IDEAS home Printed from https://ideas.repec.org/p/nbr/nberwo/26157.html
   My bibliography  Save this paper

The Impact of the ACA on Insurance Coverage Disparities After Four Years

Author

Listed:
  • Charles J. Courtemanche
  • Ishtiaque Fazlul
  • James Marton
  • Benjamin D. Ukert
  • Aaron Yelowitz
  • Daniela Zapata

Abstract

The purpose of this paper is to estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after four years. We use data from the 2011–2017 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults. Our methods feature a difference-in-difference-in-differences model, developed in the recent ACA literature, which separately identifies the effects of the nationwide and Medicaid expansion portions of the law. The differences in this model come from time, state Medicaid expansion status, and local area pre-ACA uninsured rate. We stratify our sample separately by income, race/ethnicity, marital status, age, gender, and geography in order to examine access disparities. After four years, we find that the fully implemented ACA eliminated 44 percent of the coverage gap across income groups, with the Medicaid expansion accounting for this entire reduction. The ACA also reduced coverage disparities across racial groups by 26.7 percent, across marital status by 45 percent, and across age groups by 44 percent, with these changes being partly attributable to both the Medicaid expansion and nationwide components of the law.

Suggested Citation

  • Charles J. Courtemanche & Ishtiaque Fazlul & James Marton & Benjamin D. Ukert & Aaron Yelowitz & Daniela Zapata, 2019. "The Impact of the ACA on Insurance Coverage Disparities After Four Years," NBER Working Papers 26157, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:26157
    Note: EH PE
    as

