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Inequality in health insurance coverage before and after the Affordable Care Act

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  • Francesco Renna
  • Vasilios D. Kosteas
  • Kuchibhotla Dinkar

Abstract

This study examines how the Affordable Care Act (ACA) affected income related inequality in health insurance coverage in the United States. Analyzing data from the American Community Survey (ACS) from 2010 through 2018, we apply difference‐in‐differences, and triple‐differences estimation to the Recentered Influence Function OLS estimation. We find that the ACA reduced inequality in health insurance coverage in the United States. Most of this reduction was a result of the Medicaid expansion. Additional decomposition analysis shows there was little change in inequality of coverage through an employer plan, and a decrease in inequality for coverage through direct purchase of health insurance. These results indicate that the insurance exchanges also contributed to declining inequality in health insurance coverage.

Suggested Citation

  • Francesco Renna & Vasilios D. Kosteas & Kuchibhotla Dinkar, 2021. "Inequality in health insurance coverage before and after the Affordable Care Act," Health Economics, John Wiley & Sons, Ltd., vol. 30(2), pages 384-402, February.
    • Handle: RePEc:wly:hlthec:v:30:y:2021:i:2:p:384-402
    DOI: 10.1002/hec.4195
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    References listed on IDEAS

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    1. Robert Kaestner & Bowen Garrett & Jiajia Chen & Anuj Gangopadhyaya & Caitlyn Fleming, 2017. "Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(3), pages 608-642, June.
    2. Frean, Molly & Gruber, Jonathan & Sommers, Benjamin D., 2017. "Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act," Journal of Health Economics, Elsevier, vol. 53(C), pages 72-86.
    3. Van Ourti, Tom & van Doorslaer, Eddy & Koolman, Xander, 2009. "The effect of income growth and inequality on health inequality: Theory and empirical evidence from the European Panel," Journal of Health Economics, Elsevier, vol. 28(3), pages 525-539, May.
    4. Erreygers, Guido, 2009. "Correcting the Concentration Index: A reply to Wagstaff," Journal of Health Economics, Elsevier, vol. 28(2), pages 521-524, March.
    5. Tom Van Ourti, 2004. "Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 705-724, July.
    6. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    7. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    8. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    9. Kosali Simon & Aparna Soni & John Cawley, 2017. "The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(2), pages 390-417, March.
    10. McGrail, K.M. & Van Doorslaer, E. & Ross, N.A. & Sanmartin, C., 2009. "Income-related health inequalities in Canada and the United States: A decomposition analysis," American Journal of Public Health, American Public Health Association, vol. 99(10), pages 1856-1863.
    11. Andrew Jones & Ángel López Nicolás, 2006. "Allowing for heterogeneity in the decomposition of measures of inequality in health," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 4(3), pages 347-365, December.
    12. Heckley, Gawain & Gerdtham, Ulf-G. & Kjellsson, Gustav, 2016. "A general method for decomposing the causes of socioeconomic inequality in health," Journal of Health Economics, Elsevier, vol. 48(C), pages 89-106.
    13. repec:dau:papers:123456789/10510 is not listed on IDEAS
    14. Buchmueller, T.C. & Levinson, Z.M. & Levy, H.G. & Wolfe, B.L., 2016. "Effect of the affordable care act on racial and ethnic disparities in health insurance coverage," American Journal of Public Health, American Public Health Association, vol. 106(8), pages 1416-1421.
    15. Vasilios D. Kosteas & Francesco Renna, 2018. "Out of Pocket Costs and Health Insurance Take-Up Rates," Applied Health Economics and Health Policy, Springer, vol. 16(3), pages 367-380, June.
    16. Kjellsson, Gustav & Gerdtham, Ulf-G., 2013. "On correcting the concentration index for binary variables," Journal of Health Economics, Elsevier, vol. 32(3), pages 659-670.
    17. Erreygers, Guido, 2009. "Correcting the Concentration Index," Journal of Health Economics, Elsevier, vol. 28(2), pages 504-515, March.
    18. Spika, Devon & Heckley, Gawain & Gerdtham, Ulf-G., 2018. "What Do Demographics Have To Do With It? An Oaxaca-Blinder Decomposition of Changes over Time in Inequalities in Alcohol, Narcotics and Tobacco-Related Ill Health in Sweden," Working Papers 2018:27, Lund University, Department of Economics.
    19. Wildman, John, 2003. "Income related inequalities in mental health in Great Britain: analysing the causes of health inequality over time," Journal of Health Economics, Elsevier, vol. 22(2), pages 295-312, March.
    20. JØrgen Lauridsen & Terkel Christiansen & Jens Gundgaard & Unto Häkkinen & Harri Sintonen, 2007. "Decomposition of health inequality by determinants and dimensions," Health Economics, John Wiley & Sons, Ltd., vol. 16(1), pages 97-102, January.
    21. Lindsay M. Sabik & Cathy J. Bradley, 2016. "The Impact of Near‐Universal Insurance Coverage on Breast and Cervical Cancer Screening: Evidence from Massachusetts," Health Economics, John Wiley & Sons, Ltd., vol. 25(4), pages 391-407, April.
    22. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2017. "Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non‐Expansion States," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(1), pages 178-210, January.
    23. Linder, Anna & Spika, Devon & Gerdtham, Ulf-G. & Fritzell, Sara & Heckley, Gawain, 2018. "Mental Health and Its Socioeconomic Inequality in Sweden: The Role of Demographic Changes over Time," Working Papers 2018:26, Lund University, Department of Economics.
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    1. Chris Sampson’s journal round-up for 8th March 2021
      by Chris Sampson in The Academic Health Economists' Blog on 2021-03-08 12:00:01

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