Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply

Kaestner, Robert; Garrett, Bowen; Chen, Jiajia; Gangopadhyaya, Anuj; Fleming, Caitlyn

doi:10.1002/pam.21993

Cited by 243 publications

(235 citation statements)

References 35 publications

(65 reference statements)

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“…Although space limitations prohibit a complete review of this literature, to provide context, we note that there is a rich literature examining the effects of Medicaid expansion on the probability of having health insurance (e.g. Courtemanche, Marton, Ukert, Yelowitz, & Zapata, 2017;Kaestner, Garrett, Chen, Gangopadhyaya, & Fleming, 2017) and a number of studies that examine factors that might be responsible for rising opioid deaths (e.g. Ruhm, 2018).…”

Section: Literaturementioning

confidence: 99%

Medicaid expansion and opioid deaths

2019

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The United States is in the midst of an opioid epidemic, and drug overdose deaths are becoming a leading cause of death. Meanwhile, in 2010, the United States passed comprehensive health care reform providing access to care for millions of individuals who previously lacked care. Part of the new access came from expanding Medicaid, the insurance program for low‐income individuals. Expanding Medicaid was optional for states. Those individuals living in expansion states gained prescription drug coverage and hence more access to opioid pain‐relievers that are known to be addictive. However, they also gained access to medication‐assisted treatment for addiction. This paper uses a difference‐in‐differences approach and state‐level data from 2010 to 2017 to compare opioid death rates in expansion and non‐expansion states to determine if Medicaid expansion was a potential cause of rising opioid deaths. We find no evidence that Medicaid expansion is related to opioid deaths.

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Section: Literaturementioning

confidence: 99%

Medicaid expansion and opioid deaths

2019

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“…A general finding is that coverage increased more in states that implemented the Medicaid expansion than in states that did not, especially among low-income adults (Sommers et al 2015;Wherry and Miller 2016; Miller and Wherry 2017), disadvantaged populations, such as racial and ethnic minorities (McMorrow et al 2015;, and states or local areas with higher baseline rates of uninsurance (Courtemanche et al 2017;Duggan et al 2017). The effect of the Medicaid expansion on insurance coverage was especially large for childless adults (Kaestner et al 2017), who in most states were not eligible for Medicaid at all prior to 2014.…”

Section: The Aca and Its Effect On Insurance Coverage And Labor Sumentioning

confidence: 99%

Medicaid Expansion and the Unemployed

Buchmueller¹,

Levy²,

Valletta³

2019

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Any opinions expressed in this paper are those of the author(s) and not those of IZA. Research published in this series may include views on policy, but IZA takes no institutional policy positions. The IZA research network is committed to the IZA Guiding Principles of Research Integrity. The IZA Institute of Labor Economics is an independent economic research institute that conducts research in labor economics and offers evidence-based policy advice on labor market issues. Supported by the Deutsche Post Foundation, IZA runs the world's largest network of economists, whose research aims to provide answers to the global labor market challenges of our time. Our key objective is to build bridges between academic research, policymakers and society. IZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author.

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“…Income is one source of stratification that might seem particularly likely to adjust endogenously in response to the 2014 ACA provisions. Kaestner et al (2017) and Leung and Mas (2018) found little impact of the ACA Medicaid expansions on work effort, implying that the effect on income should be minimal. Gooptu et al (2016) found no impact of the ACA in part-time versus full-time employment or job reductions in 2014.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, Yue et al (2019) find that the ACA Medicaid expansion led to smaller gains among low-income Hispanics than other low-income individuals, implying a widened disparity. Kaestner et al (2017) and Wherry and Miller (2016) provide evidence that the ACA Medicaid expansion increased insurance coverage among those with low incomes or levels of education, implying reduced socioeconomic disparities in coverage. Benitez et al (2018) focuses on Kentucky, finding that much of the reduction in the uninsured rate is due to large coverage gains from areas with higher concentrations of poverty.…”

Section: Introductionmentioning

confidence: 99%

The Impact of the ACA on Insurance Coverage Disparities After Four Years

et al. 2019

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The purpose of this chapter is to estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after four years. We use data from the 2011-2017 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults. Our methods feature a difference-in-difference-in-differences model, developed in the recent ACA literature, which separately identifies the effects of the nationwide and Medicaid expansion portions of the law. The differences in this model come from time, state Medicaid expansion status, and local area pre-ACA uninsured rate. We stratify our sample separately by income, race/ethnicity, marital status, age, gender, and geography in order to examine access disparities. After four years, we find that the fully implemented ACA eliminated 44 percent of the coverage gap across income groups, with the Medicaid expansion accounting for this entire reduction. The ACA also reduced coverage disparities across racial groups by 26.7 percent, across marital status by 45 percent, and across age groups by 44 percent, with these changes being partly attributable to both the Medicaid expansion and nationwide components of the law.Prior to the main implementation of the Affordable Care Act (ACA) in 2014, there were well documented disparities in insurance coverage along multiple dimensions, such as age, race, and income (Courtemanche, Marton, and Yelowitz, 2016;Yelowitz, 2016;Courtemanche et al., 2019b). The central pieces of the ACA, including the individual mandate, subsidized Marketplace coverage, and state Medicaid expansions, were designed to reduce health insurance coverage disparities by moving the U.S. closer to universal coverage (Obama, 2016;Gruber and Sommers, 2019). The purpose of this paper is to examine the extent to which the ACA reduced disparities in coverage after four years (2014)(2015)(2016)(2017). While gains in insurance coverage after the ACA have been well documented, relatively few papers in this literature examine how the ACA affected coverage disparities and none use data from 2017. Courtemanche et al. (2017) estimate the first-year impact of the ACA on coverage using difference-in-difference-in-differences (DDD) models where the differences come from time, state Medicaid expansion decisions, and pre-ACA local area uninsured rate.Similar to the approach taken by Finkelstein (2007) andMiller (2012) to study other coverage expansions, this strategy leverages the propensity for universal coverage initiatives to provide the most intense "treatment" in local areas with the highest pre-reform uninsured rates. Using data from the American Community Survey (ACS), Courtemanche et al. (2017) find that the ACA increased coverage by an average of 5.9 percentage points in Medicaid expansion states compared to 2.8 percentage points in non-expansion states in 2014. In subsample analyses, the authors show that the fully implemented ACA (including the Medicaid expansion) redu...

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Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply

Cited by 243 publications

References 35 publications

Medicaid expansion and opioid deaths

Medicaid expansion and opioid deaths

Medicaid Expansion and the Unemployed

The Impact of the ACA on Insurance Coverage Disparities After Four Years

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