My research broadly falls within the following core themes:
1. Administrative burdens in health
2. Health insurance inequities
3. The law and politics of health reform
4. Policy feedback effects in health insurance
I largely examine these themes within the setting of private health insurance, though am interested in health insurance broadly, as well how administrative burdens intersect with reproductive health care.
BOOK PROJECTS
Coverage Denied: How Health Insurers Drive Inequality in the United States (Cambridge University Press 2026)
Who is the most vulnerable to the health insurance practice of coverage denials, and how does this insurance practice deepen health and economic inequities across race and class lines? I argue that this insurance practice -- including but extending beyond the growing reliance on prior authorization -- harms marginalized populations because of the health literacy demands that health insurance-related administrative burdens place on patients. Coverage denials are all the more prevalent in recent years as the United States has continued to witness the growth of managed care, even in health care realms typically managed by the government (Medicare Advantage, managed Medicaid), and relatedly a shift in concerns from cost containment to profit maximization. To examine this health policy problem, I conduct an original nationwide survey of 1,340 U.S. adults and supplement the nationwide survey with 111 semi-structured interviews with patients, physicians, health care advocates, health care lawyers, and health insurance executives. Combining quantitative analysis with patient and physician storytelling, I highlight not only patient vulnerabilities to this practice but both patients' and physicians' administrative burdens of appeal, and the longer-term destabilizing nature of this insurance practice as patients are left to postpone medical care and other purchasing. The findings shed light on the value of policy reforms that can help to mitigate these adverse impacts on marginalized populations.
Denied and Defenseless: The Legal Architecture of Health Insurance Inequity (in progress)
It is impossible to fully appreciate why health insurance barriers are such a uniquely American experience without understanding the Employee Retirement Income Security Act of 1974, more commonly known as ERISA. This law worsens health care access for American workers because it denies legal recourse to patients who have been wrongly denied by their health plans. What's more, in a striking departure from American principles of federalism, it preempts state laws that "relate to" the majority of employer-sponsored health insurance. The implications of this are far and wide because state efforts to improve access to health insurance will by definition be limited in scope, instead demanding action from Congress, which is notoriously gridlocked. Lying at the intersection of health and labor politics, as well as broader issues of policy feedback, and drawing on original data from congressional bill introductions and court cases, an original nationwide survey, state legislation, historical research from the Congressional Record and historical newspapers, and elite interviews with former health insurance executives and Assistant Secretaries of Labor, this book provides the first assessment of the politics of unintended consequences that have driven health insurance dissatisfaction so pervasive that it resulted in the December 4, 2024 shooting and subsequent backlash against UnitedHealthcare. And though ERISA is notoriously complex, Justice Denied seeks to make the complex digestible, offering rich context for the legal underpinnings of this health insurer behavior and the political features that have allowed for its persistence across multiple periods of proposed and enacted health reforms by Congress and the White House (namely, the Health Security Act, the Patient's Bill of Rights, the Mental Health Parity and Addiction Equity Act, and the Affordable Care Act).
ARTICLES
Projects in Progress: I examine through new survey data and new measures administrative burdens and inequities stemming from restrictive abortion policies. I am currently writing a book chapter on Medicare beneficiaries' health plan selection and utilization in the setting of prior authorization and resulting delays and denials. I additionally examine in other projects American patients' challenges with health literacy and health plan selection, health policymaking via direct democracy ballot measures, policy feedback effects in Medicaid, and federalism implications of the OBBBA.
Administrative Burdens and Inequities in Health Insurance
"Rationing by Inconvenience: How Insurance Coverage Denials Induce Administrative Burdens." 2024. Journal of Health Politics, Policy, and Law
How does the practice of health coverage denials keep care out of reach for American patients through the imposition of unevenly distributed administrative burdens? While there has been increased conversation about the extent of wrongful coverage denials and prior authorization administration in the context of Medicare Advantage, little work has examined the impact of these denials across patients enrolled in public and private insurance. I argue that the process of appealing insurers’ denials has the effect of imposing administrative burdens on patients in ways that are not equitable, and which have the effect of deepening the divide between those with meaningful access to health coverage and those for whom benefits are kept out of reach. Drawing on an original nationwide survey of 1,340 United States adults, I find support for the myriad ways in which denials can drive patients to experience administrative burden that more affluent and healthier patients are better equipped to navigate. The paper highlights the informational barriers to appeal, and the ways in which this bureaucracy deepens health divides along class lines.
