All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act / Craig Garthwaite, John A. Graves, Tal Gross, Zeynal Karaca, Victoria R. Marone, Matthew J. Notowidigdo.

Format:

Book

Author/Creator:

Garthwaite, Craig.

Contributor:

National Bureau of Economic Research.

Graves, John A.

Gross, Tal.

Karaca, Zeynal.

Marone, Victoria R.

Notowidigdo, Matthew J.

Series:

Working Paper Series (National Bureau of Economic Research) no. w26289.

NBER working paper series no. w26289

Language:

English

Physical Description:

1 online resource: illustrations (black and white);

Other Title:

All Medicaid Expansions Are Not Created Equal

Place of Publication:

Cambridge, Mass. National Bureau of Economic Research 2019.

Summary:

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.

Notes:

Print version record

September 2019.