IDEAS home Printed from https://ideas.repec.org/p/arx/papers/2506.12976.html
   My bibliography  Save this paper

Does the Expansion of Medicaid Lead to Income Adjustment -- Evidence from SIPP

Author

Listed:
  • Mingjian Li

Abstract

This study examines whether Medicaid expansion under the Affordable Care Act (ACA) led to strategic income reductions to qualify for coverage. Using monthly data from the Survey of Income and Program Participation (2013 to 2019) and a regression discontinuity design, this paper finds that childless households in expansion states with earnings just above the eligibility threshold reduced their lowest monthly earnings by 39 percentage points of the Federal Poverty Level (roughly 700 dollars for a two-person household) relative to those just below. The effect intensified as the mandate penalty increased and diminished after its repeal. Evidence suggests earnings adjustments along both intensive and extensive margins. The paper reinforces the validity of using the lowest monthly earning to identify Medicaid eligibility and provides the first evidence of a substantial labor supply response to the ACA

Suggested Citation

  • Mingjian Li, 2025. "Does the Expansion of Medicaid Lead to Income Adjustment -- Evidence from SIPP," Papers 2506.12976, arXiv.org, revised Jun 2025.
    • Handle: RePEc:arx:papers:2506.12976
    as

    Download full text from publisher

    File URL: http://arxiv.org/pdf/2506.12976
    File Function: Latest version
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Zhuan Pei, 2017. "Eligibility Recertification and Dynamic Opt-In Incentives in Income-Tested Social Programs: Evidence from Medicaid/CHIP," American Economic Journal: Economic Policy, American Economic Association, vol. 9(1), pages 241-276, February.
    2. Raj Chetty & John N. Friedman & Tore Olsen & Luigi Pistaferri, 2011. "Adjustment Costs, Firm Responses, and Micro vs. Macro Labor Supply Elasticities: Evidence from Danish Tax Records," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 126(2), pages 749-804.
    3. Laura R. Wherry & Bruce D. Meyer, 2016. "Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 556-588.
    4. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 431-466.
    5. Ithai Z. Lurie & Daniel W. Sacks & Bradley Heim, 2021. "Does the Individual Mandate Affect Insurance Coverage? Evidence from Tax Returns," American Economic Journal: Economic Policy, American Economic Association, vol. 13(2), pages 378-407, May.
    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, President and Fellows of Harvard College, vol. 129(2), pages 653-696.
    8. David M. Cutler & Jonathan Gruber, 1996. "Does Public Insurance Crowd out Private Insurance?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 391-430.
    9. Emmanuel Saez, 2010. "Do Taxpayers Bunch at Kink Points?," American Economic Journal: Economic Policy, American Economic Association, vol. 2(3), pages 180-212, August.
    10. Henrik J. Kleven & Mazhar Waseem, 2013. "Using Notches to Uncover Optimization Frictions and Structural Elasticities: Theory and Evidence from Pakistan," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 128(2), pages 669-723.
    11. Aaron S. Yelowitz, 1995. "The Medicaid Notch, Labor Supply, and Welfare Participation: Evidence from Eligibility Expansions," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 110(4), pages 909-939.
    12. 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.
    13. Ham, John C. & Shore-Sheppard, Lara, 2005. "The effect of Medicaid expansions for low-income children on Medicaid participation and private insurance coverage: evidence from the SIPP," Journal of Public Economics, Elsevier, vol. 89(1), pages 57-83, January.
    14. Andrew Goodman-Bacon, 2016. "The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes," NBER Working Papers 22899, National Bureau of Economic Research, Inc.
    15. 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.
    16. Andrew Goodman-Bacon, 2021. "The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes," American Economic Review, American Economic Association, vol. 111(8), pages 2550-2593, August.
    17. Pauline Leung & Alexandre Mas, 2018. "Employment Effects of the Affordable Care Act Medicaid Expansions," Industrial Relations: A Journal of Economy and Society, Wiley Blackwell, vol. 57(2), pages 206-234, April.
    18. Heim, Bradley T. & Hunter, Gillian & Isen, Adam & Lurie, Ithai Z. & Ramnath, Shanthi P., 2021. "Income Responses to the Affordable Care Act: Evidence from a Premium Tax Credit Notch," Journal of Health Economics, Elsevier, vol. 76(C).
