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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, 2018. "The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare," NBER Working Papers 25153, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:25153
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    References listed on IDEAS

    as
    1. Thomas C. Buchmueller & Sarah Miller & Marko Vujicic, 2014. "How Do Providers Respond to Public Health Insurance Expansions? Evidence from Adult Medicaid Dental Benefits," NBER Working Papers 20053, National Bureau of Economic Research, Inc.
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    6. Melissa McInerney & Jennifer M. Mellor & Lindsay M. Sabik, 2017. "The Effects of State Medicaid Expansions for Working-Age Adults on Senior Medicare Beneficiaries," American Economic Journal: Economic Policy, American Economic Association, vol. 9(3), pages 408-438, August.
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    11. Diane Alexander & Molly Schnell, 2017. "Closing the Gap: The Impact of the Medicaid Primary Care Rate Increase on Access and Health," Working Paper Series WP-2017-10, Federal Reserve Bank of Chicago.
    12. Hu, Luojia & Kaestner, Robert & Mazumder, Bhashkar & Miller, Sarah & Wong, Ashley, 2018. "The effect of the affordable care act Medicaid expansions on financial wellbeing," Journal of Public Economics, Elsevier, vol. 163(C), pages 99-112.
    13. Ausmita Ghosh & Kosali Simon & Benjamin D. Sommers, 2017. "The Effect of State Medicaid Expansions on Prescription Drug Use: Evidence from the Affordable Care Act," NBER Working Papers 23044, National Bureau of Economic Research, Inc.
    14. Glied, Sherry & Hong, Kai, 2018. "Health care in a multi-payer system: Spillovers of health care service demand among adults under 65 on utilization and outcomes in medicare," Journal of Health Economics, Elsevier, vol. 60(C), pages 165-176.
    15. 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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    1. Dunn, Abe & Knepper, Matthew & Dauda, Seidu, 2021. "Insurance expansions and hospital utilization: Relabeling and reabling?," Journal of Health Economics, Elsevier, vol. 78(C).
    2. 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.
    3. 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.
    4. 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).
    5. 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).
    6. Borgschulte, Mark & Vogler, Jacob, 2020. "Did the ACA Medicaid expansion save lives?," Journal of Health Economics, Elsevier, vol. 72(C).
    7. 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.
    8. 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).
    9. 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.
    10. 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).
    11. 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.

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    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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