"Administrative Burdens and Inequities in COBRA Take-Up." 2025. World Medical & Health Policy Journal
To what extent does COBRA’s lack of program visibility and complexity induce inequities in access to this form of health insurance? Though COBRA has long been an important tool for helping workers to avoid “job lock,” precious little scholarship has been devoted to understanding its reach. Relying on the first nationwide survey on COBRA take-up and utilization, this article examines the administrative burdens associated with COBRA take-up and finds that not only are White workers far more aware of the option of COBRA enrollment than are their Black and Hispanic counterparts, but the racial, educational, and economic divides persist when evaluating workers’ understandings of its impact on their health care costs. However, the effect of race on misinformation about the financial impact of COBRA disappears when isolating analysis to union members, suggesting that organized labor can play a critical role in reducing disparities in understanding about health insurance. The findings call attention to a great need for the government and employers to better convey the tradeoffs associated with COBRA take-up, so as to reduce the inequities in this realm of health care access.
Behavioral Health
"Systematic Review and Meta-Analysis of Depression, Anxiety, and Suicidal Ideation Among Ph.D. Students." 2021. Scientific Reports.
University administrators and mental health clinicians have raised concerns about depression and anxiety among Ph.D. students, yet no study has systematically synthesized the available evidence in this area. After searching the literature for studies reporting on depression, anxiety, and/or suicidal ideation among Ph.D. students, we included 32 articles. Among 16 studies reporting the prevalence of clinically significant symptoms of depression across 23,469 Ph.D. students, the pooled estimate of the proportion of students with depression was 0.24 (95% confidence interval [CI], 0.18–0.31; I2 = 98.75%). In a meta-analysis of the nine studies reporting the prevalence of clinically significant symptoms of anxiety across 15,626 students, the estimated proportion of students with anxiety was 0.17 (95% CI, 0.12–0.23; I2 = 98.05%). We conclude that depression and anxiety are highly prevalent among Ph.D. students. Data limitations precluded our ability to obtain a pooled estimate of suicidal ideation prevalence. Programs that systematically monitor and promote the mental health of Ph.D. students are urgently needed.
Other Public Health:
"Trump's Second Presidency Begins: Evaluating Effects on the US Health System" (with Scott Greer, Holly Jarman, and Rachel Kulikoff). 2025. Lancet Regional Health-Americas.
The first hundred days of the second Trump administration was unprecedented, with the administration taking remarkably aggressive, often questionably legal actions across health policy. This article uses the Health Systems Performance Assessment Framework to identify key policies regarding resources, financing, governance, and service delivery and their impact on the cost, quality, access, and equity of the US health system. The evaluation is largely negative. The administration, in its very energetic first hundred days, has already undermined resources, financing, and in particular governance in areas as diverse as oversight of long-term care, scientific research, and vaccination policy. Administration rhetoric and budget proposals called for severe reductions in health care access and actions to terminate services for particular groups, such as immigrants or gender minorities. Many of the particular actions, such as mass layoffs of specialist scientific and regulatory staff, will be difficult to reverse.
"Firearm Laws and Pediatric Firearm Mortality in the US" (with Jeremy Faust et al). 2025. JAMA Pediatrics
Did states enacting permissive firearm laws after 2010—when McDonald v Chicago was decided by the US Supreme Court—subsequently experience higher rates of pediatric firearm mortality? Excess mortality analysis found that a group of states with the most permissive firearm laws after 2010 experienced more than 6029 firearm deaths in children and adolescents aged 0 to 17 years between 2011 and 2023 and 1424 excess firearm deaths in a group of states with permissive laws. In the most permissive states, the largest increase occurred in the non-Hispanic Black pediatric population; among all states, 4 states had statistical decreases in pediatric firearm mortality during the study period, all of which were in states with strict firearm policies. These results demonstrate that permissive firearm laws contributed to thousands of excess firearm deaths among children living in states with permissive policies; future work should focus on determining which types of laws conferred the most harm and which offered the most protection.
