The goal of the Affordable Care Act (ACA) was to achieve nearly universal health insurance coverage through a combination of mandates, subsidies, marketplaces, and Medicaid expansions, most of which took effect in 2014. We use data from the Behavioral Risk Factor Surveillance System to examine the impacts of the ACA on health care access, risky health behaviors, and self-assessed health after two years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from state participation in the Medicaid expansion and pre-ACA uninsured rates. Results suggest that the ACA led to sizeable improvements in access to health care in both Medicaid expansion and non-expansion states, with the gains being larger in expansion states along some dimensions. No statistically significant effects on risky behaviors or self-assessed health emerge for the full sample. However, we find some evidence that the ACA improved self-assessed health among older non-elderly adults, particularly in expansion states.
Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed HealthJune 28, 2017
Impact of Children’s Health Insurance Bene fit on Labor Supply: Evidence from Newly Arrived Immigrants in the United States by Keshar M. Ghimire :: SSRNJune 24, 2017
This paper exploits the State Children’s Health Insurance Program of the United States to investigate impact of a publicly funded health insurance benefit for children on work behavior of adult men and women. Drawing data from the Annual Social and Economic Supplement of the Current Population Survey and employing a triple- difference identification strategy, I find that public health insurance benefit for children decreases labor supply of women but increases that of men. Estimates suggest that, on average, labor force participation rate of women decreased by 7.4 percentage points while that of men increased by 5.5 percentage points as their families became eligible for State Children’s Health Insurance Program. The findings are supported by a number of robustness checks and a falsification exercise.
Estimating the Recession-Mortality Relationship When Migration Matters by Vellore Arthi, Brian Beach, William Walker Hanlon :: SSRNJune 24, 2017
A large literature following Ruhm (2000) suggests that mortality falls during recessions and rises during booms. The panel-data approach used to generate these results assumes that either there is no substantial migration response to temporary changes in local economic conditions, or that any such response is accurately captured by intercensal population estimates. To assess the importance of these assumptions, we examine two natural experiments: the recession in cotton textile-producing districts of Britain during the U.S. Civil War, and the coal boom in Appalachian counties of the U.S. that followed the OPEC oil embargo in the 1970s. In both settings, we find evidence of a substantial migratory response. Moreover, we show that estimates of the relationship between business cycles and mortality are highly sensitive to assumptions related to migration. After adjusting for migration, we find that mortality increased during the cotton recession, but was largely unaffected by the coal boom. Overall, our results suggest that migration can meaningfully bias estimates of the impact of business-cycle fluctuations on mortality.
The Impact of Recent Mental Health Changes on Employment: New Evidence from Longitudinal Data by Sophie Mitra, Kristine Jones :: SSRNJune 24, 2017
This study uses longitudinal data and four different measures of mental health to tease out the impact of psychiatric disorder onsets and recoveries on employment outcomes. Results suggest that developing a mental health problem leads to a significant increase in the probability of transitioning to non-employment, while a recovery increases the probability of return to work among the not employed with a mental health problem. No consistent effect was found on hours worked and earnings. Research and policy attention is needed with respect to early interventions such as job retention programmes to help workers with mental health problems remain employed as well as interventions that may lead to recovery and return to work. More research is needed especially with data and models that can differentiate between the effects of mental health onsets and recoveries on employment exit and return to work transitions.
Cyclical Job Ladders by Firm Size and Firm Wage by John Haltiwanger, Henry R. Hyatt, Lisa Kahn, Erika McEntarfer :: SSRNJune 24, 2017
We study whether workers progress up firm wage and size job ladders, and the cyclicality of this movement. Search theory predicts that workers should flow towards larger, higher paying firms. However, we see little evidence of a firm size ladder, partly because small, young firms poach workers from all other businesses. In contrast, we find strong evidence of a firm wage ladder that is highly procyclical. During the Great Recession, this firm wage ladder collapsed, with net worker reallocation to higher wage firms falling to zero. The earnings consequences from this lack of upward progression are sizable.
Reducing Inequality Through Dynamic Complementarity: Evidence from Head Start and Public School Spending by Rucker Johnson, C. Kirabo Jackson :: SSRNJune 24, 2017
We explore whether early childhood human-capital investments are complementary to those made later in life. Using the Panel Study of Income Dynamics, we compare the adult outcomes of cohorts who were differentially exposed to policy-induced changes in pre-school (Head Start) spending and school-finance-reform-induced changes in public K12 school spending during childhood, depending on place and year of birth. Difference-in-difference instrumental variables and sibling-difference estimates indicate that, for poor children, increases in Head Start spending and increases in public K12 spending each individually increased educational attainment and earnings, and reduced the likelihood of both poverty and incarceration in adulthood. The benefits of Head Start spending were larger when followed by access to better-funded public K12 schools, and the increases in K12 spending were more efficacious for poor children who were exposed to higher levels of Head Start spending during their preschool years. The findings suggest that early investments in the skills of disadvantaged children that are followed by sustained educational investments over time can effectively break the cycle of poverty.
Subsidizing Health Insurance for Low-Income Adults: Evidence from
Massachusetts. Amy Finkelstein, Nathaniel Hendren, Mark Shepard∗
Abstract: How much are low-income individuals willing to pay for health insurance, and what are the implications for insurance markets? Using administrative data from Massachusetts’ subsidized insurance exchange, we exploit discontinuities in the subsidy schedule to estimate willingness to pay and costs of insurance among low-income adults. As subsidies decline, insurance take-up falls rapidly, dropping about 25% for each $40 increase in monthly enrollee premiums. Marginal enrollees tend to be lower-cost, consistent with adverse selection into insurance. But across the entire distribution we can observe – approximately the bottom 70% of the willingness to pay distribution – enrollee willingness to pay is three to four times below own expected medical costs. As a result, we estimate that take-up will be highly incomplete even with generous subsidies: if enrollee premiums were 25% of insurers’ average costs, at most half of potential enrollees would buy insurance, and even premiums subsidized down to 10% of average costs would still leave at least 20% uninsured. We briefly consider explanations for this finding – which suggests an important role for uncompensated care for the uninsured – and explore normative implications for insurance subsidies for low-income individuals.
As discussed above, states cannot combine savings under Section 1115 and Section 1332 waivers into a single budget-deficit neutrality test. This clarification, along with the further definition of the guardrails, has been characterized by some as limiting states’ flexibility under the statute. As such, it is not clear how many states will pursue Section 1332 waivers and whether any of the reforms will lead to changes in Medicaid or CHIP. Furthermore, given the timing of their implementation (January 2017), the change in
administration at the federal level may alter the parameters in which states can seek these waivers.
Nevada’s Republican governor vetoed a bill late Friday that would have created the nation’s first “Medicaid for all” insurance offering, a plan that drew widespread attention as states brace for changes in the federal Affordable Care Act.
The bill would have allowed any state resident to buy into Medicaid, the federal-state program for people with low incomes or disabilities. The idea, which its Democratic sponsor said would have created a guaranteed health coverage option that was affordable, has drawn the interest of other liberal-leaning states as congress works to repeal major portions of the Affordable Care Act, including the law’s Medicaid expansion.
We’ve all heard about the insurers that are pulling out of Affordable Care Act marketplaces, but sometimes you have to see it to really get it. This map is based on data from the Kaiser Family Foundation for the first four years of the ACA marketplaces. You can really see the difference in 2017, when high-profile insurance exits left 21 percent of all ACA customers with only one insurer in their area.