The Effects of ACA Medicaid Expansions on Health After 5 Years

Abstract

We examine the Affordable Care Act Medicaid expansion effects on self-rated health status over 5 years. The study uses data from the Behavioral Risk Factor Surveillance System for 2011-2018 and a difference-in-differences design. There is improvement in health status on a 1 to 5 point scale from poor to excellent health among individuals below 100% of the federal poverty line by 0.031, 0.068, 0.031, 0.064, and 0.087 points in 2014, 2015, 2016, 2017, and 2018, respectively. Changes in 2015, 2017, and 2018 are statistically significant ( p < .05), and the 2014 change is marginally significant. The difference between 2014 and 2018 effects is statistically significant ( p < .05). In most years, we cannot distinguish changes in days not in good physical or mental health from no effect. Overall, there is only minimal evidence for effects intensifying over time, suggesting that health gains thus far have mostly occurred early on due to unmet needs among those previously uninsured.

Effects of Virginia’s 2019 Medicaid Expansion on Health Insurance Coverage, Access to Care, and Health Status

“…Overall, we find little evidence of changes in self-reported health status for either income group in the first two years of expansion. Taken as a whole, the results are largely similar to those on the 2014 Medicaid expansions in their first year, [6][7][8]36,37 indicating similar benefits to the eligible population for an expansion that happened six years later.…”

“…To select the BRFSS sample below 138% FPL (also considering number of adults and children in the households), we used midpoints of these income categories following previous studies. 7 , 17 , 21 , 25 In the sample with income below 100% FPL, we did not exclude those who were previously eligible for Medicaid (parents with income below 38% FPL) because of prior evidence of spillover effects (i.e., “welcome mat” effects) on coverage among previously income eligible individuals. 26 In sensitively analyses, we excluded parents with income that would have been previously eligible for coverage (below 38% FPL).…”

“…Specifically, we compared outcome changes after the expansion in Virginia with a group of control states which included 15 states that had not adopted the ACA Medicaid expansion as of December 2020, and four states (Delaware, New York, Massachusetts, and Vermont) plus Washington DC that had full or near full expansions before 2014, similar to previous studies. 3 , 4 , 17 , 25 Because of these prior expansions, these states were likely less affected by the 2014 ACA Medicaid expansion than states that expanded in 2014. For states that expanded in 2014, recent studies suggested growing effects on health status in 2018.…”

“…For states that expanded in 2014, recent studies suggested growing effects on health status in 2018. 15 , 17 For this reason, we did not include states that expanded in 2014 or later as control states.…”

Bridging the Divide: Does Social Capital Moderate the Impact of Polarization on Health?

“…The effects of Medicare expansion have been especially well studied. Medicaid expansion in 2014 has been linked to more frequent use of health care systems and earlier detection of diabetes and high cholesterol (Wherry and Miller 2016), improvements in overall health between 2014 and 2018 (Semprini et al 2020), and declines in disease-related mortality up through 2017 (Miller, Johnson, and Wherry 2021).…”