Association for Public Policy Analysis & Management

With the 2010 passage of the Affordable Care Act (ACA), health insurance options and costs changed for millions of people around the country. The ACA created new paths to gaining health insurance coverage, particularly for young adults and low- and moderate-income Americans. The federal individual mandate, dependent coverage provision, creation of the Marketplace, and expansion of Medicaid eligibility (in some states) reduce the need to rely on a spouse’s employer-provided health insurance. Each of these components of the ACA individually could impact marriage and divorce decisions, and the combination of these components of the ACA will also affect marriage and divorce decisions. As a result, we hypothesize that there will be differential impacts of the ACA on marriage and divorce for individuals based on income, state of residence, age, parental status, and gender. This paper focuses on the ACA’s impact on marriage and divorce among low-income nonelderly Americans targeted by the Medicaid expansion and the Marketplace.

Determining the impacts of the ACA on marriage and divorce for nonelderly adults is challenging given the complexity of the changes under the ACA. To some degree, every person in the country is affected by the changes introduced under the ACA-from first time eligibility for Medicaid for many low-income childless adults in states that expanded Medicaid, to financial assistance with purchasing private coverage for many moderate-income adults, to expanded access to preventive care for adults at all income levels. We take advantage of the variation in the ACA changes introduced for people at different income levels and in different states to estimate the impacts of the ACA for low- and moderate-income adults relative of higher-income adults. We also recognize that there may be differential impacts among low- and moderate-income individuals based on state of residence, so we estimate the impacts of the ACA for low- and moderate-income adults in expansion states relative to low- and higher-income adults in non-expansion states.

Using American Community Survey (ACS) data from 2008-2014, our difference-in-differences models will consider the timing of the implementation of key elements of the ACA (dependent coverage provision, Medicaid expansion, and the Marketplace). The quasi-experimental design estimates changes in marriage over time among these two groups, relative to changes in marriage over time among individuals with higher income With this research we are able to quantify the early causal effects of ACA, particularly the Medicaid expansion, on marriage and divorce. Our findings are especially important for low-income nonelderly adults given the stabilizing effects of both marriage (Light, 2004) and health insurance (Long, Stockley, and Dahlen, 2012) for low-income populations, and the negative economic consequences of divorce (Ananat and Michaels, 2008).