Did the ACA Medicaid Expansion Save Lives?

Borgschulte, Mark; Vogler, Jacob

doi:10.2139/ssrn.3445818

Cited by 16 publications

(20 citation statements)

References 33 publications

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“…3 A small number of recent studies use population-level mortality data to estimate changes in adult mortality in expansion states compared to non-expansion states. These studies reach very different conclusions, either unable to detect mortality effects (Black et al, 2019) or estimating varying sized reductions in adult mortality: 3.6 percent among adults ages 20-64 (Borgschulte and Vogler, 2020) and 1.2 percent among adults ages 55-64 (Chen, 2019). Yan et al (2020) find no reduction in all-cause mortality among adults ages 20-64, but a 2.7 percent decrease in health care amenable mortality.…”

Section: Introductionmentioning

confidence: 96%

“…Meanwhile, analyses of mortality data rely on death records aggregated to the state-or county-level, without information on individual-level factors that determine eligibility such as income (e.g. Borgschulte and Vogler, 2020;Chen, 2019;Khatana et al, 2019;Swaminathan et al, 2018;Yan et al, 2020). Without information on these relevant individuallevel characteristics, these studies may be underpowered to reliably detect mortality effects of the ACA (Allen and Sommers, 2019), and may in fact vastly overstate magnitudes (Black et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data

Miller

Johnson

Wherry

2021

The Quarterly Journal of Economics

158

118

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We use large-scale federal survey data linked to administrative death records to investigate the relationship between Medicaid enrollment and mortality. Our analysis compares changes in mortality for near-elderly adults in states with and without Affordable Care Act Medicaid expansions. We identify adults most likely to benefit using survey information on socioeconomic status, citizenship status, and public program participation. We find that, prior to the ACA expansions, mortality rates across expansion and nonexpansion states trended similarly, but beginning in the first year of the policy, there were significant reductions in mortality in states that opted to expand relative to nonexpanders. Individuals in expansion states experienced a 0.132 percentage point decline in annual mortality, a 9.4 percent reduction over the sample mean, as a result of the Medicaid expansions. The effect is driven by a reduction in disease-related deaths and grows over time. A variety of alternative specifications, methods of inference, placebo tests, and sample definitions confirm our main result.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data

Miller

Johnson

Wherry

2021

The Quarterly Journal of Economics

158

118

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“…3 The issue is also disputed among policymakers, some of whom have expressed skepticism about whether health insurance reduces mortality (Phillips, 2017). reduce adult mortality in certain contexts (Card, Dobkin and Maestas, 2009;Sommers, Baicker and Epstein, 2012;Sommers, Long and Baicker, 2014;Swaminathan et al, 2018;Khatana et al, 2019;Borgschulte and Vogler, 2019;Miller et al, 2019), 4 but the results that emerge from these studies rely on unveriable and sometimes controversial assumptions (Levy and Meltzer, 2008;Woolhandler and Himmelstein, 2017;Black et al, 2019).…”

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confidence: 99%

“…coverage: P r (C i (1) = 0) < P r (C i (0) = 0) and for each m ∈ {1, 2, ...12}, either P r (C i (1) = m) > P r (C i (0) = m) or else the dierence is not statistically signicant.35 On this point, we refer readers to the discussion and literature review inBorgschulte and Vogler (2019), who argue that such spillover eects may explain why studies in this literature tend to observe very large eects of coverage among the treated.…”

mentioning

confidence: 99%

Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach

Goldin

Lurie

McCubbin

2020

The Quarterly Journal of Economics

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We evaluate a randomized outreach study in which the IRS sent informational letters to 3.9 million households that paid a tax penalty for lacking health insurance coverage under the Affordable Care Act. Drawing on administrative data, we study the effect of this intervention on taxpayers subsequent health insurance enrollment and mortality. We find the intervention led to increased coverage during the subsequent two years and reduced mortality among middle-aged adults over the same time period. The results provide experimental evidence that health insurance coverage can reduce mortality in the United States.

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“…Many states have increased coverage in recent years and a growing literature has shown the importance of Medicaid expansions on several outcomes. The literature finds that the Medicaid expansions change health care access (e.g., Courtemanche et al., 2019; Garthwaite et al., 2019; Huh, 2021) and decrease mortality (e.g., Borgschulte & Vogler, 2020; Miller et al., 2019). In addition, the literature documents positive externalities of the Medicaid expansions on non‐health related outcomes, such as financial well‐being (e.g., Miller et al., 2018), crime (e.g., He & Barkowski, 2020; Vogler, 2020), and child support (e.g., Bullinger, 2021).…”

Section: Introductionmentioning

confidence: 99%