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This article aimed to determine the association between the Affordable Care Act young adult mandate and suicidal behavior. From 2007 to 2013, we used the Nationwide/National Inpatient Sample and National Poison Data System to examine suicide attempt, and Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to examine suicide. We aggregated each outcome by quarter/year and conducted a difference-in-differences linear regression to compare young adults aged 19 to 25 years with those 27 to 29 years before and after implementation. There were not statistically significant associations between the mandate and suicide attempt inpatient hospitalizations (unstandardized beta coefficient [ b] = −0.72, p = .12, standard error [ SE] = 0.42) and percentage of poisoning cases due to suspected suicidal intent ( b = 0.23, p = .19, SE = 0.16). There was a statistically significant association when examining suicide prevalence ( b = −0.03, p = .01, SE = 0.001). The results suggest that health insurance may buffer against but is unlikely to reverse the increasing suicide rate.

Conventional wisdom often holds that the healthcare sector fares better than other sectors during economic downturns. However, little research has examined the relationship between local economic conditions and healthcare employment. Understanding how the healthcare sector responds to economic conditions is important for policymakers seeking to ensure an adequate supply of healthcare workers, as well as for those directing displaced workers into new jobs. We examine the impact of macroeconomic conditions on both the healthcare labor market and the pipeline of healthcare workers receiving healthcare degrees during 2005–2017 (the pre-COVID era). Our results indicate that the healthcare sector is stable across past business cycles. If anything, when areas experience more severe local economic downturns, healthcare employment increases. Much remains unknown about how the healthcare sector will fare during the current recession. Our study represents an important backdrop as policymakers consider ways to sustain the healthcare sector during current economic and public health turbulence.

Context: Twenty states are pursuing community engagement requirements (“work requirements”) in Medicaid, though legal challenges are ongoing. While most non-disabled low-income individuals work, it is less clear how many engage in the required number of hours of qualifying community engagement activities, and what heterogeneity may exist by race/ethnicity, age, and gender. Our objective was to estimate current levels of employment and other community engagement activities among potential Medicaid beneficiaries. Methods: We analyzed the US Census Bureau’s national time-use survey data covering the years 2015 through 2018. Our main sample consisted of non-disabled adults between 19 and 64 years, with family incomes less than 138% of the federal poverty level (N=2,551). Findings: Nationally, low-income adults who might become subject to Medicaid work requirements already spent an average of 30 hours per week on community engagement activities. However, 22% of the low-income population – particularly women, older adults, and those with less education – would not currently satisfy a 20-hour-per week requirement. Conclusions: Although the majority of potential Medicaid beneficiaries already meet community engagement requirements or are exempt, 22% would not currently satisfy a 20-hour-per week requirement and could therefore be at risk for losing coverage.

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