Did the Affordable Care Act Improve Health?

December 14, 2018

Key Takeaways

The research showed that the full ACA raised the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that didn’t expand Medicaid. This appears to be due to increases in both employer-provided and individuals’ private coverage.

The greatest coverage gains from the full ACA were for relatively young, healthy individuals. Because this group wasn’t necessarily unhealthy to begin with, it is unclear whether health has improved due to the ACA.

One of the key components of the Affordable Care Act (ACA) was the expansion of Medicaid to bolster the number of Americans receiving health insurance coverage, which would in theory improve access to health care and therefore health. However, not every state participated in the expansion, resulting in large discrepancies in coverage.

Research from UK’s Aaron Yelowitz, “Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States” (Journal of Policy Analysis and Management), carefully documented how much the gains in both public and private insurance coverage were due primarily to the health care legislation and asked what inferences can be made about the impact of the ACA on Americans’ overall health. “Our economy at the time [2014-2015] was also experiencing some strong growth,” explains Yelowitz. “So we wanted to explore if these gains were in fact solely due to the enacted health care policy.”

While the research showed that health insurance coverage increased as expected, the paper also documented some surprising findings. The full ACA raised the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that didn’t expand Medicaid. The expansion of private insurance coverage from the ACA appears to be due to increases in both employer-provided and individuals’ private coverage. However, the largest coverage gains from the full ACA were for relatively young, healthy individuals. “We care about these gains from primarily healthy individuals because if you look past the insurance enrollment number, you can start to ask how does this translate to improved health?” says Yelowitz. “This allows us a framework to show that while these groups gained coverage, they weren’t necessarily unhealthy to begin with, so it is unclear whether health has improved due to the ACA.” Aaron Yelowitz is associate professor of economics, and director of the Institute for the Study of Free Enterprise.

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

Authors:

Aaron Yelowitz, Professor of Economics; Director of the Institute for the Study of Free Enterprise, Gatton College of Business and Economics at the University of Kentucky 
Charles Courtemanche, Associate Professor of Economics, Gatton College of Business and Economics at the University of Kentucky 
James Marton, Associate Professor of Economics, Georgia State University
Benjamin D. Ukert, postdoctoral researcher at the Leonard Davis Institute of Health Economics and the Injury Science Center at the Perelman School of Medicine.
Daniela Zapata, Senior Research Associate within IMPAQ's Health Division

Publication:

Journal of Policy Analysis and Management, Vol. 36(1), pages 178-210, 2017

Read Online