ESSAYS ON HEALTH COVERAGE EXPANSIONS AND ITS IMPACTS ON LOW INCOME POPULATIONS
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2023
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Abstract
This dissertation is composed of two chapters that apply econometric techniques toevaluate the impacts of the Affordable Care Act Medicaid expansion on health coverage for
low-income populations. The first chapter evaluates who enrolled in Medicaid as a consequence
of the Affordable Care Act (ACA). Using the 2010–2017 American Community
Survey, I estimate how characteristics relating to work status and race/ethnicity affect the
probability that an individual will be a complier, defined as those induced by the ACA
Medicaid expansion to obtain Medicaid coverage. Across all states, I find that part-time
workers, not non-workers, are the most likely to be compliers. This finding is not consistent
with certain notions that Medicaid participants are the ”undeserving poor” - a sentiment
that may have hindered efforts to expand Medicaid in certain states. Additionally, I find
that in non-expansion states, many of which have high Black populations, the probability
of being a complier is higher for Blacks than for other racial/ethnic groups, suggesting that
Black people in non-expansion states would be the largest beneficiaries of any new expansions.
This paper not only identifies the types of individuals who were already impacted by
the expansion but also identifies which populations would benefit the most from subsequent
expansions.
The second chapter analyzes how effective was the ACA in enrolling children already
eligible for Medicaid and Children Health Insurance Program (CHIP). Utilizing the American
Community Survey (ACS) from 2012 to 2017, I adopt a difference-in-differences approach
that measures the changes in public and private coverage for Medicaid and CHIP eligible
children before and after the enactment of the ACA Medicaid expansion. I find that there
are modest yet significant increases in public coverage for children who were previously
eligible for Medicaid and CHIP prior to the expansion, providing evidence of a “welcome
mat” effect. However, I observe significant crowding out in employer-sponsored insurance
for both previously eligible children and children who became newly eligible as a result of
the new adjusted gross income (MAGI) thresholds established after 2014. My findings not only establish, under the ACA Medicaid expansion, clear evidence of a “welcome mat” effect
for children across various age and income groups, but they may also suggest that parents
favor fully subsidized public coverage over partially subsidized private insurance for their
children.
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Economics, Economic theory, ACA, Compliers, Expansion, Medicaid, Welcome Mat
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