Health Impacts of the Affordable Care Act Insurance Expansions: An Analysis of the 2014 Medicaid Expansions and the 2010 Young Adult Provision

We examine the health impacts of two insurance expansions that occurred through the Affordable Care Act: the Medicaid expansion for adults and the young adult dependent coverage expansion. These provisions targeted two highly-uninsured populations. While the young adult provision started in 2010, the majority of the Medicaid expansions did not occur until 2014. Thus, our data period allows us to report on early responses to Medicaid expansion, and more medium-term responses to the young adult expansion. We use the Behavioral Risk Factor Surveillance System data covering 2012-2014 to examine Medicaid expansion, and the National Health Interview Study 2007-2015 to study the young adult provision. To examine the Medicaid expansion, we use a quasi-experimental study design comparing Medicaid-expansion-eligible individuals in states that expanded ACA Medicaid to those in states that did not expand Medicaid. To examine the young adult mandate, we compare those in ages targeted by the policy (19-25), to those slightly older (27-29), in periods after the ACA provision compared to before the provision. We include in the Appendix a summary of existing literature studying the impact of insurance on coverage, access, utilization, health, and labor market outcomes. We find that the Medicaid expansion led to a significant increase in insurance enrollment, self-assessed health, and access to care for low-income childless adults, but did not change the probability of having a personal doctor. The young adult mandate significantly reduced the uninsurance rate of 19-25 year-olds, mainly through gains in parental insurance coverage, but did not lead to significant changes in disability, mental health, access and utilization outcomes.