American Political Institutions and Separation of Powers Conflict
"Congressional Assertions of the Spending Power: Institutional Conflict and Regulatory Authority." 2016. Journal of Law, Economics, and Organization 32(2): 272-305.
This study seeks to answer a crucial and unexplored question about American regulatory law and policy: How do majority coalitions in Congress use the spending power to circumvent intra-branch conflict and judicial constraints against regulating by finding alternate avenues to regulate states and private actors? This study provides the first large-scale empirical evidence of congressional use of the spending power to assert implementation authority in the face of constraints against more direct legislating. It is through this process of conditioning funds upon regulatory compliance that Congress works toward ideal policy outcomes without inciting institutional conflict with the other branches or from the opposing party. I base my conditional spending analysis on data on statutory specificity and congressional delegation from the 80th to the 110th Congresses provided by Sean Farhang, and include additional measures of institutional conflict. The above argument is supported by the empirical analysis.
"Divided Government and the Fragmentation of American Law" (with Sean Farhang). 2016. American Journal of Political Science 60(2): 401-17.
We investigate institutional explanations for Congress’s choice to fragment statutory frameworks for policy implementation. We argue that divided party government, which fuels legislative-executive conflict over control of the bureaucracy, motivates Congress to fragment implementation power as a strategy to enhance its control over implementation. We develop a novel measure of fragmentation in policy implementation, collect data on it over the period 1947 to 2008, and test hypotheses linking separation of powers structures to legislative design of fragmented implementation power. We find that divided party government is powerfully associated with fragmentation in policy implementation, and that this association contributed to the long-run growth of fragmentation in the post-war U.S. We further find that legislative coalitions are more likely to fragment implementation power in the face of greater uncertainty about remaining in the majority.
1. Administrative burdens in health
2. Health insurance inequities
3. The law and politics of health reform
4. Policy feedback effects in health insurance
I largely examine these themes within the setting of private health insurance, though am interested in health insurance broadly, as well how administrative burdens intersect with reproductive health care.
BOOK PROJECTS
Coverage Denied: How Health Insurers Drive Inequality in the United States (Cambridge University Press 2026)
Who is the most vulnerable to the health insurance practice of coverage denials, and how does this insurance practice deepen health and economic inequities across race and class lines? I argue that this insurance practice -- including but extending beyond the growing reliance on prior authorization -- harms marginalized populations because of the health literacy demands that health insurance-related administrative burdens place on patients. Coverage denials are all the more prevalent in recent years as the United States has continued to witness the growth of managed care, even in health care realms typically managed by the government (Medicare Advantage, managed Medicaid), and relatedly a shift in concerns from cost containment to profit maximization. To examine this health policy problem, I conduct an original nationwide survey of 1,340 U.S. adults and supplement the nationwide survey with 111 semi-structured interviews with patients, physicians, health care advocates, health care lawyers, and health insurance executives. Combining quantitative analysis with patient and physician storytelling, I highlight not only patient vulnerabilities to this practice but both patients' and physicians' administrative burdens of appeal, and the longer-term destabilizing nature of this insurance practice as patients are left to postpone medical care and other purchasing. The findings shed light on the value of policy reforms that can help to mitigate these adverse impacts on marginalized populations.
