State Medicaid Expansion and the Self-Employed

This paper examines effects of state Medicaid Expansion via the Affordable Care Act on the self-employed. We first examine impacts on the probability of self-employment and find small and not significant estimated effects of Medicaid expansion on the likelihood of being self-employed. We then examine effects of Medicaid expansion on the probability of having health insurance for persons who are self-employed. State Medicaid expansion increased overall health insurance coverage rates, with especially large impacts for the unincorporated self-employed. Impacts on health insurance rates of the self-employed also strengthened over time. The results indicate that Medicaid expansion does not affect entry into self-employment but it does provide significant health insurance benefits for many small business owners with low incomes who otherwise would face considerable difficulty obtaining health insurance.