Objective To estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after three years. Data Source The 2011‐2016 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults. Design We estimate a difference‐in‐difference‐in‐differences model to separately identify the effects of the nationwide and Medicaid expansion portions of the ACA using the methodology developed in the recent ACA literature. The differences come from time, state Medicaid expansion status, and local area pre‐ACA uninsured rates. In order to focus on access disparities, we stratify our sample separately by income, race/ethnicity, marital status, age, gender, and geography. Principal Findings After three years, the fully implemented ACA eliminated 43% of the coverage gap across income groups, with the Medicaid expansion accounting for this entire reduction. The ACA also reduced coverage disparities across racial groups by 23%, across marital status by 46%, and across age‐groups by 36%, with these changes being partly attributable to both the Medicaid expansion and nationwide components of the law. Conclusions The fully implemented ACA has been successful in reducing coverage disparities across multiple groups.

The purpose of this chapter is to estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after four years. We use data from the 2011-2017 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults. Our methods feature a difference-in-difference-in-differences model, developed in the recent ACA literature, which separately identifies the effects of the nationwide and Medicaid expansion portions of the law. The differences in this model come from time, state Medicaid expansion status, and local area pre-ACA uninsured rate. We stratify our sample separately by income, race/ethnicity, marital status, age, gender, and geography in order to examine access disparities. After four years, we find that the fully implemented ACA eliminated 44 percent of the coverage gap across income groups, with the Medicaid expansion accounting for this entire reduction. The ACA also reduced coverage disparities across racial groups by 26.7 percent, across marital status by 45 percent, and across age groups by 44 percent, with these changes being partly attributable to both the Medicaid expansion and nationwide components of the law.Prior to the main implementation of the Affordable Care Act (ACA) in 2014, there were well documented disparities in insurance coverage along multiple dimensions, such as age, race, and income (Courtemanche, Marton, and Yelowitz, 2016;Yelowitz, 2016;Courtemanche et al., 2019b). The central pieces of the ACA, including the individual mandate, subsidized Marketplace coverage, and state Medicaid expansions, were designed to reduce health insurance coverage disparities by moving the U.S. closer to universal coverage (Obama, 2016;Gruber and Sommers, 2019). The purpose of this paper is to examine the extent to which the ACA reduced disparities in coverage after four years (2014)(2015)(2016)(2017). While gains in insurance coverage after the ACA have been well documented, relatively few papers in this literature examine how the ACA affected coverage disparities and none use data from 2017. Courtemanche et al. (2017) estimate the first-year impact of the ACA on coverage using difference-in-difference-in-differences (DDD) models where the differences come from time, state Medicaid expansion decisions, and pre-ACA local area uninsured rate.Similar to the approach taken by Finkelstein (2007) andMiller (2012) to study other coverage expansions, this strategy leverages the propensity for universal coverage initiatives to provide the most intense "treatment" in local areas with the highest pre-reform uninsured rates. Using data from the American Community Survey (ACS), Courtemanche et al. (2017) find that the ACA increased coverage by an average of 5.9 percentage points in Medicaid expansion states compared to 2.8 percentage points in non-expansion states in 2014. In subsample analyses, the authors show that the fully implemented ACA (including the Medicaid expansion) redu...

The purpose of this chapter is to estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after four years. We use data from the 2011-2017 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults. Our methods feature a difference-indifference in differences model, developed in the recent ACA literature, which separately identifies the effects of the nationwide and Medicaid expansion portions of the law. The differences in this model come from time, state Medicaid expansion status, and local area pre-ACA uninsured rate. We stratify our sample separately by income, race/ethnicity, marital status, age, gender, and geography in order to examine access disparities. After four years, we find that the fully implemented ACA eliminated 44 percent of the coverage gap across income groups, with the Medicaid expansion accounting for this entire reduction. The ACA also reduced coverage disparities across racial groups by 26.7 percent, across marital status by 45 percent, and across age groups by 44 percent, with these changes being partly attributable to both the Medicaid expansion and nationwide components of the law.

Background Though the harmful impacts of child marriage have been evaluated across several domains, evidence on the relationship between child marriage and health behaviors over the life course is limited. In this paper, we examined whether getting married as a child is associated with one of the most common risky health behaviors, tobacco use, in adulthood. Methods Using nationally representative data from India, we compared the odds in favor of tobacco use among early adult (age 22–34) and early middle-aged (age 35–44) women who were married before age 18 with that of those who were married as youths (age 18–21). We estimated univariate and multivariable logistic regressions to obtain odds ratios in favor of any tobacco-use and relative risk ratios in favor of mutually exclusive types of tobacco use (smoking-only, smokeless-only, and dual-use). We also explored the intensive margin of the relationship by assessing if the odds of tobacco use in adulthood were affected by how early (13 or less, 14–15, or 16–17) a child bride was married. Results We find that the adjusted odds of tobacco use for those who were married as a child were 1.3 and 1.2 times that of those who were married as a youth among early adult and early middle-aged women, respectively. The younger was the child bride when married, the higher were the odds of tobacco use as an adult. The relative risks of different types of tobacco use were also higher for child brides than their peers. Conclusions These results are the first evidence of the association between child marriage and a major risky health behavior, tobacco use, over the life course. These findings will inform policies to strengthen child marriage prevention efforts and targeted tobacco control initiatives in the low-and-middle income countries.