Denied and Defenseless: The Legal Architecture of Health Insurance Inequity (in progress)
It is impossible to fully appreciate why health insurance barriers are such a uniquely American experience without understanding the Employee Retirement Income Security Act of 1974, more commonly known as ERISA. This law worsens health care access for American workers because it denies legal recourse to patients who have been wrongly denied by their health plans. What's more, in a striking departure from American principles of federalism, it preempts state laws that "relate to" the majority of employer-sponsored health insurance. The implications of this are far and wide because state efforts to improve access to health insurance will by definition be limited in scope, instead demanding action from Congress, which is notoriously gridlocked. Lying at the intersection of health and labor politics, as well as broader issues of policy feedback, and drawing on original data from congressional bill introductions and court cases, an original nationwide survey, state legislation, historical research from the Congressional Record and historical newspapers, and elite interviews with former health insurance executives and Assistant Secretaries of Labor, this book provides the first assessment of the politics of unintended consequences that have driven health insurance dissatisfaction so pervasive that it resulted in the December 4, 2024 shooting and subsequent backlash against UnitedHealthcare. And though ERISA is notoriously complex, Justice Denied seeks to make the complex digestible, offering rich context for the legal underpinnings of this health insurer behavior and the political features that have allowed for its persistence across multiple periods of proposed and enacted health reforms by Congress and the White House (namely, the Health Security Act, the Patient's Bill of Rights, the Mental Health Parity and Addiction Equity Act, and the Affordable Care Act).
ARTICLES
Projects in Progress: I examine through new survey data and new measures administrative burdens and inequities stemming from restrictive abortion policies. I am currently writing a book chapter on Medicare beneficiaries' health plan selection and utilization in the setting of prior authorization and resulting delays and denials. I additionally examine in other projects American patients' challenges with health literacy and health plan selection, health policymaking via direct democracy ballot measures, policy feedback effects in Medicaid, and federalism implications of the OBBBA.
Administrative Burdens and Inequities in Health Insurance
"Rationing by Inconvenience: How Insurance Coverage Denials Induce Administrative Burdens." 2024. Journal of Health Politics, Policy, and Law
How does the practice of health coverage denials keep care out of reach for American patients through the imposition of unevenly distributed administrative burdens? While there has been increased conversation about the extent of wrongful coverage denials and prior authorization administration in the context of Medicare Advantage, little work has examined the impact of these denials across patients enrolled in public and private insurance. I argue that the process of appealing insurers’ denials has the effect of imposing administrative burdens on patients in ways that are not equitable, and which have the effect of deepening the divide between those with meaningful access to health coverage and those for whom benefits are kept out of reach. Drawing on an original nationwide survey of 1,340 United States adults, I find support for the myriad ways in which denials can drive patients to experience administrative burden that more affluent and healthier patients are better equipped to navigate. The paper highlights the informational barriers to appeal, and the ways in which this bureaucracy deepens health divides along class lines.
"Administrative Burdens and Inequities in COBRA Take-Up." 2025. World Medical & Health Policy Journal
To what extent does COBRA’s lack of program visibility and complexity induce inequities in access to this form of health insurance? Though COBRA has long been an important tool for helping workers to avoid “job lock,” precious little scholarship has been devoted to understanding its reach. Relying on the first nationwide survey on COBRA take-up and utilization, this article examines the administrative burdens associated with COBRA take-up and finds that not only are White workers far more aware of the option of COBRA enrollment than are their Black and Hispanic counterparts, but the racial, educational, and economic divides persist when evaluating workers’ understandings of its impact on their health care costs. However, the effect of race on misinformation about the financial impact of COBRA disappears when isolating analysis to union members, suggesting that organized labor can play a critical role in reducing disparities in understanding about health insurance. The findings call attention to a great need for the government and employers to better convey the tradeoffs associated with COBRA take-up, so as to reduce the inequities in this realm of health care access.
Behavioral Health
"Systematic Review and Meta-Analysis of Depression, Anxiety, and Suicidal Ideation Among Ph.D. Students." 2021. Scientific Reports.
University administrators and mental health clinicians have raised concerns about depression and anxiety among Ph.D. students, yet no study has systematically synthesized the available evidence in this area. After searching the literature for studies reporting on depression, anxiety, and/or suicidal ideation among Ph.D. students, we included 32 articles. Among 16 studies reporting the prevalence of clinically significant symptoms of depression across 23,469 Ph.D. students, the pooled estimate of the proportion of students with depression was 0.24 (95% confidence interval [CI], 0.18–0.31; I2 = 98.75%). In a meta-analysis of the nine studies reporting the prevalence of clinically significant symptoms of anxiety across 15,626 students, the estimated proportion of students with anxiety was 0.17 (95% CI, 0.12–0.23; I2 = 98.05%). We conclude that depression and anxiety are highly prevalent among Ph.D. students. Data limitations precluded our ability to obtain a pooled estimate of suicidal ideation prevalence. Programs that systematically monitor and promote the mental health of Ph.D. students are urgently needed.
