IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0267244.html
   My bibliography  Save this article

The Affordable Care Act Medicaid expansion: A difference-in-differences study of spillover participation in SNAP

Author

Listed:
  • Paulette Cha
  • José J Escarce

Abstract

The Affordable Care Act’s Medicaid expansion to individuals with adults under 138 percent of the federal poverty level led to insurance coverage for millions of Americans in participating states. This study investigates Medicaid expansion’s potential spillover participation in the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamp Program). In addition to providing public insurance, the policy connects individuals to SNAP, affecting social determinants of health such as hunger. We use difference-in-differences regression to estimate the effect of the Medicaid expansion on SNAP participation among approximately 414,000 individuals from across the United States. The Current Population Survey is used to answer the main research question, and the SNAP Quality Control Database allows for supplemental analyses. Medicaid expansion produces a 2.9 percentage point increase (p = 0.002) in SNAP participation among individuals under 138 percent of federal poverty. Subgroup analyses find a larger 5.0 percentage point increase (p = 0.002) in households under 75 percent of federal poverty without children. Able-Bodied Adults Without Dependents (ABAWDs) are a category of individuals with limited access to SNAP. Although they are a subset of adults without children, we found no spillover effect for ABAWDs. We find an increase in SNAP households with $0 income, supporting the finding that spillover was strongest for very-low-income individuals. Joint processing of Medicaid and SNAP applications helps facilitate the connection between Medicaid expansion and SNAP. Our findings contribute to a growing body of evidence that Medicaid expansion does more than improve access to health care by connecting eligible individuals to supports like SNAP. SNAP recipients have increased access to food, an important social determinant of health. Our study supports reducing administrative burdens to help connect individuals to safety net programs. Finally, we note that ABAWDs are a vulnerable group that need targeted program outreach.

Suggested Citation

  • Paulette Cha & José J Escarce, 2022. "The Affordable Care Act Medicaid expansion: A difference-in-differences study of spillover participation in SNAP," PLOS ONE, Public Library of Science, vol. 17(5), pages 1-20, May.
    • Handle: RePEc:plo:pone00:0267244
    DOI: 10.1371/journal.pone.0267244
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267244
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0267244&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0267244?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Janet Currie, 2004. "The Take Up of Social Benefits," NBER Working Papers 10488, National Bureau of Economic Research, Inc.
    2. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    3. Rebecca M. Blank & Patricia Ruggles, 1996. "When Do Women Use Aid to Families with Dependent Children and Food Stamps? The Dynamics of Eligibility Versus Participation," Journal of Human Resources, University of Wisconsin Press, vol. 31(1), pages 57-89.
    4. Beth Osborne Daponte & Seth Sanders & Lowell Taylor, 1999. "Why Do Low-Income Households not Use Food Stamps? Evidence from an Experiment," Journal of Human Resources, University of Wisconsin Press, vol. 34(3), pages 612-628.
    5. Liana Fox & Irwin Garfinkel & Neeraj Kaushal & Jane Waldfogel & Christopher Wimer, 2014. "Waging War on Poverty: Historical Trends in Poverty Using the Supplemental Poverty Measure," NBER Working Papers 19789, National Bureau of Economic Research, Inc.
    6. Douglas Almond & Hilary W. Hoynes & Diane Whitmore Schanzenbach, 2011. "Inside the War on Poverty: The Impact of Food Stamps on Birth Outcomes," The Review of Economics and Statistics, MIT Press, vol. 93(2), pages 387-403, May.
    7. Marianne Bitler & Hilary Hoynes, 2016. "The More Things Change, the More They Stay the Same? The Safety Net and Poverty in the Great Recession," Journal of Labor Economics, University of Chicago Press, vol. 34(S1), pages 403-444.
    8. Burney, Shaheer & Boehm, Rebecca & Lopez, Rigoberto, 2021. "The impact of the ACA Medicaid expansion on SNAP participation," Food Policy, Elsevier, vol. 101(C).
    9. Hilary Hoynes & Diane Whitmore Schanzenbach & Douglas Almond, 2016. "Long-Run Impacts of Childhood Access to the Safety Net," American Economic Review, American Economic Association, vol. 106(4), pages 903-934, April.
    10. 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.
    Full references (including those not matched with items on IDEAS)

