JPAM Featured Article: "Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States"
As part of our ongoing effort to promote JPAM authors to the APPAM membership and the public policy world at large, we are asking JPAM authors to answer a few questions to promote their research article on the APPAM website.
By: Charles Courtemanche
What was the genesis/history of the idea for your research?
We had just completed a study (published in Health Economics in 2016) that documented changes in insurance coverage by state in 2014, the first year of full ACA implementation. However, we realized that, given the non-random nature of states’ Medicaid expansion decisions and natural year-to-year fluctuations in insurance coverage, these results likely did not reflect causal effects of the ACA. So we wanted to develop an econometric framework that could identify the causal effects.
What is the main conclusion that becomes evident from your research? (Or, what is our main takeaway?)
At the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those without a college degree, non-whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.
What are some of the more interesting or surprising findings/conclusions, you discovered during this process?
One surprising result was that simple pre-post comparisons (like in our Health Economics paper mentioned above) seem to understate the coverage gains from the Medicaid expansion. Another is that the gains in private insurance coverage were not just due to privately purchased coverage via the new health insurance exchanges; we also saw an increase in employer-provided coverage. While we cannot say exactly why this is the case, one possibility is greater uptake of available employer-sponsored plans due to the individual mandate to have health insurance coverage.
Dr. Charles Courtemanche is an Associate Professor of Economics in the Andrew Young School of Policy Studies at Georgia State University. He is a health economist and applied microeconomist with particular research interests in the economics of obesity, public policies to expand insurance coverage, and big box retailers. His research has been published in a variety of journals including the Economic Journal, Journal of Public Economics, Journal of Health Economics, Journal of Urban Economics, Journal of Economic History, and Journal of Policy Analysis and Management. He has received funding from the National Institutes of Health, United States Department of Agriculture, and Food and Drug Administration. Dr. Courtemanche has previously been a faculty member at the University of Louisville and the University of North Carolina at Greensboro. He is also a Research Associate in the Health Economics Program at the National Bureau of Economic Research and a Research Affiliate with the Institute for the Study of Labor (IZA).
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