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Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data

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  • Sarah Miller
  • Norman Johnson
  • Laura R Wherry

Abstract

We use large-scale federal survey data linked to administrative death records to investigate the relationship between Medicaid enrollment and mortality. Our analysis compares changes in mortality for near-elderly adults in states with and without Affordable Care Act Medicaid expansions. We identify adults most likely to benefit using survey information on socioeconomic status, citizenship status, and public program participation. We find that prior to the ACA expansions, mortality rates across expansion and nonexpansion states trended similarly, but beginning in the first year of the policy, there were significant reductions in mortality in states that opted to expand relative to nonexpanders. Individuals in expansion states experienced a 0.132 percentage point decline in annual mortality, a 9.4% reduction over the sample mean, as a result of the Medicaid expansions. The effect is driven by a reduction in disease-related deaths and grows over time. A variety of alternative specifications, methods of inference, placebo tests, and sample definitions confirm our main result.

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  • Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, Oxford University Press, vol. 136(3), pages 1783-1829.
  • Handle: RePEc:oup:qjecon:v:136:y:2021:i:3:p:1783-1829.
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    2. Sarah Miller & Luojia Hu & Robert Kaestner & Bhashkar Mazumder & Ashley Wong, 2021. "The ACA Medicaid Expansion in Michigan and Financial Health," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(2), pages 348-375, March.
    3. Cesur, Resul & Freidman, Travis & Sabia, Joseph J., 2020. "War, traumatic health shocks, and religiosity," Journal of Economic Behavior & Organization, Elsevier, vol. 179(C), pages 475-502.
    4. Jason Abaluck & Mauricio Caceres Bravo & Peter Hull: & Amanda Starc, 2021. "Mortality Effects and Choice Across Private Health Insurance Plans," The Quarterly Journal of Economics, Oxford University Press, vol. 136(3), pages 1557-1610.
    5. Kim, Seonghoon & Koh, Kanghyock, 2019. "The Effects of the Affordable Care Act Medicaid Expansion on Subjective Well-being," IZA Discussion Papers 12636, Institute of Labor Economics (IZA).
    6. Seonghoon Kim & Kanghyock Koh, 2022. "Health insurance and subjective well‐being: Evidence from two healthcare reforms in the United States," Health Economics, John Wiley & Sons, Ltd., vol. 31(1), pages 233-249, January.
    7. Borgschulte, Mark & Vogler, Jacob, 2019. "Did the ACA Medicaid Expansion Save Lives?," IZA Discussion Papers 12552, Institute of Labor Economics (IZA).
    8. Díaz, Carlos & Fossati, Sebastian & Trajtenberg, Nicolás, 2021. "Stay at Home if You Can: COVID-19 Stay-at-Home Guidelines and Local Crime," Working Papers 2021-8, University of Alberta, Department of Economics.
    9. Jacob Vogler, 2020. "Access to Healthcare and Criminal Behavior: Evidence from the ACA Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 39(4), pages 1166-1213, September.
    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. 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.
    12. 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.
    13. Kevin Milligan & Tammy Schirle, 2021. "The evolution of longevity: Evidence from Canada," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 54(1), pages 164-192, February.
    14. Marquez-Padilla, Fernanda, 2021. "When less is more: Can reduced health monitoring improve medication adherence?," Journal of Health Economics, Elsevier, vol. 75(C).
    15. Atheendar S Venkataramani & Rourke O’Brien & Gregory L Whitehorn & Alexander C Tsai, 2020. "Economic influences on population health in the United States: Toward policymaking driven by data and evidence," PLOS Medicine, Public Library of Science, vol. 17(9), pages 1-17, September.
    16. Louis‐Philippe Beland & Jason Huh & Dongwoo Kim, 2021. "The effect of Affordable Care Act Medicaid expansions on foster care admissions," Health Economics, John Wiley & Sons, Ltd., vol. 30(11), pages 2943-2951, November.
    17. J Dustin Tracy & Kevin A James & Hillard Kaplan & Stephen Rassenti, 2021. "An investigation of health insurance policy and behavior in a virtual environment," PLOS ONE, Public Library of Science, vol. 16(4), pages 1-26, April.
    18. Jonathan Gruber & Benjamin D. Sommers, 2020. "Fiscal Federalism and the Budget Impacts of the Affordable Care Act's Medicaid Expansion," NBER Working Papers 26862, National Bureau of Economic Research, Inc.
    19. Amitabh Chandra & Evan Flack & Ziad Obermeyer, 2021. "The Health Costs of Cost-Sharing," NBER Working Papers 28439, National Bureau of Economic Research, Inc.
    20. Anup Malani & Phoebe Holtzman & Kosuke Imai & Cynthia Kinnan & Morgen Miller & Shailender Swaminathan & Alessandra Voena & Bartosz Woda & Gabriella Conti, 2021. "Effect of Health Insurance in India: A Randomized Controlled Trial," Working Papers 2021-055, Human Capital and Economic Opportunity Working Group.

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    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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