John Cawley1,2,3, Aparna Soni4, Kosali Simon5,6. 1. Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA. JHC38@cornell.edu. 2. Department of Economics, Cornell University, Ithaca, NY, USA. JHC38@cornell.edu. 3. National Bureau of Economic Research, Cambridge, MA, USA. JHC38@cornell.edu. 4. Department of Business Economics and Public Policy, Indiana University - Bloomington, Bloomington, IN, USA. 5. National Bureau of Economic Research, Cambridge, MA, USA. 6. School of Public and Environmental Affairs, Indiana University - Bloomington, Bloomington, IN, USA.
Abstract
BACKGROUND: The Affordable Care Act (ACA) of 2010 incentivized states to expand eligibility for their Medicaid programs. Many did so in 2014, and there has been great interest in understanding the effects of these expansions on access to health care, health care utilization, and population health. OBJECTIVE: To estimate the longer-term (three-year) impact of Medicaid expansions on insurance coverage, access to care, preventive care, self-assessed health, and risky health behaviors. DESIGN: A difference-in-differences model, exploiting variation across states and over time in Medicaid expansion, was estimated using data from the Behavioral Risk Factor Surveillance System (BRFSS) for 2010-2016. PARTICIPANTS: Low-income childless adults aged 19-64 years in the BRFSS. MAIN MEASURES: Outcomes included insurance coverage, access to care, several forms of preventive care (e.g., routine checkups, flu shots, HIV tests, dental visits, and cancer screening), risky health behaviors (e.g., smoking, alcohol abuse, obesity), and self-assessed health. KEY RESULTS: The previously documented benefits of Medicaid expansions on insurance coverage, access to care, preventive care, and self-assessed health have persisted 3 years after expansion. There was no detectable effect on risky health behaviors. CONCLUSIONS: The Affordable Care Act was motivated in part by a desire to increase health insurance coverage, improve access to care, and increase use of preventive care. The Medicaid expansions facilitated by the ACA are helping to achieve those objectives, and the benefits have persisted 3 years after expansion.
BACKGROUND: The Affordable Care Act (ACA) of 2010 incentivized states to expand eligibility for their Medicaid programs. Many did so in 2014, and there has been great interest in understanding the effects of these expansions on access to health care, health care utilization, and population health. OBJECTIVE: To estimate the longer-term (three-year) impact of Medicaid expansions on insurance coverage, access to care, preventive care, self-assessed health, and risky health behaviors. DESIGN: A difference-in-differences model, exploiting variation across states and over time in Medicaid expansion, was estimated using data from the Behavioral Risk Factor Surveillance System (BRFSS) for 2010-2016. PARTICIPANTS: Low-income childless adults aged 19-64 years in the BRFSS. MAIN MEASURES: Outcomes included insurance coverage, access to care, several forms of preventive care (e.g., routine checkups, flu shots, HIV tests, dental visits, and cancer screening), risky health behaviors (e.g., smoking, alcohol abuse, obesity), and self-assessed health. KEY RESULTS: The previously documented benefits of Medicaid expansions on insurance coverage, access to care, preventive care, and self-assessed health have persisted 3 years after expansion. There was no detectable effect on risky health behaviors. CONCLUSIONS: The Affordable Care Act was motivated in part by a desire to increase health insurance coverage, improve access to care, and increase use of preventive care. The Medicaid expansions facilitated by the ACA are helping to achieve those objectives, and the benefits have persisted 3 years after expansion.
Entities:
Keywords:
Affordable Care Act; Medicaid; health behaviors; health insurance; preventive care