Panel Paper:
Using Variation in the Marketplace Rollout to Identify the Effects of the ACA on Coverage, Access, and out-of-Pocket Spending
*Names in bold indicate Presenter
Sherry Glied
Dean and Professor
NYU Wagner Graduate School of Public Service
Stephanie Ma
MPA student
NYU Wagner Graduate School of Public Service
Claudia Solis-Roman
MPA student
NYU Wagner Graduate School of Public Service
Since implementation of the Affordable Care Act’s coverage expansions in 2014, the US uninsurance rate has declined substantially. While the overall timing of the decline strongly suggests that it is a consequence of the coverage expansions, other concurrent changes may also have influenced the rate. We use the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance Survey (BRFSS), and the Current Population Survey (CPS) to relate changes in enrollment by month in the Marketplaces and expansions of Medicaid across states and over time to changes in uninsurance probabilities, access to care and out-of-pocket spending.
We find that for each additional 1.0% of the non-elderly adult population who enrolled in the Marketplaces, between 0.7% and 0.9% (BRFSS and NHIS). In States that chose to participate in the ACA’s Medicaid expansion, about 2% of the population gained coverage. These Medicaid expansions and increases in Marketplace enrollment rates are associated with fewer delays in care and increased use of a personal doctor. In IV analyses, using enrollment rates and expansions as instruments, coverage is significantly and substantially related to fewer delays in care due to cost and to the likelihood of reporting a personal doctor (BRFSS and NHIS). Finally, the probability that Marketplace-eligible people incurred high out-of-pocket costs or high combined premium and out-of-pocket costs declined as enrollment in the Marketplaces increased.
