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Impacts of the Affordable Care Act on health insurance coverage in Medicaid expansion and non-expansion states

Author: Charles Joseph CourtemancheJames MartonBenjamin UkertAaron S YelowitzDaniela ZapataAll authors
Publisher: Cambridge, Mass. : National Bureau of Economic Research, 2016.
Series: Working paper series (National Bureau of Economic Research), no. 22182.
Edition/Format:   eBook : Document : EnglishView all editions and formats
Summary:
The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage using data from the American Community Survey. We utilize  Read more...
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Material Type: Document, Internet resource
Document Type: Internet Resource, Computer File
All Authors / Contributors: Charles Joseph Courtemanche; James Marton; Benjamin Ukert; Aaron S Yelowitz; Daniela Zapata; National Bureau of Economic Research,
OCLC Number: 947906575
Notes: "April 2016"
Description: 1 online resource (52 pages) : illustrations.
Series Title: Working paper series (National Bureau of Economic Research), no. 22182.
Responsibility: Charles Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata.

Abstract:

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 3.0 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those with incomes below the Medicaid eligibility threshold, non-whites, young adults, and unmarried individuals. We find some evidence that the Medicaid expansion partially crowded out private coverage among low-income individuals.

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