Working Paper: NBER ID: w23722
Authors: Charles Courtemanche; Andrew Friedson; Andrew P. Koller; Daniel I. Rees
Abstract: This study contributes to the literature on supply-side adjustments to insurance expansions by examining the effect of the Affordable Care Act (ACA) on ambulance response times. Exploiting temporal and geographic variation in the implementation of the ACA as well as pre-treatment differences in uninsured rates, we estimate that the expansions of private and Medicaid coverage under the ACA combined to slow ambulance response times by an average of 19%. We conclude that, through extending coverage to individuals who, in its absence, would not have availed themselves of emergency medical services, the ACA added strain to emergency response systems.
Keywords: Affordable Care Act; ambulance response times; insurance coverage; emergency medical services
JEL Codes: I11; I13; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Implementation of the ACA (G52) | Increase in ambulance response times (R41) |
| Increased demand for emergency medical services due to expanded coverage (I11) | Slower ambulance response times (R41) |
| Insurance enrollment increase (I13) | Slowdown in ambulance response times (R41) |
| ACA implementation (G52) | Increased probability of ambulances failing to arrive within 8 minutes (R41) |