Social and Behavioral Sciences Commons^™

Mental Health Is Wealth Too: Did The Affordable Care Act Medicaid Expansion Improve Mental Health Outcomes?, Dereck Wang

Honors Theses

The ongoing COVID-19 pandemic has greatly exacerbated mental health, which has long been a growing problem in the United States; poor mental health not only jeopardizes the well-being of Americans but also has severe implications for America’s economy. Not only do mental health conditions have significant costs of treatment, but the absenteeism, presenteeism, early retirement, and mortality stemming from poor mental health also severely impact productivity. One health policy that could alleviate this problem is Medicaid expansion. The Affordable Care Act gave states the choice to expand Medicaid eligibility for individuals with incomes up to 138% of the federal poverty …

Three Essays In Healthcare Economics And Policy Analysis, Tuyen Pham

Graduate Theses, Dissertations, and Problem Reports

This dissertation research consists of three essays on healthcare economics and policy analysis. Chapter 1 investigates and explains the failure of a proposition on limiting dialysis clinic profits in California in 2018. The proposition would have required dialysis clinics to issue refunds to patients or their payers for revenue that exceeds 115% of the direct cost of treatment. In this chapter, a conceptual framework of how voters weigh costs and benefits is developed and two different empirical approaches, simple OLS and Double Post LASSO, are employed to identify key determinants of the voting outcome. The empirical results suggest that counties …

How Does Occupational Licensing Affect Entry Into The Medical Field? An Examination Of Emts, Aaron Yelowitz, Samuel J. Ingram

Institute for the Study of Free Enterprise Working Papers

The COVID-19 pandemic has led to temporary suspensions of many occupational licensing laws, especially for health care professionals, in an effort to manage surges in health care demand. The crisis highlights more general concerns about occupational licensing laws, yet convincing empirical evidence on the degree to which such laws have inhibited entry into health care professions is scarce because most studies must rely on cross-sectional variation to identify such effects. In this study, we indirectly examine how occupational licensing affects the choice to become an Emergency Medical Technician (EMT) by exploiting the demand-side shock from the Affordable Care Act (ACA). …

The Affordable Care Act And Entrepreneurship Lock: An Updated Examination Of Employer-Based Healthcare’S Effect On Self-Employment By Demographic Group, Sean Ruddy

Undergraduate Economic Review

This paper capitalizes on a natural experiment created by differences in Medicaid expansion under The Patient Protection and Affordable Care Act (ACA). A difference and difference model comparing states that did and did not expand Medicaid is conducted to investigate if providing an alternative and low-cost source of health insurance affects self-employment rates overall and across different demographic groups. The results suggest that living in a state that expanded Medicaid was associated with a 1.4 percent increase in the likelihood that an individual will be self-employed and that this effect is heterogeneous across different demographics, being largest among African Americans.

Effect Of The Affordable Care Act Medicaid Expansion On Labor Participation Of Female Registered Nurses In Outpatient Care, Deborah R. Weissner

Theses and Dissertations

Medicaid expansions were used to examine the effects of a surge in demand for primary care on the labor participation of registered nurses (RN) in outpatient settings relative to hospitals. Using difference-in-differences and two-way fixed effects with the American Community Survey Public Use Microdata Sample single-year 2010 through 2017 files, I find an increase in the probability of an RN working in an outpatient setting among (1) young, unmarried RNs with a maximum household income of 501 percent of the federal poverty level and (2) young unmarried RNs who have at least one child under age 6. These results are …

The Full Impact Of The Affordable Care Act On Political Participation, Charles J. Courtemanche, James Marton, Aaron Yelowitz

Economics Faculty Publications

This article examines the impact of both the Medicaid expansion and the private insurance-related components of the Affordable Care Act (ACA) on voter turnout and registration. We employ a difference-in-difference-in-differences identification strategy exploiting variation over time, state Medicaid expansion status, and within-state local area pre-ACA uninsured rates. Using data between 2006 and 2016 from the November Current Population Survey and the Census Bureau's Small Area Health Insurance Estimates, our results suggest little effect of the ACA on voter turnout or registration.

Impact Of The Affordable Care Act On Referral To Care For People Living With Hiv In Appalachia, Cameron A. Wade, Timothy N. Crawford, Nicole Leedy, Alice C. Thornton

Journal of Appalachian Health

Introduction: The Affordable Care Act (ACA) enacted on March 23, 2010 significantly impacted access to healthcare for people living with HIV (PLWH). Expansion of care was accomplished in three areas: eliminating exclusions for pre-existing conditions, elimination of lifetime caps on healthcare expenditures, and expansion of Medicaid eligibility.

