and Environmental Affairs

  • Indiana University


Interests: Health economics, regulation, environmental economics, substance abuse, access to care
Alex is a health economist that examines how regulations affect public health with interests in population health, environmental economics, substance abuse, and access to care. Hollingsworth joined the O'Neill school as an assistant professor in the fall of 2015 after completing his PhD in Economics at the University of Arizona. In 2018, Alex was recognized by the Association for Public Policy Analysis and Management with the 40 for 40 fellowship, honoring outstanding early career researchers. Alex teaches courses on statistics, health regulation, and an overview of the U.S. health care system. His efforts in the classroom were recognized in 2018 when he was awarded the university-level Trustees Teaching Award.


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


      Hollingsworth, Alex., Ashley Kranz and Debbie Freund


      Accepted at the American Journal of Managed Care. Under embargo until publication. Draft and code available upon request.


      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.

      2019.

      [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.

      2019.

      [code]
      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.

      2019.

      [code] [ungated link]

      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.

      2018.

      [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.

      2017.

      [code] [ungated link]
      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.

      2017.

      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.

    Working Papers

    Work in Progress
    • Recreational Marijuana and Substitution of Psychoactive Substances: An Application of Synthetic Control Using Lasso.


      Hollingsworth, Alex. and Coady Wing


      Draft available upon request.

      [code]
      NUMBER 14
    • Does providing insurance coverage reduce the spread of infectious disease? Evidence from HIV diagnoses.


      Hollingsworth, Alex., Shyam Raman, Dan Sacks, and Katherine Wen



      NUMBER 15