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The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes

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  • Mark Duggan
  • Gopi Shah Goda
  • Emilie Jackson

Abstract

The Affordable Care Act (ACA) includes several provisions designed to expand insurance coverage that also alter the tie between employment and health insurance. In this paper, we exploit variation across geographic areas in the potential impact of the ACA to estimate its effect on health insurance coverage and labor market outcomes in the first two years after the implementation of its main features. Our measures of potential ACA impact come from pre-existing population shares of uninsured individuals within income groups that were targeted by Medicaid expansions and federal subsidies for private health insurance, interacted with each state’s Medicaid expansion status. Our findings indicate that the majority of the increase in health insurance coverage since 2013 is due to the ACA and that areas in which the potential Medicaid and exchange enrollments were higher saw substantially larger increases in coverage. While labor market outcomes in the aggregate were not significantly affected, our results indicate that labor force participation reductions in areas with higher potential exchange enrollment were offset by increases in labor force participation in areas with higher potential Medicaid enrollment

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  • Mark Duggan & Gopi Shah Goda & Emilie Jackson, 2017. "The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes," NBER Working Papers 23607, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:23607
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    References listed on IDEAS

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    Cited by:

    1. 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.
    2. Mark Duggan & Gopi Shah Goda & Gina Li, 2020. "The Effects of the Affordable Care Act on the Near Elderly: Evidence for Health Insurance Coverage and Labor Market Outcomes," NBER Chapters, in: Tax Policy and the Economy, Volume 35, National Bureau of Economic Research, Inc.
    3. McInerney, Melissa & Meiselbach, Mark K., 2020. "Distributional Effects of Recent Health Insurance Expansions on Weight-Related Outcomes," Economics & Human Biology, Elsevier, vol. 38(C).
    4. Charles J. Courtemanche & Ishtiaque Fazlul & James Marton & Benjamin D. Ukert & Aaron Yelowitz & Daniela Zapata, 2019. "The Impact of the ACA on Insurance Coverage Disparities After Four Years," NBER Working Papers 26157, National Bureau of Economic Research, Inc.
    5. Katharine G. Abraham & Melissa S. Kearney, 2018. "Explaining the Decline in the U.S. Employment-to-Population Ratio: a Review of the Evidence," NBER Working Papers 24333, National Bureau of Economic Research, Inc.
    6. Lizhong Peng & Xiaohui Guo & Chad D. Meyerhoefer, 2020. "The effects of Medicaid expansion on labor market outcomes: Evidence from border counties," Health Economics, John Wiley & Sons, Ltd., vol. 29(3), pages 245-260, March.
    7. Mark Duggan & Atul Gupta & Emilie Jackson, 2019. "The Impact of the Affordable Care Act: Evidence from California's Hospital Sector," NBER Working Papers 25488, National Bureau of Economic Research, Inc.
    8. Gallagher, Emily A. & Gopalan, Radhakrishnan & Grinstein-Weiss, Michal, 2019. "The effect of health insurance on home payment delinquency: Evidence from ACA Marketplace subsidies," Journal of Public Economics, Elsevier, vol. 172(C), pages 67-83.
    9. 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.
    10. , 2019. "Medicaid Expansion and the Unemployed," Working Paper Series 2019-29, Federal Reserve Bank of San Francisco.
    11. Carril, Rodrigo & Duggan, Mark, 2020. "The impact of industry consolidation on government procurement: Evidence from Department of Defense contracting," Journal of Public Economics, Elsevier, vol. 184(C).
    12. Anil Kumar, 2017. "Does Medicaid Generosity Affect Household Income?," Working Papers 1709, Federal Reserve Bank of Dallas.
    13. Jeffrey Clemens & Lisa B. Kahn & Jonathan Meer, 2018. "The Minimum Wage, Fringe Benefits, and Worker Welfare," NBER Working Papers 24635, National Bureau of Economic Research, Inc.
    14. Hanming Fang & Andrew J. Shephard, 2019. "Household Labor Search, Spousal Insurance, and Health Care Reform," NBER Working Papers 26350, National Bureau of Economic Research, Inc.
    15. Kumar, Anil, 2020. "Does medicaid generosity affect household income?," Economic Modelling, Elsevier, vol. 92(C), pages 239-256.
    16. Casey B. Mulligan, 2019. "The Employer Penalty, Voluntary Compliance, and the Size Distribution of Firms: Evidence from a Survey of Small Businesses," NBER Chapters, in: Tax Policy and the Economy, Volume 34, National Bureau of Economic Research, Inc.
    17. Jeffrey Clemens & Drew McNichols & Joseph J. Sabia, 2020. "The Long-Run Effects of the Affordable Care Act: A Pre-Committed Research Design Over the COVID-19 Recession and Recovery," NBER Working Papers 27999, National Bureau of Economic Research, Inc.
    18. 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.
    19. Beuermann, Diether W. & Pecha, Camilo J., 2020. "The effect of eliminating health user fees on adult health and labor supply in Jamaica," Journal of Health Economics, Elsevier, vol. 73(C).
    20. James Bailey & Dhaval Dave, 2019. "The Effect of the Affordable Care Act on Entrepreneurship among Older Adults," Eastern Economic Journal, Palgrave Macmillan;Eastern Economic Association, vol. 45(1), pages 141-159, January.
    21. David A. Matsa & Amalia R. Miller, 2018. "Who Votes for Medicaid Expansion? Lessons from Maine’s 2017 Referendum," NBER Working Papers 25109, National Bureau of Economic Research, Inc.
    22. Rajashri Chakrabarti & Maxim Pinkovskiy, 2019. "The Affordable Care Act and the Market for Higher Education," CESifo Working Paper Series 7869, CESifo.

    More about this item

    JEL classification:

    • H31 - Public Economics - - Fiscal Policies and Behavior of Economic Agents - - - Household
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • J18 - Labor and Demographic Economics - - Demographic Economics - - - Public Policy
    • J20 - Labor and Demographic Economics - - Demand and Supply of Labor - - - General
    • J38 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs - - - Public Policy

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