    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. Elira Kuka, 2020. "Quantifying the Benefits of Social Insurance: Unemployment Insurance and Health," The Review of Economics and Statistics, MIT Press, vol. 102(3), pages 490-505, July.
    2. Bradley Hardy & Timothy Smeeding & James P. Ziliak, 2018. "The Changing Safety Net for Low-Income Parents and Their Children: Structural or Cyclical Changes in Income Support Policy?," Demography, Springer;Population Association of America (PAA), vol. 55(1), pages 189-221, February.
    3. Kuhn, Michael A., 2018. "Who feels the calorie crunch and when? The impact of school meals on cyclical food insecurity," Journal of Public Economics, Elsevier, vol. 166(C), pages 27-38.
    4. Bronchetti, Erin T. & Christensen, Garret & Hoynes, Hilary W., 2019. "Local food prices, SNAP purchasing power, and child health," Journal of Health Economics, Elsevier, vol. 68(C).
    5. Wang, Julia Shu-Huah & Zhao, Xi & Nam, Jaehyun, 2021. "The effects of welfare participation on parenting stress and parental engagement using an instrumental variables approach: Evidence from the Supplemental Nutrition Assistance Program," Children and Youth Services Review, Elsevier, vol. 121(C).
    6. Nicolas R. Ziebarth, 2018. "Social Insurance and Health," Contributions to Economic Analysis, in: Health Econometrics, volume 127, pages 57-84, Emerald Group Publishing Limited.
    7. Vaughn, Cody N., 2023. "Welfare reform and childhood health status and utilization," Children and Youth Services Review, Elsevier, vol. 150(C).
    8. Zantomio, Francesca, 2008. "The route to take-up: raising incentives or lowering barriers?," ISER Working Paper Series 2008-35, Institute for Social and Economic Research.
    9. Jeehoon Han, 2020. "Snap Expansions And Participation In Government Safety Net Programs," Economic Inquiry, Western Economic Association International, vol. 58(4), pages 1929-1948, October.
    10. Figari, Francesco & Paulus, Alari & Sutherland, Holly, 2014. "Microsimulation and policy analysis," ISER Working Paper Series 2014-23, Institute for Social and Economic Research.
    11. Sylvain Chareyron, 2016. "Le non-recours aux aides sociales sous conditions de ressources," Erudite Ph.D Dissertations, Erudite, number ph16-01 edited by Yannick L'Horty & François Legendre, September.
    12. Ahsan, Md Nazmul & Maharaj, Riddhi, 2018. "Parental human capital and child health at birth in India," Economics & Human Biology, Elsevier, vol. 30(C), pages 130-149.
    13. Sylvia E Twersky, 2019. "Restrictive state laws aimed at immigrants: Effects on enrollment in the food stamp program by U.S. citizen children in immigrant families," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-18, May.
    14. Momi Dahan & Udi Nisan, 2010. "The effect of benefits level on take-up rates: evidence from a natural experiment," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 17(2), pages 151-173, April.
    15. Gabriella Conti & Rita Ginja, 2023. "Who Benefits from Free Health Insurance?: Evidence from Mexico," Journal of Human Resources, University of Wisconsin Press, vol. 58(1), pages 146-182.
    16. Petra Persson & Maya Rossin-Slater, 2018. "Family Ruptures, Stress, and the Mental Health of the Next Generation," American Economic Review, American Economic Association, vol. 108(4-5), pages 1214-1252, April.
    17. Victor Chernozhukov & Iván Fernández-Val & Blaise Melly & Kaspar Wüthrich, 2020. "Generic Inference on Quantile and Quantile Effect Functions for Discrete Outcomes," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 115(529), pages 123-137, January.
    18. González, Libertad & Trommlerová, Sofia, 2022. "Cash transfers before pregnancy and infant health," Journal of Health Economics, Elsevier, vol. 83(C).
    19. Dean Jolliffe & Juan Margitic & Martin Ravallion & Laura Tiehen, 2024. "Food stamps and America's poorest," American Journal of Agricultural Economics, John Wiley & Sons, vol. 106(4), pages 1380-1409, August.
    20. David Neumark & Brian Asquith & Brittany Bass, 2020. "Longer‐Run Effects Of Anti‐Poverty Policies On Disadvantaged Neighborhoods," Contemporary Economic Policy, Western Economic Association International, vol. 38(3), pages 409-434, July.

    More about this item

    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:plo:pone00:0267244. 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: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    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.