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The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes

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  • Mark Duggan
  • Gopi Shah Goda
  • Emilie Jackson

Abstract

The Affordable Care Act (ACA) includes several provisions designed to expand health insurance coverage that also alter the tie between employment and health insurance. In this paper, we exploit variation across geographic areas in the potential impact of the ACA to estimate its effect on health insurance and labor market outcomes in its first four years. Our findings indicate that approximately 70 percent of the increase in health insurance coverage since 2013 is due to the ACA. We also find that these increases in health insurance coverage did not result in statistically significant changes in labor market outcomes.

Suggested Citation

  • 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.
  • Handle: RePEc:ntj:journl:v:72:y:2019:i:2:p:261-322
    DOI: 10.17310/ntj.2019.2.01
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    1. Robert Kaestner & Bowen Garrett & Jiajia Chen & Anuj Gangopadhyaya & Caitlyn Fleming, 2017. "Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(3), pages 608-642, June.
    2. Congressional Budget Office, 2014. "Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014," Reports 45231, Congressional Budget Office.
    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. David M. Blau & Donna B. Gilleskie, 2001. "Retiree Health Insurance and the Labor Force Behavior of Older Men in the 1990s," The Review of Economics and Statistics, MIT Press, vol. 83(1), pages 64-80, February.
    5. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 431-466.
    6. Shoven, John B. & Slavov, Sita Nataraj, 2014. "The role of retiree health insurance in the early retirement of public sector employees," Journal of Health Economics, Elsevier, vol. 38(C), pages 99-108.
    7. Craig Garthwaite & Tal Gross & Matthew J. Notowidigdo, 2014. "Public Health Insurance, Labor Supply, and Employment Lock," The Quarterly Journal of Economics, Oxford University Press, vol. 129(2), pages 653-696.
    8. Fitzpatrick, Maria D., 2014. "Retiree health insurance for public school employees: Does it affect retirement?," Journal of Health Economics, Elsevier, vol. 38(C), pages 88-98.
    9. 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.
    10. Gabriel Chodorow-Reich & Laura Feiveson & Zachary Liscow & William Gui Woolston, 2012. "Does State Fiscal Relief during Recessions Increase Employment? Evidence from the American Recovery and Reinvestment Act," American Economic Journal: Economic Policy, American Economic Association, vol. 4(3), pages 118-145, August.
    11. James Bailey & Anna Chorniy, 2016. "Employer-Provided Health Insurance And Job Mobility: Did The Affordable Care Act Reduce Job Lock?," Contemporary Economic Policy, Western Economic Association International, vol. 34(1), pages 173-183, January.
    12. Eric French & John Bailey Jones, 2011. "The Effects of Health Insurance and Self‐Insurance on Retirement Behavior," Econometrica, Econometric Society, vol. 79(3), pages 693-732, May.
    13. Kolstad, Jonathan T. & Kowalski, Amanda E., 2012. "The impact of health care reform on hospital and preventive care: Evidence from Massachusetts," Journal of Public Economics, Elsevier, vol. 96(11), pages 909-929.
    14. Congressional Budget Office, 2014. "Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014," Reports 45231, Congressional Budget Office.
    15. Congressional Budget Office, 2015. "The Budget and Economic Outlook: 2015 to 2025," Reports 49892, Congressional Budget Office.
    16. John Rust & Christopher Phelan, 1997. "How Social Security and Medicare Affect Retirement Behavior in a World of Incomplete Markets," Econometrica, Econometric Society, vol. 65(4), pages 781-832, July.
    17. Yaa Akosa Antwi & Asako S. Moriya & Kosali Simon, 2013. "Effects of Federal Policy to Insure Young Adults: Evidence from the 2010 Affordable Care Act's Dependent-Coverage Mandate," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 1-28, November.
    18. David M. Blau & Donna B. Gilleskie, 2008. "The Role Of Retiree Health Insurance In The Employment Behavior Of Older Men," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 49(2), pages 475-514, May.
    19. Brigitte C. Madrian, 1994. "Employment-Based Health Insurance and Job Mobility: Is there Evidence of Job-Lock?," The Quarterly Journal of Economics, Oxford University Press, vol. 109(1), pages 27-54.
    20. Congressional Budget Office, 2014. "Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014," Reports 45231, Congressional Budget Office.
    21. Finkelstein, Amy & McKnight, Robin, 2008. "What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending," Journal of Public Economics, Elsevier, vol. 92(7), pages 1644-1668, July.
