The impact of the Affordable Care Act Medicaid expansions on agricultural workers' health insurance coverage, medical care utilization, and labor supply

Nearly 30% of documented agricultural workers, that is, those who are authorized to work in the U.S. and may be eligible for government‐sponsored Medicaid coverage, lacked health insurance coverage in 2016. We estimate the impact of the 2014 state‐level Medicaid expansions that were part of the Affordable Care Act (ACA) on farm workers' health insurance coverage, health care utilization, and labor supply. Using confidential individual‐level data from the National Agricultural Workers Survey (NAWS) for the decade between 2007 and 2016, we employ a difference‐in‐differences econometric model to compare workers in states that expanded Medicaid in 2014 to workers in states that did not. We find that, following the ACA Medicaid expansions, documented agricultural workers experience a 12‐percentage point (24%) increase in the likelihood of having health insurance, which is entirely driven by an increase in the likelihood of having a government‐sponsored health insurance plan. We do not detect a decrease in private (employer‐sponsored or worker‐acquired) health insurance coverage. Further, we find no evidence that the ACA Medicaid expansions led to a decline in farm workers' labor supply; in fact, our results imply that there was a small increase in farm workers' hours. In a number of falsification tests, we also show that the Medicaid expansions do not appear to have an impact on undocumented (unauthorized) farm workers' health care utilization, and there was no increase in Medicaid payments for health services among this group of farm workers who were largely ineligible for Medicaid.