Access to Healthcare and Criminal Behavior: Evidence from the ACA Medicaid Expansions

Abstract

I investigate the causal relationship between access to healthcare and crime following state decisions to expand Medicaid coverage after the Affordable Care Act. I combine state-level crime data from the Federal Bureau of Investigation Uniform Crime Reports for the years 2009 through 2018 with variation in insurance eligibility generated by the Medicaid expansion. Using a difference-indifferences design, my findings indicate that states that expanded Medicaid have experienced a 5.3 percent reduction in annual reported violent crime rates relative to nonexpansion states. This effect is explained by decreases in aggravated assaults and corresponds to 17 fewer incidents per 100,000 people. The estimated decrease in reported crime amounts to an annual cost savings of approximately $4 billion.

Does the ACA Medicaid Expansion Affect Hospitals’ Financial Performance?

“…The literature on Medicaid expansion's impact on patients finds that health care reform under the ACA, especially states’ Medicaid expansion, improves patients’ access to health care and health outcomes, and the impact is more pronounced for low-income or vulnerable groups (Sommers et al 2015; McMorrow et al 2015; Wherry and Miller 2016; Frean et al 2017; Soni et al 2017; Wehby and Lyu 2018; Denham and Veazie 2019; Hamersma et al 2019). The existing research also demonstrates that Medicaid expansion has positively affected patients’ utilization of services, the affordability of care (Kirby and Vistnes 2016; McMorrow et al 2015; Soni et al 2017), child support (Bullinger 2021), reduced crime (Vogler 2020), mortality (Borgschulte and Vogler 2020), and, in some expansion states, has positive economic effects on employment, personal income savings, and state tax revenues (Ayanian et al 2017; Heim and Yang 2017). 1…”

“…These decisions have substantially changed frontline health care providers’ external market and policy environments. Since the passage of the ACA, there has been an outpouring of empirical studies examining the effects of state Medicaid expansion (Haeder 2020), most of which find positive short-term impacts on insurance coverage (Courtemanche et al 2017; Sommers 2017 a ), population health outcomes (Simon, Soni and Cawley 2017; Sommers 2017 b ; Borgschulte and Vogler 2020), and broader economic outcomes (Mathur, Slavov and Strain 2016; Heim and Yang 2017; Kaestner et al 2017; Leung and Mas 2018; Gangopadhyaya and Garrett 2020; Vogler 2020; Bullinger 2021).…”

The Effect of Public Health Insurance on Criminal Recidivism

“…They find these effects to be strongest among relatively serious crimes, including homicides, aggravated assaults, robbery, and motor vehicle theft. In the context of the ACA's Medicaid expansion, Vogler (2020) and He and Barkowski (2020) both provide evidence of Medicaid‐induced reduction in violent crimes. More importantly, both studies find limited effects of Medicaid expansions on property crimes.…”

“…This paper joins a relatively new literature that attempts to understand how access to health insurance impacts criminal outcomes. Existing literature thus far focuses largely on the changes in aggregate crime rates as an outcome (He & Barkowski, 2020; Vogler, 2020; Wen, Hockenberry, & Cummings, 2017). Our study moves beyond these papers in several ways.…”

“…See, e.g.,Jácome (2020), who matches on observable characteristics of men in groups with low and high Medicaid enrollment to assess the causal effect of losing Medicaid eligibility on the likelihood of incarceration. See, also,Vogler (2020), who conditions on state-level time-varying control variables and region-by-year fixed effects in dynamic and most of the static specifications that explore the difference in crime rates between expansion and non-expansion states.Journal of PolicyAnalysis and Management DOI: 10.1002/pam Published on behalf of the Association for Public Policy Analysis and Management…”