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

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

Research output: Contribution to journalArticlepeer-review

69 Scopus citations


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.

Original languageEnglish
Pages (from-to)307-316
Number of pages10
JournalHealth Services Research
StatePublished - Feb 2019

Bibliographical note

Publisher Copyright:
© 2018 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust


  • gender/sex differences in health and health care
  • health care financing/insurance/premiums
  • health policy/politics/law/regulation
  • medicaid
  • racial/ethnic differences in health and health care
  • state health policies

ASJC Scopus subject areas

  • Health Policy


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