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Does Medicaid Expansion Lead to Income Adjustment? Evidence from the Survey of Income Program Participation

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  • Mingjian Li

Abstract

Using monthly Survey of Income Program Participation (SIPP) data and a regression discontinuity (RD) design at the 138 percent Federal Poverty Line (FPL) threshold, this paper shows that childless adults in Medicaid expansion states lowered their lowest monthly earnings by about 39 FPL percentage points, equal to 700 dollars in 2025 for a two person household, to qualify for Medicaid. The response was largest when the individual mandate penalty was in effect and declined after the penalty was reduced to zero in 2019. Evidence from zero earnings months and hours worked indicates adjustments along both extensive and intensive margins. These results validate lowest monthly earnings as a practical eligibility measure and provide new evidence of substantial labor supply responses to the Affordable Care Act Medicaid notch.

Suggested Citation

  • Mingjian Li, 2025. "Does Medicaid Expansion Lead to Income Adjustment? Evidence from the Survey of Income Program Participation," Papers 2506.12976, arXiv.org, revised Sep 2025.
    • Handle: RePEc:arx:papers:2506.12976
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    References listed on IDEAS

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    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, 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.
    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. 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.
    17. 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.
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