IDEAS home Printed from https://ideas.repec.org/p/fip/fednsr/89061.html
   My bibliography  Save this paper

The Affordable Care Act and the COVID-19 Pandemic: A Regression Discontinuity Analysis

Author

Abstract

Did Medicaid expansion under the Affordable Care Act affect the course of the COVID-19 pandemic? We answer this question using a regression discontinuity design for counties near the borders of states that expanded Medicaid with states that did not. Relevant covariates change continuously across the Medicaid expansion frontier. We find that (1) health insurance changes discontinuously at the frontier, (2) COVID-19 testing is discontinuously larger in Medicaid-expanding states, and (3) the fraction of beds occupied in ICUs is discontinuously smaller in Medicaid-expanding states. We also find that (4) COVID- 19 cases and deaths do not change discontinuously at the frontier, with the precision of these estimates being low, but the null result on deaths being general across demographic groups. Finally, we find that (5) smart thermometer readings of fever rates from Kinsa, Inc. do not change discontinuously at the Medicaid expansion frontier.

Suggested Citation

  • Ruchi Avtar & Rajashri Chakrabarti & Lindsay Meyerson & William Nober & Maxim L. Pinkovskiy, 2020. "The Affordable Care Act and the COVID-19 Pandemic: A Regression Discontinuity Analysis," Staff Reports 948, Federal Reserve Bank of New York.
  • Handle: RePEc:fip:fednsr:89061
    Note: Revised December 2022.
    as

    Download full text from publisher

    File URL: https://www.newyorkfed.org/medialibrary/media/research/staff_reports/sr948.pdf
    File Function: Full text
    Download Restriction: no

