University of Kentucky
This chapter examines trends in Medicaid enrollment across the income distribution after the ACA’s Medicaid expansion. Using data from the American Community Survey between 2012 and 2017, we compare Medicaid coverage over time in 9 states that expanded Medicaid in 2014 with no previous expansion for able-bodied, working-age adults with 12 states that had not expanded Medicaid by 2019 and also had no previous expansion for such adults. A difference-in-differences model is used to formalize this comparison.
This paper examines the impacts of the Affordable Care Act (ACA) – which substantially increased insurance coverage through regulations, mandates, subsidies, and Medicaid expansions – on behaviors related to future health risks after three years. Using data from the Behavioral Risk Factor Surveillance System and an identification strategy that leverages variation in pre-ACA uninsured rates and state Medicaid expansion decisions, we show that the ACA increased preventive care utilization along several dimensions, but also increased risky drinking.
This research sheds new light on the effects of the Affordable Care Act. During the first two years of the ACA access to health care increased but health outcomes and behaviors remained unchanged, according to findings by Institute Director Yelowitz with coauthors Courtemanche, Marton, Ukert and Zapata. With efforts at the national level to repeal and replace the ACA this research suggests that though access to care may decrease, health outcomes are unlikely to change.
Dr. Yelowitz’s research explores the unintended consequences and individual incentives that arise when the government sets up health insurance markets outside of the free enterprise system. Following the Affordable Care Act expansion, the integrity of the Kentucky Medicaid program may be at risk. This first look finds that 38 percent of Kentucky’s new Medicaid enrollees were not eligible for the program in 2014, according to data from the American Community Survey.