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Did the ACA Medicaid Expansion Save Lives?

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  • Borgschulte, Mark

    (University of Illinois at Urbana-Champaign)

  • Vogler, Jacob

    (University of Illinois at Urbana-Champaign)

Abstract

We estimate the effect of the Affordable Care Act Medicaid expansion on county-level mortality in the first four years following expansion. We find a reduction in all-cause mortality in ages 20 to 64 equaling 11.36 deaths per 100,000 individuals, a 3.6 percent decrease. This estimate is largely driven by reductions in causes of death likely to be influenced by access to health care, and equates to one life saved per 310 newly covered individuals. A cost-benefit analysis shows that the improvement in welfare due to mortality responses may offset the entire net-of-transfers expenditure associated with the expansion.

Suggested Citation

  • Borgschulte, Mark & Vogler, Jacob, 2019. "Did the ACA Medicaid Expansion Save Lives?," IZA Discussion Papers 12552, Institute of Labor Economics (IZA).
  • Handle: RePEc:iza:izadps:dp12552
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    1. Tatyana Deryugina & Garth Heutel & Nolan H. Miller & David Molitor & Julian Reif, 2019. "The Mortality and Medical Costs of Air Pollution: Evidence from Changes in Wind Direction," American Economic Review, American Economic Association, vol. 109(12), pages 4178-4219, December.
    2. Joseph E. Aldy & W. Kip Viscusi, 2008. "Adjusting the Value of a Statistical Life for Age and Cohort Effects," The Review of Economics and Statistics, MIT Press, vol. 90(3), pages 573-581, August.
    3. Frean, Molly & Gruber, Jonathan & Sommers, Benjamin D., 2017. "Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act," Journal of Health Economics, Elsevier, vol. 53(C), pages 72-86.
    4. A. Smith, Jeffrey & E. Todd, Petra, 2005. "Does matching overcome LaLonde's critique of nonexperimental estimators?," Journal of Econometrics, Elsevier, vol. 125(1-2), pages 305-353.
    5. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 431-466.
    6. Alexandre Belloni & Victor Chernozhukov & Christian Hansen & Damian Kozbur, 2016. "Inference in High-Dimensional Panel Models With an Application to Gun Control," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 34(4), pages 590-605, October.
    7. Luojia Hu & Robert Kaestner & Bhashkar Mazumder & Sarah Miller & Ashley Wong, 2016. "The Effect of the Patient Protection and Affordable Care Act Medicaid Expansions on Financial Wellbeing," NBER Working Papers 22170, National Bureau of Economic Research, Inc.
    8. Benjamin D. Sommers, 2017. "State Medicaid Expansions and Mortality, Revisited: A Cost-Benefit Analysis," American Journal of Health Economics, University of Chicago Press, vol. 3(3), pages 392-421, Summer.
    9. Benjamin D. Sommers, 2017. "State Medicaid Expansions and Mortality, Revisited: A Cost-Benefit Analysis," American Journal of Health Economics, MIT Press, vol. 3(3), pages 392-421, Summer.
    10. 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.
    11. Keisuke Hirano & Guido W. Imbens & Geert Ridder, 2003. "Efficient Estimation of Average Treatment Effects Using the Estimated Propensity Score," Econometrica, Econometric Society, vol. 71(4), pages 1161-1189, July.
    12. Bernard Black & José-Antonio Espín-Sánchez & Eric French & Kate Litvak, 2017. "The Long-Term Effect of Health Insurance on Near-Elderly Health and Mortality," American Journal of Health Economics, University of Chicago Press, vol. 3(3), pages 281-311, Summer.
    13. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, Oxford University Press, vol. 136(3), pages 1783-1829.
    14. Colleen M. Carey & Sarah Miller & Laura R. Wherry, 2020. "The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare," American Economic Journal: Applied Economics, American Economic Association, vol. 12(4), pages 288-318, October.
    15. Phillips, Julie A., 2014. "A changing epidemiology of suicide? The influence of birth cohorts on suicide rates in the United States," Social Science & Medicine, Elsevier, vol. 114(C), pages 151-160.
    16. Finkelstein, Amy & McKnight, Robin, 2008. "What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending," Journal of Public Economics, Elsevier, vol. 92(7), pages 1644-1668, July.
    17. Sarah Miller & Luojia Hu & Robert Kaestner & Bhashkar Mazumder & Ashley Wong, 2021. "The ACA Medicaid Expansion in Michigan and Financial Health," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(2), pages 348-375, March.
    18. Ausmita Ghosh & Kosali Simon & Benjamin D. Sommers, 2017. "The Effect of State Medicaid Expansions on Prescription Drug Use: Evidence from the Affordable Care Act," NBER Working Papers 23044, National Bureau of Economic Research, Inc.
    19. Huh, Jason & Reif, Julian, 2017. "Did Medicare Part D reduce mortality?," Journal of Health Economics, Elsevier, vol. 53(C), pages 17-37.
    20. David Card & Lara D. Shore-Sheppard, 2004. "Using Discontinuous Eligibility Rules to Identify the Effects of the Federal Medicaid Expansions on Low-Income Children," The Review of Economics and Statistics, MIT Press, vol. 86(3), pages 752-766, August.
    21. Kenneth Brevoort & Daniel Grodzicki & Martin B. Hackmann, 2017. "Medicaid and Financial Health," NBER Working Papers 24002, National Bureau of Economic Research, Inc.
    22. Andrew Goodman-Bacon, 2018. "Public Insurance and Mortality: Evidence from Medicaid Implementation," Journal of Political Economy, University of Chicago Press, vol. 126(1), pages 216-262.
    23. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-1296, December.
    24. Bernard Black & Alex Hollingsworth & Leticia Nunes & Kosali Simon, 2019. "Simulated Power Analyses for Observational Studies: An Application to the Affordable Care Act Medicaid Expansion," NBER Working Papers 25568, National Bureau of Economic Research, Inc.
    25. Bhatt, C.B. & Beck-Sagué, C.M., 2018. "Medicaid expansion and infant mortality in the United States," American Journal of Public Health, American Public Health Association, vol. 108(4), pages 565-567.
    26. Imbens,Guido W. & Rubin,Donald B., 2015. "Causal Inference for Statistics, Social, and Biomedical Sciences," Cambridge Books, Cambridge University Press, number 9780521885881.
    27. Clayton, Denise Hammock, 2019. "The Effect of Prescription Drug Coverage on Mortality: Evidence from Medicaid Implementation," Journal of Health Economics, Elsevier, vol. 63(C), pages 100-113.
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    Cited by:

    1. Jacob Vogler, 2020. "Access to Healthcare and Criminal Behavior: Evidence from the ACA Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 39(4), pages 1166-1213, September.
    2. Jacob Goldin & Ithai Z. Lurie & Janet McCubbin, 2019. "Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach," NBER Working Papers 26533, National Bureau of Economic Research, Inc.
    3. 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.
    4. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, Oxford University Press, vol. 136(3), pages 1783-1829.
    5. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, Oxford University Press, vol. 136(3), pages 1783-1829.
    6. J Dustin Tracy & Kevin A James & Hillard Kaplan & Stephen Rassenti, 2021. "An investigation of health insurance policy and behavior in a virtual environment," PLOS ONE, Public Library of Science, vol. 16(4), pages 1-26, April.

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    More about this item

    Keywords

    health insurance; Medicaid; mortality; public health insurance; healthcare; Affordable Care Act;
    All these keywords.

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

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