Affordable Care Act Medicaid expansions and the nurse labor market

Abstract

Shortages in healthcare labor markets were a major concern voiced by critics of the 2010 Patient Protection and Affordable Care Act (ACA). Using a difference-indifferences strategy, I find the 2014 ACA Medicaid expansions increased the average workweek by 30 min for registered nurses (RNs) and 50 min for licensed practical nurses (LPNs), driven by an increase in fulltime work. RNs and LPNs were 3 and 5 percentage points more likely to work full-time, respectively, due to the Medicaid expansions. There is little evidence of increased nurse employment on the extensive margin.

Effect of Medicaid Expansion on Health Insurance for Low-Income Nursing Home Aides

“…First, ACS is a census-based data and may not capture all occupation-specific information. However, ACS data has been extensively used to study nursing workforce as well as direct care workforce in different care settings including nursing homes (Buerhaus et al, 2017; DiNardi, 2021; Kelly et al, 2020). Second, ACS data is a repeated cross-sectional survey of individuals instead of a panel.…”

“…With respect to insurance, ACS has information on not only whether an individual has insurance coverage but also the type of insurance coverage at the time of interview. Several ACA evaluation studies have used the ACS data to examine health insurance coverage (Courtemanche et al, 2017; Duggan et al, 2019; Kaestner et al, 2017; Leung & Mas, 2018; Stimpson et al, 2019; Wehby & Lyu, 2018), but only a few have taken advantage of the ACS data to examine the impact of ACA Medicaid expansion for a specific occupation group that is likely to have differential impact compared to the general population (DiNardi, 2021; Woronkowicz et al, 2020).…”