    19. Edward Harris & Shannon Mok, 2015. "How CBO Estimates the Effects of the Affordable Care Act on the Labor Market: Working Paper 2015-09," Working Papers 51065, Congressional Budget Office.
    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. Gamino, Aaron M., 2025. "The impact of an SCHIP freeze on children and parent's health insurance coverage," Journal of Economic Behavior & Organization, Elsevier, vol. 229(C).
    2. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters, in: Economics of Means-Tested Transfer Programs in the United States, Volume 1, pages 21-136, National Bureau of Economic Research, Inc.
    3. Zhuan Pei, 2017. "Eligibility Recertification and Dynamic Opt-In Incentives in Income-Tested Social Programs: Evidence from Medicaid/CHIP," American Economic Journal: Economic Policy, American Economic Association, vol. 9(1), pages 241-276, February.
    4. Scott Barkowski, 2020. "Does government health insurance reduce job lock and job push?," Southern Economic Journal, John Wiley & Sons, vol. 87(1), pages 122-169, July.
    5. Konstantin Kunze, 2022. "Public Health Insurance of Children and Parental Labor Market Outcomes," Working Papers 349, University of California, Davis, Department of Economics.
    6. Kevin Wood, 2019. "Health insurance reform and retirement: Evidence from the Affordable Care Act," Health Economics, John Wiley & Sons, Ltd., vol. 28(12), pages 1462-1475, December.
    7. 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.
    8. Boudreaux, Michel & Lipton, Brandy, 2018. "Medicaid Benefit Generosity and Labor Market Outcomes: Evidence from Medicaid Adult Vision Benefits," MPRA Paper 83916, University Library of Munich, Germany.
    9. Kumar, Anil, 2020. "Does medicaid generosity affect household income?," Economic Modelling, Elsevier, vol. 92(C), pages 239-256.
    10. Konstantin Kunze, 2025. "Public Health Insurance of Children and Maternal Labor Market Outcomes," Papers 2504.10215, arXiv.org, revised Apr 2025.
    11. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1783-1829.
    12. Hull, Marie & Yan, Ji, 2024. "The impact of children's access to public health insurance on their cognitive development and behavior," Journal of Health Economics, Elsevier, vol. 98(C).
    13. Hilary W. Hoynes & Diane Whitmore Schanzenbach, 2018. "Safety Nets Investments in Children," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 49(1 (Spring), pages 89-150.
    14. Dhaval Dave & Sandra L. Decker & Robert Kaestner & Kosali I. Simon, 2015. "The Effect of Medicaid Expansions in the Late 1980s and Early 1990s on the Labor Supply of Pregnant Women," American Journal of Health Economics, MIT Press, vol. 1(2), pages 165-193, Spring.
    15. Julie Shi, 2016. "Income Responses to Health Insurance Subsidies: Evidence from Massachusetts," American Journal of Health Economics, MIT Press, vol. 2(1), pages 96-124, January.
    16. Erkmen Giray Aslim, 2019. "The Relationship Between Health Insurance and Early Retirement: Evidence from the Affordable Care Act," Eastern Economic Journal, Palgrave Macmillan;Eastern Economic Association, vol. 45(1), pages 112-140, January.
    17. Marianne P. Bitler & Madeline Zavodny, 2014. "Medicaid: A Review of the Literature," NBER Working Papers 20169, National Bureau of Economic Research, Inc.
    18. Helen Levy & Thomas Buchmueller & Sayeh Nikpay, 2015. "The Effect of Health Reform on Retirement," Working Papers wp329, University of Michigan, Michigan Retirement Research Center.
    19. Padmaja Ayyagari, 2019. "Health Insurance and Early Retirement Plans: Evidence from the Affordable Care Act," American Journal of Health Economics, University of Chicago Press, vol. 5(4), pages 533-560, Fall.
    20. Pauline Leung & Alexandre Mas, 2016. "Employment Effects of the ACA Medicaid Expansions," Working Papers 594, Princeton University, Department of Economics, Industrial Relations Section..

    More about this item

    JEL classification:

    • H31 - Public Economics - - Fiscal Policies and Behavior of Economic Agents - - - Household
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J22 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Time Allocation and Labor Supply

    NEP fields

    This paper has been announced in the following NEP Reports:

    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:arx:papers:2506.12976. 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: arXiv administrators (email available below). General contact details of provider: http://arxiv.org/ .

    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.