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The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare

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  • Colleen M. Carey
  • Sarah Miller
  • Laura R. Wherry

Abstract

Some states have not adopted the Affordable Care Act (ACA) Medicaid expansions due to concerns that the expansions may impair access to care and utilization for those who are already insured. We investigate such negative spillovers using a large panel of Medicare beneficiaries. Across many subgroups and outcomes, we find no evidence that the expansions reduced utilization among Medicare beneficiaries and can rule out all but very small changes in utilization or spending. These results indicate that the expansions in Medicaid did not impair access to care or utilization for the Medicare population.

Suggested Citation

  • Colleen M. Carey & Sarah Miller & Laura R. Wherry, 2020. "The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare," American Economic Journal: Applied Economics, American Economic Association, vol. 12(4), pages 288-318, October.
    • Handle: RePEc:aea:aejapp:v:12:y:2020:i:4:p:288-318
    DOI: 10.1257/app.20190176
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    References listed on IDEAS

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    11. Kosali Simon & Aparna Soni & John Cawley, 2017. "The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(2), pages 390-417, March.
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    14. Thomas Buchmueller & Sarah Miller & Marko Vujicic, 2016. "How Do Providers Respond to Changes in Public Health Insurance Coverage? Evidence from Adult Medicaid Dental Benefits," American Economic Journal: Economic Policy, American Economic Association, vol. 8(4), pages 70-102, November.
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 19th October 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-10-19 11:00:05

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    Cited by:

    1. Guihua Wang, 2022. "The Effect of Medicaid Expansion on Wait Time in the Emergency Department," Management Science, INFORMS, vol. 68(9), pages 6648-6665, September.
    2. Dunn, Abe & Knepper, Matthew & Dauda, Seidu, 2021. "Insurance expansions and hospital utilization: Relabeling and reabling?," Journal of Health Economics, Elsevier, vol. 78(C).
    3. Barkowski, Scott & Jun, Dajung & Zhang, Yuting, 2022. "Medicaid Expansion Spillover Effects on Health Care Consumption and Coverage: Evidence from Medicare Administrative Data," MPRA Paper 112178, University Library of Munich, Germany.
    4. Dillender, Marcus & Friedson, Andrew & Gian, Cong & Simon, Kosali, 2019. "Does the healthcare educational market respond to short-run local demand?," Economics of Education Review, Elsevier, vol. 73(C).
    5. Denis Agniel & Jonathan H. Cantor & Johanna Catherine Maclean & Kosali I. Simon & Erin Taylor, 2023. "Insurance Coverage and Provision of Opioid Treatment: Evidence from Medicare," NBER Working Papers 31884, National Bureau of Economic Research, Inc.
    6. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1783-1829.
    7. Neprash, Hannah T. & Zink, Anna & Sheridan, Bethany & Hempstead, Katherine, 2021. "The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care," Journal of Health Economics, Elsevier, vol. 80(C).
    8. Borgschulte, Mark & Vogler, Jacob, 2020. "Did the ACA Medicaid expansion save lives?," Journal of Health Economics, Elsevier, vol. 72(C).
    9. Dillender, Marcus & Jinks, Lu & Lo Sasso, Anthony T., 2023. "When (and why) providers do not respond to changes in reimbursement rates," Journal of Public Economics, Elsevier, vol. 217(C).
    10. Shyam Raman & Johanna Catherine Maclean & W. David Bradford & Coleman Drake, 2023. "Recreational cannabis and opioid distribution," Health Economics, John Wiley & Sons, Ltd., vol. 32(4), pages 747-754, April.
    11. Geruso, Michael & Richards, Michael R., 2022. "Trading spaces: Medicare's regulatory spillovers on treatment setting for non-Medicare patients," Journal of Health Economics, Elsevier, vol. 84(C).

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    More about this item

    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

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