    22. 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.
    23. Boyle, Melissa A. & Lahey, Joanna N., 2010. "Health insurance and the labor supply decisions of older workers: Evidence from a U.S. Department of Veterans Affairs expansion," Journal of Public Economics, Elsevier, vol. 94(7-8), pages 467-478, August.
    24. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, Oxford University Press, vol. 119(1), pages 249-275.
    25. Robin L. Lumsdaine & James H. Stock & David A. Wise, 1996. "Retirement Incentives: The Interaction between Employer-Provided Pensions, Social Security, and Retiree Health Benefits," NBER Chapters, in: The Economic Effects of Aging in the United States and Japan, pages 261-293, National Bureau of Economic Research, Inc.
    26. Amy Finkelstein, 2007. "The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare," The Quarterly Journal of Economics, Oxford University Press, vol. 122(1), pages 1-37.
    27. Laura Dague & Thomas DeLeire & Lindsey Leininger, 2017. "The Effect of Public Insurance Coverage for Childless Adults on Labor Supply," American Economic Journal: Economic Policy, American Economic Association, vol. 9(2), pages 124-154, May.
    28. Alan L. Gustman & Thomas L. Steinmeier, 1994. "Employer-Provided Health Insurance and Retirement Behavior," ILR Review, Cornell University, ILR School, vol. 48(1), pages 124-140, October.
    29. Jonathan Gruber & Brigitte C. Madrian, 2002. "Health Insurance, Labor Supply, and Job Mobility: A Critical Review of the Literature," JCPR Working Papers 255, Northwestern University/University of Chicago Joint Center for Poverty Research.
    30. Norma B. Coe & Mashfiqur Khan & Matthew S. Rutledge, 2013. "Sticky Ages: Why Is Age 65 Still a Retirement Peak?," Working Papers, Center for Retirement Research at Boston College wp2013-2, Center for Retirement Research.
    31. Congressional Budget Office, 2015. "An Update to the Budget and Economic Outlook: 2015 to 2025," Reports 50724, Congressional Budget Office.
    32. Gustman, Alan L. & Steinmeier, Thomas L. & Tabatabai, Nahid, 2019. "The Affordable Care Act as retiree health insurance: implications for retirement and Social Security claiming," Journal of Pension Economics and Finance, Cambridge University Press, vol. 18(3), pages 415-449, July.
    33. Casey B. Mulligan, 2015. "The New Employment And Income Taxes," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 34(2), pages 466-473, March.
    34. Nyce, Steven & Schieber, Sylvester J. & Shoven, John B. & Slavov, Sita Nataraj & Wise, David A., 2013. "Does retiree health insurance encourage early retirement?," Journal of Public Economics, Elsevier, vol. 104(C), pages 40-51.
    35. Congressional Budget Office, 2015. "The Budget and Economic Outlook: 2015 to 2025," Reports 49892, Congressional Budget Office.
    36. Hamersma, Sarah & Kim, Matthew, 2013. "Participation and crowd out: Assessing the effects of parental Medicaid expansions," Journal of Health Economics, Elsevier, vol. 32(1), pages 160-171.
    37. Lynn A. Karoly & Jeannette A. Rogowski, 1994. "The Effect of Access to Post-Retirement Health Insurance on the Decision to Retire Early," ILR Review, Cornell University, ILR School, vol. 48(1), pages 103-123, October.
    38. Bradley Heim & Ithai Lurie & Kosali Simon, 2015. "The Impact of the Affordable Care Act Young Adult Provision on Labor Market Outcomes: Evidence from Tax Data," Tax Policy and the Economy, University of Chicago Press, vol. 29(1), pages 133-157.
    39. Katherine Baicker & Amy Finkelstein & Jae Song & Sarah Taubman, 2014. "The Impact of Medicaid on Labor Market Activity and Program Participation: Evidence from the Oregon Health Insurance Experiment," American Economic Review, American Economic Association, vol. 104(5), pages 322-328, May.
    40. Helen Levy & Thomas Buchmueller & Sayeh Nikpay, 2015. "The Effect of Health Reform on Retirement," Working Papers wp329, University of Michigan, Michigan Retirement Research Center.
    41. Marcus Dillender & Carolyn Heinrich & Susan Houseman, 2016. "Effects of the Affordable Care Act on Part-Time Employment: Early Evidence," Upjohn Working Papers 16-258, W.E. Upjohn Institute for Employment Research.
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    More about this item

    JEL classification:

    • H31 - Public Economics - - Fiscal Policies and Behavior of Economic Agents - - - Household
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • J18 - Labor and Demographic Economics - - Demographic Economics - - - Public Policy
    • J20 - Labor and Demographic Economics - - Demand and Supply of Labor - - - General
    • J38 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs - - - Public Policy

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