The impact of Medicaid expansion on employer provision of health insurance

  • Jean M. Abraham
  • Anne B. Royalty
  • Coleman Drake
Research article


Using the 2010–2015 Medical Expenditure Panel Survey-Insurance Component, this study investigates the effect of the Affordable Care Act’s Medicaid eligibility expansion on four employer-sponsored insurance (ESI) outcomes: offers of health insurance, eligibility, take-up, and the out-of-pocket premium paid by employees for single coverage. Using a difference-in-differences identification strategy, we cannot reject the hypothesis of a zero effect of the Medicaid eligibility expansion on an establishment’s probability of offering ESI, the percentage of an establishment’s workforce that takes up coverage, or the out-of-pocket premium for single coverage. We find some evidence suggestive of an inverse relationship between the expansion of Medicaid and the percentage of an establishment’s workers eligible for ESI. In line with other employer- and individual-level studies of the effect of the ACA on employment-related outcomes, we find that employer provision of health insurance was largely unaffected by the Medicaid expansions.


Employer-sponsored health insurance Premiums Affordable Care Act Medicaid 

JEL Classification

I13 I18 J33 J38 



This work has been supported by the Robert Wood Johnson Foundation SHARE Program and award #94-16-01 from the Russell Sage Foundation. Any opinions expressed are those of the author(s) alone and should not be construed as representing the opinions of either Foundation. Any opinions and conclusions expressed herein are those of the author(s) and do not necessarily represent the views of the U.S. Census Bureau. All results have been reviewed to ensure that no confidential information is disclosed. This research also uses data from the Census Bureau’s Longitudinal Employer Household Dynamics Program, which was partially supported by the following National Science Foundation Grants SES-9978093, SES-0339191 and ITR-0427889; National Institute on Aging Grant AG018854; and Grants from the Alfred P. Sloan Foundation.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Health Policy and ManagementUniversity of MinnesotaMinneapolisUSA
  2. 2.Department of EconomicsIndiana University Purdue University IndianapolisIndianapolisUSA
  3. 3.Department of Health Policy and ManagementUniversity of PittsburghPittsburghUSA

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