Working Paper: NBER ID: w22265
Authors: Kosali Simon; Aparna Soni; John Cawley
Abstract: The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors. One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance. \nThis paper estimates how the ACA-facilitated state-level expansions of Medicaid in 2014 affected these outcomes. Using data from the Behavioral Risk Factor Surveillance System, and a difference-in-differences model that compares states that did and did not expand Medicaid, we examine the impact of the expansions on preventive care (e.g. dental visits, immunizations, mammograms, cancer screenings), risky health behaviors (e.g. smoking, heavy drinking, lack of exercise, obesity), and self-assessed health. \nWe find that the expansions increased insurance coverage and access to care among the targeted population of low-income childless adults. The expansions also increased use of certain forms of preventive care but there is no evidence that they increased ex ante moral hazard (i.e., there is no evidence that risky health behaviors increased in response to health insurance coverage). The Medicaid expansions also modestly improved self-assessed health.
Keywords: No keywords provided
JEL Codes: I12; I13; I28
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Medicaid expansion (I18) | health insurance coverage (I13) |
| Medicaid expansion (I18) | health insurance coverage among childless adults (I13) |
| Medicaid expansion (I18) | access to care (I14) |
| Medicaid expansion (I18) | likelihood of having a personal doctor (I11) |
| Medicaid expansion (I18) | cost-related barriers to care (I11) |
| Medicaid expansion (I18) | probability of receiving an HIV test (C83) |
| Medicaid expansion (I18) | routine checkups (I19) |
| Medicaid expansion (I18) | flu vaccinations (I19) |
| Medicaid expansion (I18) | cancer screenings (I12) |
| Medicaid expansion (I18) | risky health behaviors (smoking, heavy drinking, obesity) (I12) |
| Medicaid expansion (I18) | smoking participation among childless adults (I12) |
| Medicaid expansion (I18) | self-assessed health (I14) |