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Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health

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  • Charles Courtemanche
  • James Marton
  • Benjamin Ukert
  • Aaron Yelowitz
  • Daniela Zapata

Abstract

The goal of the Affordable Care Act (ACA) was to achieve nearly universal health insurance coverage through a combination of mandates, subsidies, marketplaces, and Medicaid expansions, most of which took effect in 2014. We use data from the Behavioral Risk Factor Surveillance System to examine the impacts of the ACA on health care access, risky health behaviors, and self‐assessed health after two years. We estimate difference‐in‐difference‐in‐differences models that exploit variation in treatment intensity from state participation in the Medicaid expansion and pre‐ACA uninsured rates. Results suggest that the ACA led to sizeable improvements in access to health care in both Medicaid expansion and nonexpansion states, with the gains being larger in expansion states along some dimensions. However, we do not find clear effects on risky behaviors or self‐assessed health.

Suggested Citation

  • 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.
  • Handle: RePEc:wly:soecon:v:84:y:2018:i:3:p:660-691
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    File URL: https://doi.org/10.1002/soej.12245
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    Cited by:

    1. Courtemanche, Charles & Friedson, Andrew I. & Koller, Andrew P. & Rees, Daniel I., 2017. "The Affordable Care Act and Ambulance Response Times," IZA Discussion Papers 10951, Institute for the Study of Labor (IZA).
    2. Jacqueline Fiore, 2017. "The Impact of the Affordable Care Act's Medicaid Expansion on Medicaid Spending by Health Care Service Category," Working Papers 1706, Tulane University, Department of Economics, revised Mar 2018.
    3. Ziebarth, Nicolas R., 2017. "Social Insurance and Health," IZA Discussion Papers 10918, Institute for the Study of Labor (IZA).
    4. Maclean, J. Catherine & Saloner, Brendan, 2017. "The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act," IZA Discussion Papers 10745, Institute for the Study of Labor (IZA).
    5. Kim, Seonghoon & Koh, Kanghyock, 2018. "Does Health Insurance Make People Happier? Evidence from Massachusetts' Healthcare Reform," IZA Discussion Papers 11879, Institute for the Study of Labor (IZA).
    6. Itzik Fadlon & Torben Heien Nielsen, 2017. "Family Health Behaviors," NBER Working Papers 24042, National Bureau of Economic Research, Inc.
    7. Marcella Alsan & Crystal Yang, 2018. "Fear and the Safety Net: Evidence from Secure Communities," NBER Working Papers 24731, National Bureau of Economic Research, Inc.
    8. Charles Courtemanche & Andrew Friedson & Daniel I. Rees, 2018. "Ambulance Utilization in New York City after the Implementation of the Affordable Care Act," NBER Working Papers 24480, National Bureau of Economic Research, Inc.
    9. Burney, Shaheer & Boehm, Rebecca L. & Lopez, Rigoberto A., 2018. "Impact of the 2014 Medicaid Expansion on SNAP Participation," 2018 Annual Meeting, August 5-7, Washington, D.C. 273847, Agricultural and Applied Economics Association.
    10. Johanna Catherine Maclean & Michael F. Pesko & Steven C. Hill, 2017. "The Effect of Insurance Expansions on Smoking Cessation Medication Prescriptions: Evidence from ACA Medicaid Expansions," NBER Working Papers 23450, National Bureau of Economic Research, Inc.
    11. 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 for the Study of Labor (IZA).
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    15. Argys, Laura & Friedson, Andrew & Pitts, M. Melinda & Tello-Trillo, D. Sebastian, 2017. "Losing Public Health Insurance: TennCare Disenrollment and Personal Financial Distress," FRB Atlanta Working Paper 2017-6, Federal Reserve Bank of Atlanta, revised 01 Sep 2017.

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    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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