Working Paper: NBER ID: w25153
Authors: Colleen M. Carey; Sarah Miller; Laura R. Wherry
Abstract: Some states have not adopted the Affordable Care Act (ACA) Medicaid expansions due to concerns that the expansions may impair access to care and utilization for those who are already insured. We investigate such negative spillovers using a large panel of Medicare beneficiaries. Across many subgroups and outcomes, we find no evidence that the expansions reduced utilization among Medicare beneficiaries, and can rule out all but very small changes in utilization or spending. These results indicate that the expansions in Medicaid did not impair access to care or utilization for the Medicare population.
Keywords: Medicaid Expansion; Affordable Care Act; Medicare; Healthcare Utilization; Negative Spillovers
JEL Codes: H51; I11; I13
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Medicaid expansions (I18) | utilization of Medicare beneficiaries (I18) |
| Medicaid expansions (I18) | primary care visits (I11) |
| Medicaid expansions (I18) | total physician services (I11) |
| Medicaid expansions (I18) | work-related relative value units (RVUs) of primary care services (I11) |
| Medicaid expansions (I18) | demand shocks from ACA expansions (G52) |