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All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act

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  • Craig Garthwaite
  • John A. Graves
  • Tal Gross
  • Zeynal Karaca
  • Victoria R. Marone
  • Matthew J. Notowidigdo

Abstract

We use comprehensive patient-level discharge data to study the effect of Medicaid on the use of hospital services. Our analysis relies on cross-state variation in the Affordable Care Act’s Medicaid expansion, along with within-state variation across ZIP Codes in exposure to the expansion. We find that the Medicaid expansion increased Medicaid visits and decreased uninsured visits. The net effect is positive for all visits, suggesting that those who gain coverage through Medicaid consume more hospital services than they would if they remained uninsured. The increase in emergency department visits is largely accounted for by “deferrable” medical conditions. Those who gained coverage under the Medicaid expansion appear to be those who had relatively high need for hospital services, suggesting that the expansion was well targeted. Lastly, we find significant heterogeneity across Medicaid-expansion states in the effects of the expansion, with some states experiencing a large increase in total utilization and other states experiencing little change. Increases in hospital utilization were larger in Medicaid-expansion states that had more residents gaining coverage and lower pre-expansion levels of hospital uncompensated care costs.

Suggested Citation

  • Craig Garthwaite & John A. Graves & Tal Gross & Zeynal Karaca & Victoria R. Marone & Matthew J. Notowidigdo, 2019. "All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act," NBER Working Papers 26289, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:26289
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    References listed on IDEAS

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    1. Downes, Henry & Phillips, David C. & Sullivan, James X., 2022. "The effect of emergency financial assistance on healthcare use," Journal of Public Economics, Elsevier, vol. 208(C).
    2. Naoki Aizawa & Chao Fu, 2020. "Interaction of the Labor Market and the Health Insurance System: Employer-Sponsored, Individual, and Public Insurance," NBER Working Papers 26713, National Bureau of Economic Research, Inc.
    3. Amitabh Chandra & Carrie H. Colla & Jonathan S. Skinner, 2023. "Productivity Variation and Input Misallocation: Evidence from Hospitals," NBER Working Papers 31569, National Bureau of Economic Research, Inc.
    4. Louis‐Philippe Beland & Jason Huh & Dongwoo Kim, 2021. "The effect of Affordable Care Act Medicaid expansions on foster care admissions," Health Economics, John Wiley & Sons, Ltd., vol. 30(11), pages 2943-2951, November.
    5. Louis-Philippe Beland & Jason Huh & Dongwoo Kim, 2021. "The Effect of ACA Medicaid Expansions on Foster Care Admissions," Carleton Economic Papers 21-07, Carleton University, Department of Economics.

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    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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