Purpose: This study evaluated the impact of state implementation of the ACA Medicaid expansion on referral to HIV care at a Ryan White federally funded clinic in Kentucky (University of Kentucky Bluegrass Care Clinic [UK BCC]).

Methods: Retrospective chart review of all newly enrolled patients at the UK BCC between March 2010 and …

The Aca's Dependent Coverage Mandate: An Investigation Of Its Effects On Mortality With Regard To Race, Jack W. Derwin

Honors Papers

I add to literature investigating the effects of the Affordable Care Act’s (ACA) dependent coverage mandate (DCM). I examine how the mandate, which increased health insurance coverage for 19 to 25 year-olds, impacted short-run mortality rates for the affected age group. Unlike previous research, I examine if and how young adult mortality was affected differentially by race. I use data from the CDC’s “WONDER” database to conduct difference-in-difference analysis to assess the effects of the policy change on mortality. I find that the DCM had a significant negative impact on mortality rates for the affected age group as a whole, …

Does The Healthcare Educational Market Respond To Short-Run Local Demand?, Marcus O. Dillender, Andrew Friedson, Cong Gian, Kosali Simon

Upjohn Institute Policy and Research Briefs

No abstract provided.

Effects Of Innovations In Health Care Provision And Financing, Hoda Nouri Khajavi

Dissertations, Theses, and Capstone Projects

This dissertation consists of four chapters that study the impacts of innovations in health care provision and financing. The relentless rise in US health care costs has led the Centers for Medicare and Medicaid Services to launch various pilot programs to create financial incentives for health care providers, suppliers, and local communities to improve the efficiency of the health care system. The fist chapter of this manuscript reviews the main pilot programs implemented and/or funded by the Centers for Medicare and Medicaid Services since the 111th United States Congress passed the Patient Protection and Affordable Care Act, also known as …

Does The Healthcare Educational Market Respond To Short-Run Local Demand?, Marcus O. Dillender, Andrew Friedson, Cong Gian, Kosali Simon

Upjohn Institute Working Papers

The Patient Protection and Affordable Care Act (ACA) increased demand for healthcare across the U.S., but it is unclear if or how the supply side has responded to meet this demand. In this paper, we take advantage of plausibly exogenous geographical heterogeneity in the ACA in order to examine the response of the healthcare education sector to increased demand for healthcare services. We look across educational fields, types of degrees, and types of institutions; we pay particular attention to settings where our conceptual model predicts heightened responses. We find no statistically significant evidence of increases in graduates and can rule …

Medicaid Coverage Across The Income Distribution Under The Affordable Care Act, Charles J. Courtemanche, James Marton, Aaron Yelowitz

Institute for the Study of Free Enterprise Working Papers

This chapter examines trends in Medicaid enrollment across the income distribution after the ACA’s Medicaid expansion.Using data from the American Community Survey between 2012and 2017, we compare Medicaid coverage over time in 9 states that expanded Medicaid in 2014 with no previous expansion for able-bodied, working-age adults with 12 states that had not expanded Medicaid by 2019 and also had no previous expansion for such adults. A difference-in-differences model is used to formalize this comparison. Similar to many previous studies, we find that Medicaid coverage increased dramatically for income-eligible adults under 138% of the federal poverty level (FPL). In addition, …

The Effects Of The Affordable Care Act Medicaid Expansion On Breast And Cervical Cancer Screening Rates On Low-Income Childless Women, Michelle Raissa Kobou Wafo

Economics

In 2010, the Obama administration passed the Patient Protection and Affordable Care Act (ACA) commonly known as Obamacare. However, it is in 2014 that several key parts of the ACA went into effect. Among those key parts is the Medicaid expansion program. States that chose to adopt the policy, expanded Medicaid access to everyone under 138 percent of the federal poverty line. This extension had the largest impact on childless adults who previously were not covered by the program. Moreover, ACA made it mandatory for all health plans (private and public) to include the ten essential health benefits in their …

Effects The 2014 Medicaid Expansion On Seat Belt Use: An Investigation Into Moral Hazard, Paul Pangburn

