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The Long Shadow of American Slavery: Its Influence on the Affordable Care Act

Author

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  • Vinish Shrestha

    (Department of Economics, Towson University)

Abstract

This study investigates the relationship between slavery and the efficacy of the Affordable Care Act (ACA) in the American South. Using a Causal Forest approach, the results reveal heterogeneous treatment effects of the ACA-Medicaid expansion, with larger reductions in unin- sured rates concentrated in counties with low cotton suitability measures. In Medicaid expansion states, counties more reliant on slavery experienced lower reductions in uninsured rates following the ACA, primarily driven by lower Medicaid coverage among poor Whites. The evidence sug- gests that current political preferences, as explained by determinants of slavery such as cotton suitability and malaria stability indices, serve as a pathway linking the influence of slavery to the health reform. Moreover, the influence of slavery is attenuated in counties that underwent faster mechanization in the mid-1990s. Overall, findings imply that the legacy of slavery has hindered the implementation of the ACA in the South.

Suggested Citation

  • Vinish Shrestha, 2023. "The Long Shadow of American Slavery: Its Influence on the Affordable Care Act," Working Papers 2023-02, Towson University, Department of Economics, revised Jul 2024.
    • Handle: RePEc:tow:wpaper:2023-02
    as

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    File URL: http://webapps.towson.edu/cbe/economics/workingpapers/2023-02.pdf
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    References listed on IDEAS

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    Cited by:

    1. Vinish Shrestha, 2024. "Heterogeneous Impacts of ACA-Medicaid Expansion on Insurance and Labor Market Outcomes in the American South," Working Papers 2024-08, Towson University, Department of Economics, revised Jun 2024.

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    More about this item

    Keywords

    The Patient Protection and Affordable Care Act (ACA); Slavery; Institution; ACA-related preferences; ACA efficacy; American South; Politics.;
    All these keywords.

    JEL classification:

    • P00 - Political Economy and Comparative Economic Systems - - General - - - General
    • P43 - Political Economy and Comparative Economic Systems - - Other Economic Systems - - - Finance; Public Finance
    • P46 - Political Economy and Comparative Economic Systems - - Other Economic Systems - - - Consumer Economics; Health; Education and Training; Welfare, Income, Wealth, and Poverty
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • D02 - Microeconomics - - General - - - Institutions: Design, Formation, Operations, and Impact
    • B15 - Schools of Economic Thought and Methodology - - History of Economic Thought through 1925 - - - Historical; Institutional; Evolutionary

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