Journal of General Internal Medicine

, Volume 33, Issue 9, pp 1495–1497 | Cite as

Third Year of Survey Data Shows Continuing Benefits of Medicaid Expansions for Low-Income Childless Adults in the U.S.

  • John CawleyEmail author
  • Aparna Soni
  • Kosali Simon
Original Research



The Affordable Care Act (ACA) of 2010 incentivized states to expand eligibility for their Medicaid programs. Many did so in 2014, and there has been great interest in understanding the effects of these expansions on access to health care, health care utilization, and population health.


To estimate the longer-term (three-year) impact of Medicaid expansions on insurance coverage, access to care, preventive care, self-assessed health, and risky health behaviors.


A difference-in-differences model, exploiting variation across states and over time in Medicaid expansion, was estimated using data from the Behavioral Risk Factor Surveillance System (BRFSS) for 2010–2016.


Low-income childless adults aged 19–64 years in the BRFSS.

Main Measures

Outcomes included insurance coverage, access to care, several forms of preventive care (e.g., routine checkups, flu shots, HIV tests, dental visits, and cancer screening), risky health behaviors (e.g., smoking, alcohol abuse, obesity), and self-assessed health.

Key Results

The previously documented benefits of Medicaid expansions on insurance coverage, access to care, preventive care, and self-assessed health have persisted 3 years after expansion. There was no detectable effect on risky health behaviors.


The Affordable Care Act was motivated in part by a desire to increase health insurance coverage, improve access to care, and increase use of preventive care. The Medicaid expansions facilitated by the ACA are helping to achieve those objectives, and the benefits have persisted 3 years after expansion.


Affordable Care Act Medicaid health insurance preventive care health behaviors 



Cawley received financial support from the Robert Wood Johnson Foundation (RWJF) through an Investigator Award in Health Policy Research but the RWJF played no role in the design and conduct of the study. All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


  1. 1.
    Miller S, Wherry LR. Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions. N Engl J Med 2017;376(10):947–56.CrossRefPubMedGoogle Scholar
  2. 2.
    Simon K, Soni A, Cawley J. The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions. J Policy Anal Manag 2017;36(2):390–417.CrossRefGoogle Scholar
  3. 3.
    Wehby GL, Lyu W. The Impact of the ACA Medicaid Expansions on Health Insurance Coverage through 2015 and Coverage Disparities by Age, Race/Ethnicity, and Gender. Health Serv Res 2017;Early View.Google Scholar
  4. 4.
    Decker SL, Lipton BJ, Sommers BD. Medicaid Expansion Coverage Effects Grew In 2015 With Continued Improvements In Coverage Quality. Health Aff 2017;36(5):819–25.CrossRefGoogle Scholar
  5. 5.
    Antonisse L, Garfield R, Rudowitz R, Artiga S. The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review. 2017.Google Scholar
  6. 6.
    Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D. Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health. South Econ J [Internet] 2018;84(3):660–91. Available from: CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  1. 1.Department of Policy Analysis and Management Cornell UniversityIthacaUSA
  2. 2.Department of EconomicsCornell UniversityIthacaUSA
  3. 3.National Bureau of Economic ResearchCambridgeUSA
  4. 4.Department of Business Economics and Public PolicyIndiana University – BloomingtonBloomingtonUSA
  5. 5.School of Public and Environmental AffairsIndiana University – BloomingtonBloomingtonUSA

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