Economics

Under the Patient Protection and Affordable Care Act, signed into law by President Obama in 2010, health insurance coverage was expanded to 20 million previously uninsured people. Of these, 14.5 million were Medicaid eligible. Moral Hazard, a common research topic in insurance, is defined as when the private actions of an individual in a risk-sharing situation influence the probability of the outcome. There are two types of moral hazard, called ex-post moral hazard and ex-ante moral hazard. In the case of health insurance, ex-post moral hazard is when a health behavior changes after an individual becomes insured. Ex-ante moral hazard, …

[Job] Locked And [Un]Loaded: The Effect Of The Affordable Care Act Dependency Mandate On Reenlistment In The U.S. Army, Michael S. Kofoed, Wyatt J. Frasier

Upjohn Institute Policy and Research Briefs

No abstract provided.

[Job] Locked And [Un]Loaded: The Effect Of The Affordable Care Act Dependency Mandate On Reenlistment In The U.S. Army, Michael S. Kofoed, Wyatt J. Frasier

Employment Research Newsletter

No abstract provided.

[Job] Locked And [Un]Loaded: The Effect Of The Affordable Care Act Dependency Mandate On Reenlistment In The U.S. Army, Michael S. Kofoed, Wyatt J. Frasier

Upjohn Institute Working Papers

One concern with employer-based health insurance is job lock or the inability for employees to leave their current employment for better opportunities for fear of losing benefits. We use the implementation of the Affordable Care Act’s dependency mandate as a natural experiment. Data from the United States Army overcome some limitations in previous studies including the ability to examine workers with fixed contract expiration dates, uniform pay, and health coverage. We find that the ACA decreased reenlistment rates by 3.13 percent for enlisted soldiers aged 23–25. We also find that younger veterans who leave the army are more likely to …

The Effect Of The Dependent Coverage Provision Of The Affordable Care Act On Opioid Use And Abuse, Christian Carrillo

Theses and Dissertations

The non-medical use of prescription opioids has become the fastest growing drug problem in the United States. This paper examines the effect of the ACA's dependent coverage provision on the prevalence of prescription opioid misuse and abuse along with the mechanism driving the results.

The Three-Year Impact Of The Affordable Care Act On Disparities In Insurance Coverage, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata, Ishtiaque Fazlul

Economics Faculty Publications

Objective
To estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after three years.

Data Source
The 2011-2016 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults.

Design
We estimate a difference-in-difference-in-differences model to separately identify the effects of the nationwide and Medicaid expansion portions of the ACA using the methodology developed in the recent ACA literature. The differences come from time, state Medicaid expansion status, and local area pre-ACA uninsured rates. In order to focus on access disparities, we …

Effects Of The Affordable Care Act On Health Care Access And Self-Assessed Health After 3 Years, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Economics Faculty Publications

Using data from the Behavioral Risk Factor Surveillance System, we examine the causal impact of the Affordable Care Act on health-related outcomes after 3 years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from 2 sources: (1) local area prereform uninsured rates from 2013 and (2) state participation in the Medicaid expansion. Including the third postreform year leads to 2 important insights. First, gains in health insurance coverage and access to care from the policy continued to increase in the third year. Second, an improvement in the probability of reporting excellent health emerged in the third year, with …

The Pricing Impact Of Decreasing Competitiveness Of The Health Insurance Market, Lauren N. Patterson

Chancellor’s Honors Program Projects

No abstract provided.

Effects Of The Affordable Care Act On Health Behaviors After Three Years, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Institute for the Study of Free Enterprise Working Papers

This paper examines the impacts of the Affordable Care Act (ACA) – which substantially increased insurance coverage through regulations, mandates, subsidies, and Medicaid expansions – on behaviors related to future health risks after three years. Using data from the Behavioral Risk Factor Surveillance System and an identification strategy that leverages variation in pre-ACA uninsured rates and state Medicaid expansion decisions, we show that the ACA increased preventive care utilization along several dimensions, but also increased risky drinking. These results are driven by the private portions of the law, as opposed to the Medicaid expansion. We also conduct subsample analyses by …

Supporting Medicaid In Virginia, Scott Burns

Exigence

This report analyzes Medicaid in Virginia, the needs-based social health insurance program providing health coverage to children, pregnant women, working parents, the disabled, and elderly who cannot afford health costs on their own. It supports the value of the Medicaid program to these beneficiaries’ long term health, the healthcare sector, cost control and Virginia’s economy. Additionally, it analyzes healthcare policy looking at what effects the Affordable Care Act has had in improving healthcare access and what effects healthcare reform under president-elect Donald Trump’s administration and the Republican controlled 115^th United States Congress might have targeting healthcare cost. Ultimately this …

