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Impacts of the ACA Medicaid expansion on health behaviors: Evidence from household panel data

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  • Chad Cotti
  • Erik Nesson
  • Nathan Tefft

Abstract

A motivation for increasing health insurance coverage is to improve health outcomes for impacted populations. However, health insurance coverage may alternatively increase risky health behaviors due to ex ante moral hazard, and past research on this issue has led to mixed conclusions. This paper uses a panel of household purchases to estimate the effects of the recent state‐level Medicaid expansions resulting from the Affordable Care Act (ACA) on consumption goods that present adverse health risks. We utilize within‐household variation to identify whether increases in Medicaid availability impacted household purchase patterns of alcohol, nicotine‐related, snack food, and carbonated beverage products. Overall, we find little evidence that the ACA Medicaid expansion led to ex ante moral hazard across any of these products, but we find compelling evidence that the Medicaid expansions reduced cigarette consumption and increased smoking cessation product use among the Medicaid‐eligible population.

Suggested Citation

  • Chad Cotti & Erik Nesson & Nathan Tefft, 2019. "Impacts of the ACA Medicaid expansion on health behaviors: Evidence from household panel data," Health Economics, John Wiley & Sons, Ltd., vol. 28(2), pages 219-244, February.
  • Handle: RePEc:wly:hlthec:v:28:y:2019:i:2:p:219-244
    DOI: 10.1002/hec.3838
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    Cited by:

    1. Chen Huang & Feng Liu & Shijun You, 2021. "The impact of minimum wage increases on cigarette smoking," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2063-2091, September.
    2. Itzik Fadlon & Torben Heien Nielsen, 2019. "Family Health Behaviors," American Economic Review, American Economic Association, vol. 109(9), pages 3162-3191, September.
    3. Nicholas Moellman, 2020. "Healthcare and Hunger: Effects of the ACA Medicaid Expansions on Food Insecurity in America," Applied Economic Perspectives and Policy, John Wiley & Sons, vol. 42(2), pages 168-186, June.
    4. 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, December.
    5. Lei, Lianlian & Liu, Feng, 2021. "Medicaid coverage and use of nicotine replacement treatment," Economics & Human Biology, Elsevier, vol. 40(C).
    6. Panchalingam, Thadchaigeni, 2020. "Effects of Public Health Insurance Expansions on Consumption Expenditures of Targeted Households," 2020 Annual Meeting, July 26-28, Kansas City, Missouri 304513, Agricultural and Applied Economics Association.
    7. Yichen Shen & Haruko Noguchi, 2021. "The effect of coverage of smoking‐cessation aids on tobacco use: Evidence from Canada," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2200-2216, September.
    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. Xi He & Rigoberto A. Lopez & Rebecca Boehm, 2020. "Medicaid expansion and non‐alcoholic beverage choices by low‐income households," Health Economics, John Wiley & Sons, Ltd., vol. 29(11), pages 1327-1342, November.
    10. Aparna Soni, 2020. "The effects of public health insurance on health behaviors: Evidence from the fifth year of Medicaid expansion," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1586-1605, December.

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