This paper examines the effects of states’ Medicaid expansion under the Affordable Care Act (ACA) on hospitals’ financial performance in the United States. Extending previous studies that primarily focus on the immediate short-term impact of the ACA's Medicaid expansion, we investigate if the fiscal effects persist over a longer-term and if the fiscal effects vary across different hospitals. Using panel data on hospitals from 2011 to 2018, we find that hospitals’ financial performance, as gauged either by Medicaid net revenue and uncompensated care cost or by multiple profitability measures, improves in Medicaid expansion states, and the positive effects continue over time. In addition, there are significant heterogeneities in the fiscal effects across different hospitals. Hospitals’ profitability improves the most in the public sector, rural areas, and less wealthy counties.
Scholars have long debated whether home rule powers help improve municipal financial well‐being; however, a consensus has yet to be reached. This study advances the home rule literature by causally estimating the impact of home rule in Texas on municipal revenue stability. To accomplish this, we employed a difference‐in‐differences estimator coupled with event‐study specifications on a 40‐year‐long panel data set. This approach revealed strong empirical evidence that cities adopting a home rule charter had a significant reduction in the probability of experiencing revenue decline. This finding remained robust with multiple measures of revenue change, an alternative sample, and different model specifications. Moreover, we found that home rule cities’ revenue stability was likely to come from their increase in property taxes.
Changing boundaries is a major method for municipalities to accommodate growth, expand economic and tax base, and optimize resource allocation. This study leverages variation in the adoption of home rule charters in Texas to provide the first empirical examination of whether home rule adoption causes municipal boundary expansion. We employ fuzzy regression‐discontinuity and event‐study estimation methods on actual boundary data for causal inference and find that home rule cities expand their boundaries to significantly greater total area than general law cities in Texas. This finding is robust to the voluntary Boundary and Annexation Surveys data used widely by extant studies. We also find evidence that annexations allow home rule cities to fiscally expand, primarily by broadening tax bases.
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