Early Effects Of The Affordable Care Act On Health Care Access, Risky Health Behaviors, And Self-Assessed Health, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Institute for the Study of Free Enterprise Working Papers

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 …

The Effect Of Health Insurance On Young Adults' Labor Market Outcomes: Evidence From The Affordable Care Act's Dependent Coverage Expansion, Quazi Hassan

Theses and Dissertations

The Affordable Care Act’s dependent coverage mandate extended young adults’ parental coverage to age 26. I study the expansion’s impact on young adults’ labor market outcomes using a control function method. Following the expansion, I find dependent coverage lowered labor force participation, lowered incomes, and mixed evidence regarding labor supply.

How Did The Aca Affect Health Insurance Coverage In Kentucky?, Aaron Yelowitz

Institute for the Study of Free Enterprise Working Papers

The major components of the Affordable Care Act (ACA) were implemented in 2014, including the rollout of the Health Insurance Marketplace, Medicaid expansions, and the individual mandate. Kentucky stands out as one of the few southern states to expand Medicaid, and earlier work has demonstrated that Kentucky experienced some of the largest gains in health insurance coverage. The goal of the current study is to further explore the sources that individuals used to gain coverage in Kentucky using a large, publicly available dataset, the American Community Survey (ACS). Several findings emerge. First, overall health insurance coverage increased by 5.7 percentage …

Effects Of The Affordable Care Act On Part-Time Employment: Early Evidence, Marcus Dillender, Carolyn Heinrich, Susan Houseman (Corresponding Author)

Susan N. Houseman

The Affordable Care Act (ACA) requires employers with at least 50 full-time-equivalent employees to offer “affordable” health insurance to employees working 30 or more hours per week. If employers do not comply with the mandate, they may face substantial financial penalties. Employers can potentially circumvent the mandate by reducing weekly hours below the 30-hour threshold or by using other nonstandard employment arrangements (direct-hire temporaries, agency temporaries, small contractors, and independent contractors). We examine the effects of the ACA on short-hours, part-time employment. Using monthly CPS data, we estimate that the ACA resulted in an increase in low-hours, involuntary part-time employment …

Effects Of The Affordable Care Act On Part-Time Employment: Early Evidence, Marcus O. Dillender, Carolyn J. Heinrich, Susan N. Houseman (Corresponding Author)

Upjohn Institute Working Papers

The Affordable Care Act (ACA) requires employers with at least 50 full-time-equivalent employees to offer “affordable” health insurance to employees working 30 or more hours per week. If employers do not comply with the mandate, they may face substantial financial penalties. Employers can potentially circumvent the mandate by reducing weekly hours below the 30-hour threshold or by using other nonstandard employment arrangements (direct-hire temporaries, agency temporaries, small contractors, and independent contractors). We examine the effects of the ACA on short-hours, part-time employment. Using monthly CPS data, we estimate that the ACA resulted in an increase in low-hours, involuntary part-time employment …

The Affordable Care Act And Health Care In America, Michael Ryan

Undergraduate Honors Capstone Projects

What you are about to read is a final project meant to incorporate ideas from my undergraduate coursework with my interests in medicine and economics. Issues in health care, especially insurance, fascinate me and I chose to use my Honors Capstone Project as an opportunity to further my understanding of issues important to me as both a future physician and businessman. The purpose of this paper is to practice critical and analytical thinking skills by exploring some of the challenging issues surrounding American health insurance and the Affordable Care Act while also gaining a deeper understanding of the nuances of …

The Effect Of Medicaid Expansion On Emergency Department Utilization In Kentucky., Anmol Kanotra

College of Arts & Sciences Senior Honors Theses

This paper analyzes the impact of a major healthcare reform in Kentucky on outpatient emergency department (ED) visits. I exploit the variation in treatment intensity across counties to determine the effect of expanded Medicaid coverage on Medicaid ED usage rate. I find that there was an insignificant 1 percent increase in ED usage following expansion when utilizing fixed effects. Counties with a high percentage of females experience significantly higher ED rates. Additionally, counties with a lower percentage of children under 21 have higher ED rates.