Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act

  title={Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act},
  author={Molly Frean and Jonathan H Gruber and Benjamin D. Sommers},
  journal={NBER Working Paper Series},

Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States

The causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey are estimated using difference- in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates.

Medicaid Expansion And Marketplace Eligibility Both Increased Coverage, With Trade-Offs In Access, Affordability.

ACA provisions implemented in 2014 provide a valuable case study regarding the merits of using public versus subsidized private insurance to help low-income people obtain and finance health care.

Affordability of the Affordable Care Act's Medicaid Expansion: Implications for Household and Public Finances

The short-run impact of public insurance expansion under the ACA Medicaid expansion on the out-of-pocket medical spending of low-income households is investigated and it is found that the Medicaid expansion significantly reduced household OOP among Medicaid-eligible households.

Incentive(less)? The Effectiveness of Tax Credits and Cost-Sharing Subsidies in the Affordable Care Act

The Patient Protection and Affordable Care Act introduced several new policies in 2014, including subsidized private coverage. Individuals gain eligibility to substantial tax credits and cost-sharing

Public Health Insurance and Medical Spending: Evidence from the ACA Medicaid Expansion

It is found that public insurance eligibility reduced mean OOP by 18.2% among targeted households, but it did not causally increase total expenditures among beneficiaries.

1 Incentive ( less ) ? The Effectiveness of Tax Credits and Cost-Sharing Subsidies in the Affordable Care Act

for comments, suggestions, and moral support. I would also like to thank Susan Murchie for editorial assistance. All errors are my own. ABSTRACT The Patient Protection and Affordable Care Act (ACA)

Effects of Repealing the ACA Individual Mandate Penalty on Insurance Coverage and Marketplace Enrollment

Private insurance coverage rates and marketplace enrollment for adults 18–64 do not appear to have changed thus far owing to the 2019 repeal of the ACA individual mandate penalty.

The three‐year impact of the Affordable Care Act on disparities in insurance coverage

The fully implemented ACA has been successful in reducing coverage disparities across multiple groups, with these changes being partly attributable to both the Medicaid expansion and nationwide components of the law.

The Impact of the ACA on Insurance Coverage Disparities after Four Years

The purpose of this paper is to estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance

The impact of Medicaid expansion on employer provision of health insurance

It is found that employer provision of health insurance was largely unaffected by the Medicaid expansions, and there is some evidence suggestive of an inverse relationship between the expansion of Medicaid and the percentage of an establishment’s workers eligible for ESI.



Improving The Affordable Care Act: An Assessment Of Policy Options For Providing Subsidies.

One option that uses the subsidy formula employed in the insurance Marketplaces under the ACA for both the individual and employer-sponsored insurance markets, and additionally requires the subsidy to be at least $1,250 without an upper income limit on subsidy eligibility imposed, could expand insurance coverage and reduce individual market premiums relative to the ACA with no additional federal spending.

Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply

The Medicaid expansions were associated with large increases in Medicaid coverage, for example, 50 percent among childless adults, and corresponding decreases in the proportion uninsured, and there was relatively little change in private insurance coverage, although the expansions tended to decrease such coverage slightly.

Early Coverage, Access, Utilization, and Health Effects Associated With the Affordable Care Act Medicaid Expansions

State Medicaid expansions seem to be achieving the broad goals of the Patient Protection and Affordable Care Act, with an increase in insurance coverage among low-income adults in states that expanded Medicaid compared with those that did not.

Medicaid Expansion Did Not Result In Significant Employment Changes Or Job Reductions In 2014.

Analyzing labor-market participation among adults with incomes below 138 percent of the federal poverty level and comparing Medicaid expansion and nonexpansion states and Medicaid-eligible and -ineligible groups suggests that the Medicaid expansion has had limited impact on labor- market outcomes thus far.

Reasons for the wide variation in Medicaid participation rates among states hold lessons for coverage expansion in 2014.

The results suggest that when Medicaid is expanded in 2014, take-up may be less than anticipated because new enrollees will be offered a more restrictive set of benefits--known as "benchmark coverage"--compared to those in traditional Medicaid, and the majority of newly eligible adults will be in groups with traditionally lowTake-up (primarily nondisabled adults).

Regulatory Redistribution in the Market for Health Insurance

The analysis highlights an important linkage between the incidence of public insurance programs and redistributive regulations, and when targeted at the sick, public insurance expansions can relieve the distortions associated with premium regulations, potentially crowding in private coverage.

Does Public Insurance Crowd Out Private Insurance?

It is estimated that between 50 percent and 75 percent of the increase in Medicaid coverage was associated with a reduction in private insurance coverage, largely because employees took up employer-based insurance less frequently, although employers may have encouraged them to do so by contributing less for insurance.


The projected impact of the ACA is discussed in more detail, evidence is described that sheds light upon the accuracy of the projections, and some observations on those estimates are offered.

Participation and crowd out: assessing the effects of parental Medicaid expansions.

Changes in Self-reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act.

The ACA's first 2 open enrollment periods were associated with significantly improved trends in self-reported coverage, access to primary care and medications, affordability, and health.