The effect of health insurance on crime: Evidence from the Affordable Care Act Medicaid expansion

Abstract

Little evidence exists on the effect of the Affordable Care Act (ACA) on criminal behavior, a gap in the literature that this paper seeks to address. Using a simple model, we argue we should anticipate a decrease in time devoted to criminal activities in response to the expansion, because the availability of the ACA Medicaid coverage raises the opportunity cost of crime. This prediction is particularly relevant for the ACA expansion because it primarily affects childless adults, a population likely to contain individuals who engage in criminal behavior. We validate this forecast empirically using a difference-in-differences framework, estimating the expansion's effects on panel datasets of state-and county-level crime rates. Our estimates suggest that the ACA Medicaid expansion was negatively associated with burglary, vehicle theft, homicide, robbery, and assault.These crime-reduction spillover effects represent an important offset to the government's cost burden for the ACA Medicaid expansion.

Access to Healthcare and Criminal Behavior: Evidence from the ACA Medicaid Expansions

“…The authors also report that the social‐cost savings associated with an additional local treatment facility, $4.2 million, are substantially greater than the annual costs of treatment in a facility, $1.1 million. Finally, He and Barkowski (2020) also examine the effects of health insurance on crime following the ACA Medicaid expansions using a sample of states and contiguous‐border counties from 2010 to 2016. The paper reports similar results to those presented in the current study, although the authors also report reductions for other types of crimes, including burglary, vehicle theft, robbery, and homicides, that are not robust with the inclusion of an additional three years of data.…”

“…Without empirical evidence, it is unclear whether investments in healthcare lead to reductions in crime. Few studies have examined this relationship, most notably Wen, Hockenberry, and Cummings (2017), Bondurant, Lindo, and Swensen (2018), and He and Barkowski (2020). The former studies focus specifically on the link between treatment for SUD and criminal behavior.…”

“…Both find increases in treatment rates significantly reduces criminal behavior at the local level. He and Barkowski (2020) also examine the effects of health insurance on crime following the ACA Medicaid expansions using data from 2010 through 2016. The authors report similar findings to those presented here, although several of their results are not robust with the inclusion of an additional three years of data.…”

Did the ACA Medicaid Expansion Save Lives?

“…This assumption would be violated, for example, if there were responses among those who switched onto Medicaid from other sources of insurance, or if the benefits of health insurance affect households or communities. A growing literature documents responses consistent with diffuse benefits of Medicaid on, for example, financial outcomes (Hu et al (2016), crime (Vogler (2017), He (2018)), and hospital closures (Lindrooth et al (2018)); there is also little evidence of negative spillovers through congestion effects (Carey, Miller and Wherry (2018)). Large TOT estimates appear to be a feature of public insurance studies, suggesting that assessment of these programs should allow for benefits in the general population, and future research should more closely ex-amine the sources of gains from health insurance.…”

The Dependent Coverage Mandate Took a Bite Out of Crime

“…Recent studies have found that Medicaid expansions are associated with a substantial reduction in crime (Wen et al 2017;Vogler 2018;Aslim et al 2019;He and Barkowski 2020).…”