    Download full text from publisher

    File URL: http://www.nber.org/papers/w26157.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2018. "Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health," Southern Economic Journal, John Wiley & Sons, vol. 84(3), pages 660-691, January.
    2. Mark Duggan & Gopi Shah Goda & Emilie Jackson, 2019. "The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes," National Tax Journal, National Tax Association;National Tax Journal, vol. 72(2), pages 261-322, June.
    3. Frean, Molly & Gruber, Jonathan & Sommers, Benjamin D., 2017. "Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act," Journal of Health Economics, Elsevier, vol. 53(C), pages 72-86.
    4. Charles Courtemanche & James Marton & Aaron Yelowitz, 2016. "Who Gained Insurance Coverage in 2014, the First Year of Full ACA Implementation?," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 778-784, June.
    5. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2019. "Effects of the Affordable Care Act on Health Behaviors After 3 Years," Eastern Economic Journal, Palgrave Macmillan;Eastern Economic Association, vol. 45(1), pages 7-33, January.
    6. Miller, Sarah, 2012. "The effect of insurance on emergency room visits: An analysis of the 2006 Massachusetts health reform," Journal of Public Economics, Elsevier, vol. 96(11), pages 893-908.
    7. Pauline Leung & Alexandre Mas, 2018. "Employment Effects of the Affordable Care Act Medicaid Expansions," Industrial Relations: A Journal of Economy and Society, Wiley Blackwell, vol. 57(2), pages 206-234, April.
    8. Amy Finkelstein, 2007. "The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 1-37.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Jun Yeong Lee & John V. Winters, 2022. "State Medicaid Expansion and the Self-Employed," Small Business Economics, Springer, vol. 59(3), pages 925-954, October.
    2. Benjamin W. Cowan & Zhuang Hao, 2021. "Medicaid expansion and the mental health of college students," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1306-1327, June.
    3. Prabal K. De, 2021. "Impacts of insurance expansion on health cost, health access, and health behaviors: evidence from the medicaid expansion in the US," International Journal of Health Economics and Management, Springer, vol. 21(4), pages 495-510, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Yelowitz, Aaron & Ingram, Samuel J., 2021. "How Does Occupational Licensing Affect Entry into the Medical Field? An Examination of EMTs," IZA Discussion Papers 14071, Institute of Labor Economics (IZA).
    2. Mark Duggan & Atul Gupta & Emilie Jackson, 2022. "The Impact of the Affordable Care Act: Evidence from California's Hospital Sector," American Economic Journal: Economic Policy, American Economic Association, vol. 14(1), pages 111-151, February.
    3. Jonathan Gruber & Benjamin D. Sommers, 2019. "The Affordable Care Act’s Effects on Patients, Providers and the Economy: What We’ve Learned So Far," NBER Working Papers 25932, National Bureau of Economic Research, Inc.
    4. Dunn, Abe & Knepper, Matthew & Dauda, Seidu, 2021. "Insurance expansions and hospital utilization: Relabeling and reabling?," Journal of Health Economics, Elsevier, vol. 78(C).
    5. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2018. "Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health," Southern Economic Journal, John Wiley & Sons, vol. 84(3), pages 660-691, January.
    6. Courtemanche, Charles & Friedson, Andrew I. & Rees, Daniel I., 2018. "Ambulance Utilization in New York City after the Implementation of the Affordable Care Act," IZA Discussion Papers 11444, Institute of Labor Economics (IZA).
    7. Mark Duggan & Gopi Shah Goda & Emilie Jackson, 2019. "The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes," National Tax Journal, National Tax Association;National Tax Journal, vol. 72(2), pages 261-322, June.
    8. Mark Duggan & Gopi Shah Goda & Gina Li, 2021. "The Effects of the Affordable Care Act on the Near Elderly: Evidence for Health Insurance Coverage and Labor Market Outcomes," Tax Policy and the Economy, University of Chicago Press, vol. 35(1), pages 179-223.
    9. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2019. "Effects of the Affordable Care Act on Health Behaviors After 3 Years," Eastern Economic Journal, Palgrave Macmillan;Eastern Economic Association, vol. 45(1), pages 7-33, January.
    10. Lindsey Rose Bullinger, 2021. "Child Support and the Affordable Care Act's Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(1), pages 42-77, January.
    11. Cortnie Shupe, 2023. "Public Health Insurance and Medical Spending: The Incidence of the ACA Medicaid Expansion," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 42(1), pages 137-165, January.
    12. Courtemanche, Charles & Marton, James & Ukert, Benjamin & Yelowitz, Aaron & Zapata, Daniela, 2018. "Effects of the Affordable Care Act on Health Behaviors after Three Years," IZA Discussion Papers 11468, Institute of Labor Economics (IZA).
    13. Lizhong Peng & Xiaohui Guo & Chad D. Meyerhoefer, 2020. "The effects of Medicaid expansion on labor market outcomes: Evidence from border counties," Health Economics, John Wiley & Sons, Ltd., vol. 29(3), pages 245-260, March.
    14. Jeffrey Clemens & Drew McNichols & Joseph J. Sabia, 2020. "The Long-Run Effects of the Affordable Care Act: A Pre-Committed Research Design Over the COVID-19 Recession and Recovery," NBER Working Papers 27999, National Bureau of Economic Research, Inc.
    15. Cortnie Shupe, 2021. "Public Health Insurance and Medical Spending: Evidence from the ACA Medicaid Expansion," CESifo Working Paper Series 8827, CESifo.
    16. Courtemanche, Charles & Friedson, Andrew & Koller, Andrew P. & Rees, Daniel I., 2019. "The affordable care act and ambulance response times," Journal of Health Economics, Elsevier, vol. 67(C).
    17. Benjamin C. Chu, 2023. "Who did the ACA Medicaid expansion impact? Estimating the probability of being a complier," Health Economics, John Wiley & Sons, Ltd., vol. 32(7), pages 1626-1655, July.
    18. Johanna Catherine Maclean & Brendan Saloner, 2019. "The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 38(2), pages 366-393, March.
    19. Laura Argys & Andrew Friedson & M. Melinda Pitts & D. Sebastian Tello-Trillo, 2017. "Losing Public Health Insurance: TennCare Disenrollment and Personal Financial Distress," FRB Atlanta Working Paper 2017-6, Federal Reserve Bank of Atlanta.
    20. McInerney, Melissa & Meiselbach, Mark K., 2020. "Distributional Effects of Recent Health Insurance Expansions on Weight-Related Outcomes," Economics & Human Biology, Elsevier, vol. 38(C).

    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nbr:nberwo:26157. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/nberrus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.