Another Look at the Impacts of Health Reform in Massachusetts: Evidence Using New Data and a Stronger Model

Long, Sharon K.; Stockley, Karen; Yemane, Alshadye

doi:10.1257/aer.99.2.508

Cited by 52 publications

(57 citation statements)

References 6 publications

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“…There has been more work on tax policy and the demand for employersponsored insurance; see Gruber (2005) for a review. Massachusetts' 2006 health reform law, which featured premium subsidies and a state exchange, led to large reductions in the uninsured rate (Long, Stockley, & Yemane, 2009). However, the state law's other features (including individual and employer mandates) complicate the interpretation of these findings, and previous research has not disentangled the effects of subsidies versus these other provisions.…”

Section: Literature Reviewmentioning

confidence: 99%

Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act

Frean

Gruber

Sommers

2017

Journal of Health Economics

341

144

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Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. We provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time. Overall, our model explains 60% of the coverage gains in 2014-2015. We find that coverage was moderately responsive to price subsidies, with larger gains in state-based insurance exchanges than the federal exchange. The individual mandate's exemptions and penalties had little impact on coverage rates. The law increased Medicaid among individuals gaining eligibility under the ACA and among previously-eligible populations ("woodwork effect") even in non-expansion states, with no resulting reductions in private insurance. Overall, exchange premium subsidies produced 40% of the coverage gains explained by our ACA policy measures, and Medicaid the other 60%, of which 1/2 occurred among previously-eligible individuals. Americans to obtain insurance (with several exemptions, most notably related to affordability). KeywordsThese principal pieces of the ACA took effect in January 2014. 1 National data from multiple sources strongly support the notion that the ACA has reduced the uninsurance rate substantially beginning in 2014, reaching an historic low by 2015 (Cohen & Martinez, 2014;Smith & Medalia, 2015;Sommers, Gunja, Finegold, & Musco, 2015). This drop has generally been attributed to the ACA, but most analyses of the ACA to date have 1 The earliest coverage expansion enacted under the ACA was the dependent coverage provision, which mandated that private insurers allow parents to cover their children on their insurance until age 26. This provision took effect September 2010. We do not examine this policy here, since it had essentially reached steady-state by 2012 and has already been examined thoroughly elsewhere (Antwi, Moriya, & Simon, 2013). 4 been largely descriptive (Cohen & Martinez, 2014;Long et al., 2014) or limited to a particular aspect of the ACA such as the Medicaid expansion (Black & Cohen, 2015;Kaestner, Garrett, Gangopadhyaya, & Fleming, 2015;Wherry & Miller, 2016). No studies have disentangled the different coverage effects of the ACA's various provisions. Even as the 2016 election results cast uncertainty over the ACA's future, these issues remain critically important to understanding the potential impact of a partial or complete rollback of the law, as well as the potential consequences of future state or federal efforts to expand coverage.In this paper, we provide the first comprehensive model that identifies the causal impact of the ACA's numerous provisions on insurance coverage. In doing so, we also offer an empirical template for future research on this wide-ranging law. We use data from the American Community Survey (ACS) for the two years before and two years after full ACA implementation. We estimate rich mod...

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Section: Literature Reviewmentioning

confidence: 99%

Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act

Frean

Gruber

Sommers

2017

Journal of Health Economics

341

144

View full text Add to dashboard Cite

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“…Several studies examine the effect of the Massachusetts reform on insurance coverage (Long, 2008;Long Stockley, and Yemane, 2009;Kolstad and Kowalski, 2012a). There is consensus that coverage rates increased, although there is disagreement on the magnitude.…”

Section: Literature Reviewmentioning

confidence: 99%

“…7 The gains in health insurance coverage varied with socioeconomic characteristics because of heterogeneous baseline coverage: effects were large among young and low-income adults while modest for older and wealthier individuals (Niedzwiecki, 2013). The reform caused little change in coverage for children and teenagers because they were already overwhelmingly eligible under a parent's plan or through Medicaid (Long, Stockley, and Yemane, 2009;Miller, 2012b).…”

Section: Literature Reviewmentioning

confidence: 99%

“…The estimate of the impact of insurance coverage, 1 , is identified from how Massachusetts' changing health 18 The large majority of papers studying the effect of the Massachusetts healthcare law use some form of difference-in-differences identification strategy. See, for example, Kolstad and Kowalski (2012a), Courtemanche and Zapata (2014), Yelowitz and Cannon (2010), Long et al (2009), andMiller (2012a). 19 Similar methods for constructing a policy variable are consistently used by the literature examining the effect of Medicaid expansions on various outcomes.…”

Section: Vi1 Empirical Frameworkmentioning

confidence: 99%

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Health Insurance, Fertility, and the Wantedness of Pregnancies: Evidence from Massachusetts

Apostolova-Mihaylova

Yelowitz

2015

SSRN Journal

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Health insurance reform in Massachusetts lowered the financial cost of both pregnancy (by increased coverage of pregnancy-related medical events) and pregnancy prevention (by increasing access to reliable contraception and family planning). We examine fertility responses for women of childbearing age in Massachusetts and, on net, find no effect from increasing health insurance coverage. This finding, however, masks substantial heterogeneity. For married women aged 20 to 34 -who have high latent fertility and for whom pregnancies are typically wanted -fertility increased by approximately 1 percent. For unmarried women in the same age range -for whom pregnancies are typically unwanted -fertility declined by 9 percent. Fertility rates changed very little for other groups, in part because of low latent fertility or minimal gains in insurance coverage. Pregnancy wantedness increased in the aggregate through a combination of increasing wanted births and decreasing unwanted births.

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“…In particular, there is growing evidence that despite expanding eligibility for public health insurance, the Massachusetts health reform simultaneously increased both public and private health insurance coverage. Using data from a household survey, Long (2008) reported that employerbased coverage and public insurance each expanded by 2.9 percentage points, while Long, Stockley, and Yemane (2009) found a 5.6-percentage-point increase in employersponsored insurance accompanied by an 11.7-percentage-point increase in public coverage, using a DID design with CPS data. These findings were largely confirmed by , who found evidence of crowd-in using employer surveys.…”

Section: Crowd-out~{mentioning

confidence: 99%

How Do Public Health Expansions Vary by Income Strata? Evidence from Illinois' All Kids Program

2013

INQUIRY

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This paper examines how income levels affected the substitution of public health insurance for private health coverage under expansions of Illinois' State Children's Health Insurance Program (SCHIP). Building on a technique developed by Abadie and Gardeazabal (2003), I estimate that among children whose family incomes are between 200% and 300% of the federal poverty level (FPL), 35% of those covered by SCHIP would have retained private coverage in the absence of SCHIP. Significant substitution also appears between 300% and 400% FPL, but surprisingly I find evidence that the introduction of SCHIP caused an increase in private health insurance coverage for those with family incomes between 400% and 500% FPL.

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Another Look at the Impacts of Health Reform in Massachusetts: Evidence Using New Data and a Stronger Model

Cited by 52 publications

References 6 publications

Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act

Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act

Health Insurance, Fertility, and the Wantedness of Pregnancies: Evidence from Massachusetts

How Do Public Health Expansions Vary by Income Strata? Evidence from Illinois' All Kids Program

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