    File URL: https://www.newyorkfed.org/research/staff_reports/sr948
    File Function: Summary
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1783-1829.
    2. Joseph Benitez & Charles Courtemanche & Aaron Yelowitz, 2020. "Racial and Ethnic Disparities in COVID-19: Evidence from Six Large Cities," Journal of Economics, Race, and Policy, Springer, vol. 3(4), pages 243-261, December.
    3. Manasi Deshpande, 2016. "Does Welfare Inhibit Success? The Long-Term Effects of Removing Low-Income Youth from the Disability Rolls," American Economic Review, American Economic Association, vol. 106(11), pages 3300-3330, November.
    4. Finkelstein, Amy & McKnight, Robin, 2008. "What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending," Journal of Public Economics, Elsevier, vol. 92(7), pages 1644-1668, July.
    5. Jeffrey E. Harris, 2020. "The Coronavirus Epidemic Curve is Already Flattening in New York City," NBER Working Papers 26917, National Bureau of Economic Research, Inc.
    6. Allcott, Hunt & Boxell, Levi & Conway, Jacob & Gentzkow, Matthew & Thaler, Michael & Yang, David, 2020. "Polarization and public health: Partisan differences in social distancing during the coronavirus pandemic," Journal of Public Economics, Elsevier, vol. 191(C).
    7. Christopher R. Knittel & Bora Ozaltun, 2020. "What Does and Does Not Correlate with COVID-19 Death Rates," NBER Working Papers 27391, National Bureau of Economic Research, Inc.
    8. Sebastian Calonico & Matias D Cattaneo & Max H Farrell, 2020. "Optimal bandwidth choice for robust bias-corrected inference in regression discontinuity designs," The Econometrics Journal, Royal Economic Society, vol. 23(2), pages 192-210.
    9. Christopher Avery & William Bossert & Adam Clark & Glenn Ellison & Sara Fisher Ellison, 2020. "Policy Implications of Models of the Spread of Coronavirus: Perspectives and Opportunities for Economists," NBER Working Papers 27007, National Bureau of Economic Research, Inc.
    10. 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.
    11. McLaren John, 2021. "Racial Disparity in COVID-19 Deaths: Seeking Economic Roots with Census Data," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 21(3), pages 897-919, July.
    12. Christopher Avery & William Bossert & Adam Thomas Clark & Glenn Ellison & Sara Ellison, 2020. "Policy Implications of Models of the Spread of Coronavirus: Perspectives and Opportunities for Economists," CESifo Working Paper Series 8293, CESifo.
    13. Guido Imbens & Karthik Kalyanaraman, 2012. "Optimal Bandwidth Choice for the Regression Discontinuity Estimator," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 79(3), pages 933-959.
    14. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2016. "Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States," NBER Working Papers 22182, National Bureau of Economic Research, Inc.
    15. 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.
    16. David Card & Carlos Dobkin & Nicole Maestas, 2009. "Does Medicare Save Lives?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 597-636.
    17. Jeffrey Clemens & Drew McNichols & Joseph J. Sabia, 2020. "The Long-Run Effects of the Affordable Care Act: A Pre-Committed Research Design Over the COVID-19 Recession and Recovery," NBER Working Papers 27999, National Bureau of Economic Research, Inc.
    18. Thomas J. Holmes, 1998. "The Effect of State Policies on the Location of Manufacturing: Evidence from State Borders," Journal of Political Economy, University of Chicago Press, vol. 106(4), pages 667-705, August.
    19. Amy Finkelstein, 2007. "The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 1-37.
    20. Lucie Schmidt & Lara Shore-Sheppard & Tara Watson, 2019. "The Impact of Expanding Public Health Insurance on Safety Net Program Participation: Evidence from the ACA Medicaid Expansion," NBER Working Papers 26504, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Boutheina Amri & Nadia Menazla, 2022. "Obamacare During the Pandemic: A Historical, Economic and Sociopolitical Evaluation of the Initial Response of the US Government," Technium Social Sciences Journal, Technium Science, vol. 33(1), pages 638-647, July.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2018. "Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health," Southern Economic Journal, John Wiley & Sons, vol. 84(3), pages 660-691, January.
    2. Mauricio Villamizar‐Villegas & Freddy A. Pinzon‐Puerto & Maria Alejandra Ruiz‐Sanchez, 2022. "A comprehensive history of regression discontinuity designs: An empirical survey of the last 60 years," Journal of Economic Surveys, Wiley Blackwell, vol. 36(4), pages 1130-1178, September.
    3. Sarah Miller & Luojia Hu & Robert Kaestner & Bhashkar Mazumder & Ashley Wong, 2021. "The ACA Medicaid Expansion in Michigan and Financial Health," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(2), pages 348-375, March.
    4. Black, Bernard & Hollingsworth, Alex & Nunes, Letícia & Simon, Kosali, 2022. "Simulated power analyses for observational studies: An application to the Affordable Care Act Medicaid expansion," Journal of Public Economics, Elsevier, vol. 213(C).
    5. Mark Duggan & Gopi Shah Goda & Emilie Jackson, 2019. "The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes," National Tax Journal, National Tax Association;National Tax Journal, vol. 72(2), pages 261-322, June.
    6. Brevoort, Kenneth & Grodzicki, Daniel & Hackmann, Martin B., 2020. "The credit consequences of unpaid medical bills," Journal of Public Economics, Elsevier, vol. 187(C).
    7. Klein, Alexander & Crafts, Nicholas, 2023. "Unconditional Convergence in Manufacturing Productivity across U.S. States: What the Long-Run Data Show," CEPR Discussion Papers 18065, C.E.P.R. Discussion Papers.
    8. Borgschulte, Mark & Vogler, Jacob, 2020. "Did the ACA Medicaid expansion save lives?," Journal of Health Economics, Elsevier, vol. 72(C).
    9. Kenneth Brevoort & Daniel Grodzicki & Martin B. Hackmann, 2017. "Medicaid and Financial Health," NBER Working Papers 24002, National Bureau of Economic Research, Inc.
    10. Courtemanche, Charles & Friedson, Andrew & Koller, Andrew P. & Rees, Daniel I., 2019. "The affordable care act and ambulance response times," Journal of Health Economics, Elsevier, vol. 67(C).
    11. Ausmita Ghosh & Kosali Simon & Benjamin D. Sommers, 2017. "The Effect of State Medicaid Expansions on Prescription Drug Use: Evidence from the Affordable Care Act," NBER Working Papers 23044, National Bureau of Economic Research, Inc.
    12. Lucie Schmidt & Lara D. Shore-Sheppard & Tara Watson, 2020. "The Impact of the ACA Medicaid Expansion on Disability Program Applications," American Journal of Health Economics, University of Chicago Press, vol. 6(4), pages 444-476.
    13. Mark Duggan & Atul Gupta & Emilie Jackson, 2022. "The Impact of the Affordable Care Act: Evidence from California's Hospital Sector," American Economic Journal: Economic Policy, American Economic Association, vol. 14(1), pages 111-151, February.
    14. Abel Brodeur & David Gray & Anik Islam & Suraiya Bhuiyan, 2021. "A literature review of the economics of COVID‐19," Journal of Economic Surveys, Wiley Blackwell, vol. 35(4), pages 1007-1044, September.
    15. Samuel Dodini, 2023. "Insurance Subsidies, the Affordable Care Act, and Financial Stability," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 42(1), pages 97-136, January.
    16. Chad Cotti & Bryan Engelhardt & Joshua Foster & Erik Nesson & Paul Niekamp, 2021. "The relationship between in‐person voting and COVID‐19: Evidence from the Wisconsin primary," Contemporary Economic Policy, Western Economic Association International, vol. 39(4), pages 760-777, October.
    17. Lin, Lin & Zai, Xianhua, 2022. "The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme," GLO Discussion Paper Series 1180, Global Labor Organization (GLO).
    18. Raj Chetty & Amy Finkelstein, 2012. "Social Insurance: Connecting Theory to Data," NBER Working Papers 18433, National Bureau of Economic Research, Inc.
    19. Sumedha Gupta & Kosali I. Simon & Coady Wing, 2020. "Mandated and Voluntary Social Distancing During The COVID-19 Epidemic: A Review," NBER Working Papers 28139, National Bureau of Economic Research, Inc.
    20. Kondo, Ayako & Shigeoka, Hitoshi, 2013. "Effects of universal health insurance on health care utilization, and supply-side responses: Evidence from Japan," Journal of Public Economics, Elsevier, vol. 99(C), pages 1-23.

    More about this item

    Keywords

    Affordable Care Act; COVID-19; Medicaid; regression discontinuity;
    All these keywords.

    JEL classification:

    • C21 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:fip:fednsr:89061. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Gabriella Bucciarelli (email available below). General contact details of provider: https://edirc.repec.org/data/frbnyus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.