The Affordable Care Act’s Effects on Patients, Providers and the Economy: What We’ve Learned So Far

Gruber, Jonathan; Sommers, Benjamin D.

doi:10.3386/w25932

Cited by 26 publications

(30 citation statements)

References 104 publications

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“…Indeed, numerous studies have investigated the effects of ACA‐Medicaid expansion on these outcomes using quasi‐experimental differences‐in‐differences (DD) methods. Of particular relevance to our study, while there is a vast literature investigating effects of ACA‐Medicaid expansion on health care service utilization generally, 18,19 few studies have estimated the causal effects of this major policy on breast cancer service use, and available studies focus on screening and surgeries with inconclusive results. Several studies find no change in breast cancer screening in expansion states vs nonexpansion states 20‐24 .…”

Section: Introductionmentioning

confidence: 99%

The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications

Maclean

Halpern

Hill

2020

Health Services Research

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Objective To quantify the effects of the Affordable Care Act Medicaid expansion on prescriptions for effective breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) among Medicaid enrollees. Data Source/Study Setting Medicaid State Drug Utilization Database (SDUD) 2011‐2018, comprising the universe of outpatient prescription medications covered under the Medicaid program. Study Design Differences‐in‐differences and event‐study linear models compare population rates of tamoxifen and aromatase inhibitor (anastrozole, exemestane, and letrozole) use in expansion and nonexpansion states, controlling for population characteristics, state, and time. Principal Findings Relative to nonexpansion states, Medicaid‐financed hormonal therapy prescriptions increased by 27.2 per 100 000 nonelderly women in a state. This implies a 28.8 percent increase from the pre‐expansion mean of 94.2 per 100 000 nonelderly women in expansion states. The event‐study model reveals no evidence of differential pretrends in expansion and nonexpansion states and suggests use grew to 40 or more prescriptions per 100 000 nonelderly women 3‐5 years postexpansion. Conclusions Medicaid expansion may have had a meaningful impact on the ability of lower‐income women to access effective hormonal therapies used to treat breast cancer.

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Section: Introductionmentioning

confidence: 99%

The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications

Maclean

Halpern

Hill

2020

Health Services Research

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“…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 (2014-2017).…”

Section: Introductionmentioning

confidence: 99%

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

Courtemanche¹,

Fazlul²,

Marton³

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-indifference 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.

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“…Large gains in health insurance coverage were documented early in the rollout from the main components of the Affordable Care Act (ACA) in 2014 (Gruber and Sommers 2019). As originally envisioned in 2010, the ACA aimed to provide robust Medicaid coverage across all states for the poor, and vibrant state-run exchanges with private coverage for those who were more affluent.…”

Section: Introductionmentioning

confidence: 99%

“…There are several other examples of the implementation of the ACA not playing out as intended. As described in Gruber and Sommers (2019), some of the original ACA provisions never became law, such as a new program for long-term care insurance (the ill-fated CLASS Act), and others have been repeatedly delayed, such as the "Cadillac Tax" on high-cost employer insurance plans. 1 Using data from the American Community Survey between 2012 and 2017, we examine 21 states where alternative routes for higher-income, abled-bodied, working-age adults to qualify for Medicaid were essentially non-existent prior to the implementation of the ACA in 2014.…”

Section: Introductionmentioning

confidence: 99%

Medicaid Coverage Across the Income Distribution Under the Affordable Care Act

2019

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This chapter examines trends in Medicaid enrollment across the income distribution after the ACA's Medicaid expansion. Using data from the American Community Survey between 2012 and 2017, we compare Medicaid coverage over time in 9 states that expanded Medicaid in 2014 with no previous expansion for able-bodied, working-age adults with 12 states that had not expanded Medicaid by 2019 and also had no previous expansion for such adults. A difference-indifferences model is used to formalize this comparison. Similar to many previous studies, we find that Medicaid coverage increased dramatically for income-eligible adults under 138% of the federal poverty level (FPL). In addition, we show that Medicaid participation increased by 3.0 percentage points for those with incomes above 138% of the FPL from a pre-ACA baseline of 2.7% among this group. While we cannot say with certainty why these individuals were able to participate in Medicaid, we offer several potential explanations that should be the subject of future work. For example, it is possible that the ACA Medicaid expansions were administered differently at the state or local level than federal rules would require, similarly to differences between effective tax rates and statutory tax rates in many transfer programs.

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The Affordable Care Act’s Effects on Patients, Providers and the Economy: What We’ve Learned So Far

Cited by 26 publications

References 104 publications

The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications

The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications

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

Medicaid Coverage Across the Income Distribution Under the Affordable Care Act

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