Other Public Health:
"Trump's Second Presidency Begins: Evaluating Effects on the US Health System" (with Scott Greer, Holly Jarman, and Rachel Kulikoff). 2025. Lancet Regional Health-Americas.
The first hundred days of the second Trump administration was unprecedented, with the administration taking remarkably aggressive, often questionably legal actions across health policy. This article uses the Health Systems Performance Assessment Framework to identify key policies regarding resources, financing, governance, and service delivery and their impact on the cost, quality, access, and equity of the US health system. The evaluation is largely negative. The administration, in its very energetic first hundred days, has already undermined resources, financing, and in particular governance in areas as diverse as oversight of long-term care, scientific research, and vaccination policy. Administration rhetoric and budget proposals called for severe reductions in health care access and actions to terminate services for particular groups, such as immigrants or gender minorities. Many of the particular actions, such as mass layoffs of specialist scientific and regulatory staff, will be difficult to reverse.
"Firearm Laws and Pediatric Firearm Mortality in the US" (with Jeremy Faust et al). 2025. JAMA Pediatrics
Did states enacting permissive firearm laws after 2010—when McDonald v Chicago was decided by the US Supreme Court—subsequently experience higher rates of pediatric firearm mortality? Excess mortality analysis found that a group of states with the most permissive firearm laws after 2010 experienced more than 6029 firearm deaths in children and adolescents aged 0 to 17 years between 2011 and 2023 and 1424 excess firearm deaths in a group of states with permissive laws. In the most permissive states, the largest increase occurred in the non-Hispanic Black pediatric population; among all states, 4 states had statistical decreases in pediatric firearm mortality during the study period, all of which were in states with strict firearm policies. These results demonstrate that permissive firearm laws contributed to thousands of excess firearm deaths among children living in states with permissive policies; future work should focus on determining which types of laws conferred the most harm and which offered the most protection.
American Political Institutions and Separation of Powers Conflict
"Congressional Assertions of the Spending Power: Institutional Conflict and Regulatory Authority." 2016. Journal of Law, Economics, and Organization 32(2): 272-305.
This study seeks to answer a crucial and unexplored question about American regulatory law and policy: How do majority coalitions in Congress use the spending power to circumvent intra-branch conflict and judicial constraints against regulating by finding alternate avenues to regulate states and private actors? This study provides the first large-scale empirical evidence of congressional use of the spending power to assert implementation authority in the face of constraints against more direct legislating. It is through this process of conditioning funds upon regulatory compliance that Congress works toward ideal policy outcomes without inciting institutional conflict with the other branches or from the opposing party. I base my conditional spending analysis on data on statutory specificity and congressional delegation from the 80th to the 110th Congresses provided by Sean Farhang, and include additional measures of institutional conflict. The above argument is supported by the empirical analysis.
"Divided Government and the Fragmentation of American Law" (with Sean Farhang). 2016. American Journal of Political Science 60(2): 401-17.
We investigate institutional explanations for Congress’s choice to fragment statutory frameworks for policy implementation. We argue that divided party government, which fuels legislative-executive conflict over control of the bureaucracy, motivates Congress to fragment implementation power as a strategy to enhance its control over implementation. We develop a novel measure of fragmentation in policy implementation, collect data on it over the period 1947 to 2008, and test hypotheses linking separation of powers structures to legislative design of fragmented implementation power. We find that divided party government is powerfully associated with fragmentation in policy implementation, and that this association contributed to the long-run growth of fragmentation in the post-war U.S. We further find that legislative coalitions are more likely to fragment implementation power in the face of greater uncertainty about remaining in the majority.