THE IMPACT OF THE ACA ON INSURANCE COVERAGE DISPARITIES AFTER FOUR YEARS

Charles Courtemanche, Ishtiaque Fazlul, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

2 Scopus citations

Abstract

In this chapter we 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, and gender, in order to examine access disparities. After four years, the fully implemented ACA (i.e., the national components of the ACA combined with the Medicaid expansion) eliminated 44 percent of the coverage gap across income groups, with the Medicaid expansion accounting for this entire reduction. The fully implemented 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.

Original languageEnglish
Title of host publicationMedicaid
Subtitle of host publicationPolitics, Policy, and Key Issues
Pages21-51
Number of pages31
ISBN (Electronic)9781536182309
StatePublished - Jan 1 2020

Bibliographical note

Publisher Copyright:
© 2020 by Nova Science Publishers, Inc.

Keywords

  • Affordable care act
  • Disparities in insurance coverage
  • Health care finance
  • Medicaid

ASJC Scopus subject areas

  • General Health Professions
  • General Medicine

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