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The Impact of the Affordable Care Act: Evidence from California's Hospital Sector

Author

Listed:
  • Mark Duggan
  • Atul Gupta
  • Emilie Jackson

Abstract

The Affordable Care Act (ACA) authorized the largest expansion of public health insurance in the U.S. since the mid-1960s. We exploit ACA-induced changes in the discontinuity in coverage at age 65 using a regression discontinuity based design to examine effects of the expansion on health insurance coverage, hospital use, and patient health. We then link these changes to effects on hospital finances. We show that a substantial share of the federally-funded Medicaid expansion substituted for existing locally-funded safety net programs. Despite this offset, the expansion produced a substantial increase in hospital revenue and profitability, with larger gains for government hospitals. On the benefits side, we do not detect significant improvements in patient health, although the expansion led to substantially greater hospital and emergency room use, and a reallocation of care from public to private and better-quality hospitals.

Suggested Citation

  • 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.
  • Handle: RePEc:nbr:nberwo:25488
    Note: HC HE PE
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    References listed on IDEAS

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    Cited by:

    1. Borgschulte, Mark & Vogler, Jacob, 2020. "Did the ACA Medicaid expansion save lives?," Journal of Health Economics, Elsevier, vol. 72(C).
    2. Sarah Miller & Norman Johnson & Laura R. Wherry, 2019. "Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data," NBER Working Papers 26081, National Bureau of Economic Research, Inc.
    3. Jonathan Gruber & Benjamin D. Sommers, 2020. "Fiscal Federalism and the Budget Impacts of the Affordable Care Act's Medicaid Expansion," NBER Working Papers 26862, National Bureau of Economic Research, Inc.

    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • L33 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Comparison of Public and Private Enterprise and Nonprofit Institutions; Privatization; Contracting Out

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