The Affordable Care Act [ACA] authorized the largest expansion of public health insurance coverage in the U.S. since the mid-1960s. Evidence on the effects of the ACA-induced increase in insurance coverage on patient health and health care providers is still emerging. We deploy administrative data from the universe of general acute care hospitals and emergency rooms in California over 2008-15 and present new empirical evidence on the effects on insurance coverage, health care utilization, and hospital finances. Our empirical approach utilizes regression discontinuity and differences-in-differences research designs, exploiting sharp changes in Medicaid coverage due to age-based eligibility restrictions and pre-ACA variation in un-insurance shares across hospitals and markets. We have three principal findings. First, we find that approximately half of the Medicaid expansion replaced existing county safety-net programs - implying a large transfer from federal taxpayers to those in California. Second, although we find substantial increases in utilization of hospital stays and ER visits as well as sorting toward better quality hospitals, we find no detectable effects on patient health. Third, we find heterogeneous effects on revenue - government owned - safety-net' hospitals experienced large gains in revenue, while gains are modest for private hospitals. Additional revenue does not manifest in improved quality metrics or capital investment.
Author[s]
Mark Duggan
Atul Gupta
Emilie Jackson
Publication Date
May, 2018
More Publications
Publication Measuring the Ex-Ante Social Cost of Aggregate Volatility
Working PaperPublication Behavioral Public Economics: Welfare and Policy Analysis with Non-Standard Decision-Makers
Working PaperPublication The bright future of working from home
Essay, COVID-19, Work
RESEARCH ARTICLES Young, Gary J. JD, PhD; Flaherty, Stephen PhD; Zepeda, E. David PhD; Singh, Simone PhD; Rosenbaum, Sara JD professor, Center for Health Policy and Healthcare Research, D’Amore-McKim School of Business, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts research associate, Center for Health Policy and Healthcare
Research, Northeastern University assistant professor, Center for Health Policy and Healthcare Research, D’Amore-McKim School of Business, Northeastern University assistant professor, School of Public Health, University of Michigan professor, Milken Institute School of Public Health, George Washington University, Washington, D.C. For more information about the concepts in this article, contact Dr.
Young at [email protected]
The authors declare no conflicts of interest.
doi: 10.1097/JHM-D-17-00177
- Buy
Abstract
- Atul Gupta
- Emilie Jackson
- American Economic Journal: Economic Policy
- vol. 14, no. 1, February 2022
- [pp. 111-51]
- Article Information
- Comments []
Abstract
We exploit changes in the discontinuity in health insurance coverage at age 65 induced by the implementation of the Affordable Care Act to examine effects on coverage, hospital use, and patient health. We then link these changes to effects on hospital finances. We show that a substantial share of the federally funded Medicaid expansion substituted for existing locally funded safety net programs. Despite this offset, the expansion produced a substantial increase in hospital revenue, reflected in an equivalent increase in operating surplus. We do not detect improvements in patient mortality, although the expansion led to substantially greater hospital and emergency room use.Citation
Duggan, Mark, Atul Gupta, and Emilie Jackson. 2022. "The Impact of the Affordable Care Act: Evidence from California's Hospital Sector." American Economic Journal: Economic Policy, 14 [1]: 111-51. DOI: 10.1257/pol.20190279Additional Materials
- Data Set
- Online Appendix [856.47 KB]
- Author Disclosure Statement[s] [178.24 KB]
JEL Classification
- H51 National Government Expenditures and Health
- H75 State and Local Government: Health; Education; Welfare; Public Pensions
- I12 Health Behavior
- I13 Health Insurance, Public and Private
- I18 Health: Government Policy; Regulation; Public Health
- I38 Welfare, Well-Being, and Poverty: Government Programs; Provision and Effects of Welfare Programs
There are no comments for this article.
Login to Comment