The three‐year impact of the Affordable Care Act on disparities in insurance coverage

Abstract

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 Affordable Care Act's Effects on Patients, Providers, and the Economy: What We've Learned So Far

“…One somewhat unexpected finding is that nearly half of the increase in Medicaid enrollment occurred among those who were already eligible for the program in both expansion and non‐expansion states, the so called “woodwork effect,” (Frean, Gruber, & Sommers, ), which also included increased take‐up among nearly one million children (Hamersma, Kim, & Timpe, ; Kenney et al., ; Ugwi, Lyu, & Wehby, ). Several studies have also demonstrated narrowing of racial/ethnic disparities in insurance coverage after implementation of the ACA, though substantial disparities remain (Buchmueller et al., ; Courtemanche, Marton, Ukert, Yelowitz, Zapata, & Fazlul, ).…”

The Impact of the ACA on Insurance Coverage Disparities After Four Years

“…Frean et al (2017) also use data through 2015 and a DDD approach to find that coverage gains from the Medicaid expansion and Marketplace premium subsidies are larger among childless adult couples than among single adults or adults with children, but the increase from the individual mandate is largest among singles. Courtemanche et al (2019b) use three years of post-ACA data (2014)(2015)(2016) from the ACS and finds that the ACA Medicaid expansion eliminated 43 percent of the coverage gap across income groups. In addition, the authors find that the ACA reduced but did not eliminate coverage disparities across racial groups, age groups, and marital status.…”

“…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 two panels of table 5 stratify the sample into subsamples by income and race. Since each subsample must contain enough 2013 respondents to accurately compute local area uninsured rates, we are limited to a maximum of two or three subsamples per stratification, as inCourtemanche et al (2019b). For income, we consider three categories: those with income under 138 percent of the FPL, those between 138 and 400 percent, and those above 400 percent.…”

The effects of Medicaid expansion on labor market outcomes: Evidence from border counties

“…Similarly, Dague, DeLeire, and Leininger (2017) exploit an unexpected suspension in enrollment in Wisconsin's previous expansion of its Medicaid program and report a sizable reduction in employment among individuals who gained public health insurance coverage. There is also a growing literature that focuses more broadly on the full implementation of the ACA (Courtemanche et al, 2019;Courtemanche, Marton, Ukert, Yelowitz, & Zapata, 2017Duggan et al, 2019;Frean, Gruber, & Sommers, 2017). Using standard state-year difference-indifferences models applied to nationally representative survey data, none of these studies detect any statistically significant changes in employment, wages, or hours worked after the implementation of the Medicaid expansion (Frisvold & Jung, 2018;Gooptu, Moriya, Simon, & Sommers, 2016;Kaestner, Garrett, Chen, Gangopadhyaya, & Fleming, 2017;Leung & Mas, 2018).…”