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Impacts of insurance expansion on health cost, health access, and health behaviors: evidence from the medicaid expansion in the US

International Journal of Health Economics and Management volume 21, pages 495–510 (2021)Cite this article

Abstract

Expansion of subsidized health insurance may result in both safer and riskier health behavior and outcomes. While having insurance lowers cost barriers to receive both usual and preventive care, the lower potential cost from adverse health events may also promote risky behavior. In this paper, I exploit expansion in the Medicaid program under the Affordable Care Act to estimate the impact of insurance expansion on health outcomes and behaviors for low-income individuals in the US. I find that expansion of coverage has significantly lowered cost and increased access, particularly among minority populations, but has had no significant impact on preventive health behaviors. At the same time, I also find no evidence of moral hazard or increase risky behavior like smoking and drinking among residents of expansion states.

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Notes

  1. Since we do not carry out any model prediction, linear regression model is a better choice (See Greene, 2002).

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Authors and Affiliations

  1. Department of Economics and Business, The Colin Powell School at City College of New York, The Graduate Center, City University of New York, 160 Convent Avenue, New York, 10031, USA

    Prabal K. De

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The findings and conclusions in this paper are those of the author and do not necessarily represent the views of the Research Data Center, the National Center for Health Statistics, or the Centers for Disease Control and Prevention. I am grateful to Nataliya Kravets at the Center for Disease Control and Shirley H Liu at the Census Bureau for helping me access the restricted state variable. All remaining errors are mine. This research was partially funded by a grant from PSC-CUNY welfare fund.

Appendix

Appendix

See Table 5.

Table 5 Medicaid Expansion as part of ACA
Full size table

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De, P.K. Impacts of insurance expansion on health cost, health access, and health behaviors: evidence from the medicaid expansion in the US. Int J Health Econ Manag. 21, 495–510 (2021). https://doi.org/10.1007/s10754-021-09306-5

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  • DOI: https://doi.org/10.1007/s10754-021-09306-5

Keywords

  • ACA
  • Medicaid expansion
  • Moral hazard
  • Health behavior

JEL Classification

  • I12
  • I13
  • I28