Abstract:
The Patient Protection and Affordable Care Act state Medicaid expansions have been found to increase insurance coverage and access to care, but the question remains whether these expansions relieve the burden of out-of-pocket costs associated with obtaining medical care and in turn improve health outcomes. This paper considers the extent to which these expansions have alleviated this burden and have impacted health outcomes for non-elderly low-income adults using data from the 2011-2016 Current Population Survey Annual Social and Economic Supplement covering the 2010-2015 calendar years. Using a difference-in-differences framework, the analysis examines effects of the Medicaid expansions for out-of-pocket expenditures on health insurance premiums and medical care as well as on reported health, comparing expenditures across expansion and non-expansion states before and after the expansions were implemented. The analysis examines whether the expansions had different effects over the short and longer terms by comparing effects in the first and second years of their implementation. The findings show that the expansions were associated with increases in the likelihoods of having zero premium expenditures and non-premium medical out-of-pocket expenditures, suggesting the expansions were effective in improving financial well-being. The findings further show that the expansions were associated with a decrease in the likelihood of reporting excellent or very good health. Taken together with evidence from other studies that the expansions were associated with an increase in the use of preventative care and diagnosis of medical conditions, the findings of this analysis suggest the decline in reported health comes about not from a decline in utilization of care, but rather, changes in perceptions of health associated with increased utilization.