Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States
Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States
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DOI：
10.1002/pam.21961
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发表时间：
2017-12-01
影响因子：
3.8
通讯作者：
Zapata, Daniela
中科院分区：
文献类型：
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作者：
Courtemanche, Charles;Marton, James;Zapata, Daniela
平价医疗法案(ACA)旨在通过保险市场改革、强制令、补贴、医疗保险交易所和医疗补助扩大的组合，在美国实现几乎全民的医疗保险覆盖，其中大部分于2014年生效。本文利用美国社区调查的数据估计了2014年ACA对医疗保险覆盖面的因果影响。我们利用差异中的差异模型，该模型利用了由于州政府参与医疗补助扩大和当地ACA前未参保率而产生的治疗强度的横截面差异。这一战略使我们能够确定ACA在医疗补助扩大和非扩大状态下的影响。我们首选的规格表明，在治疗前的平均未参保率下，全面的ACA使居民参加保险的比例增加了5.9个百分点，而在没有扩大医疗补助的州，这一比例为2.8个百分点。ACA的私人保险扩张是由于雇主提供的保险和非集团保险的增加。从完整的ACA中获得的覆盖收益最大的是那些没有大学学位的人，非白人，年轻人，未婚个人，以及那些在家里没有孩子的人。我们没有发现任何证据表明，医疗补助计划的扩大挤占了私人保险。(C)公共政策分析和管理协会2016年。
The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, 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. (C) 2016 by the Association for Public Policy Analysis and Management.